Guides · patient gowns
Shoulder-Opening Patient Gowns for IV and Line Access
Changing a gown around an IV line without disconnecting it is the main reason to choose shoulder openings. Here is how they work, where they help most and what to check before ordering.
A shoulder-opening gown has fastenings along the top of one or both shoulders and down the sleeve, so the sleeve can be opened flat. Staff can then put on or remove the gown around an IV line, cannula, drain or arm cast without threading the line through the sleeve or disconnecting it. For wards where many patients have lines in, this saves time, reduces the handling of lines and makes gown changes more comfortable for patients.
The problem shoulder openings solve
With a standard gown, changing a patient who has an IV line in one arm means either disconnecting the line, which your clinical team may not want to do, or passing the bag and tubing through the sleeve. Both take time and carry some risk of dislodging the cannula. For patients with several lines, a drain, or a painful or immobilised arm, it becomes awkward and uncomfortable.
A shoulder opening turns the sleeve into a flap. Staff open the fastenings, lift the gown away from the arm, and close it again around the line. The patient barely needs to move.
Whether lines may be disconnected for a gown change, and how lines should be handled, is a matter for your nursing and infection-control policies. The gown simply makes it easier to follow them.
Where shoulder openings help most
| Area | Why shoulder openings help |
|---|---|
| Medical and surgical wards | Many patients have peripheral IV lines; frequent gown changes |
| Oncology and day-care infusion units | Long infusions, central lines and ports in the upper chest |
| Critical care and high-dependency units | Multiple lines, monitoring leads, limited patient movement |
| Orthopaedics | Arm casts, slings and fixators |
| Maternity and postnatal wards | IV lines during labour; front panel can drop for skin-to-skin and feeding |
| Elderly care | Stiff or painful shoulders; less lifting of arms |
| Paediatrics | Children with lines who will not hold still for a sleeve change |
Several of these settings have their own guides, including nursing and breastfeeding gowns and telemetry patient gowns, where monitoring leads add another layer of access needs.
What to specify
One shoulder or both
Opening both shoulders gives the most flexibility: staff can reach lines on either arm, and the whole front panel can be lowered for chest access. Opening only one shoulder is simpler and has fewer fastenings, but the gown then only helps with lines on that side, or it has to be put on back-to-front depending on the patient.
Most hospitals that choose shoulder openings specify both.
Length of the opening
The opening should run from the neckline across the shoulder and down the outer sleeve, far enough that the sleeve opens fully. If it stops at the top of the shoulder, the sleeve still has to be threaded over the hand. Ask the supplier to show the opening length on the sample and check it with a real IV setup or a dummy line.
Fastenings
| Fastening | On shoulder openings | Watch-outs |
|---|---|---|
| Press studs | Fast to open and close; neat; can be done one-handed | Need enough studs, closely spaced, so the sleeve does not gape |
| Ties | Adjustable; no hardware | Several ties along a sleeve are slow to tie and untie |
| Mixed | Studs on the shoulders and sleeves, ties at the back | Popular combination; check both types after washing |
Press studs are the most common choice on shoulder openings because of speed. Specify enough studs to keep the sleeve closed when the patient moves, and check how well they hold after several washes in your own laundry. A full comparison of fastenings is in ties vs press studs on patient gowns.
MRI and imaging
If patients wearing these gowns may go to MRI, metal press studs are a problem. Gowns intended for the MRI suite should be specified without metal fastenings, and your imaging team should confirm the design against their MRI safety policy. See patient gowns for MRI.
Sleeve length
Short sleeves are the usual choice for shoulder-opening gowns because they leave the lower arm free for cannulas and blood pressure cuffs. Long-sleeve versions can work where patients feel cold, provided the opening runs all the way down so the sleeve can still be lifted clear.
Fabric
Shoulder-opening gowns go through the same laundry as other gowns, so the usual choice applies:
- Cotton: soft and absorbent, comfortable for long stays
- Poly-cotton: keeps shape and colour over more washes, dries faster
Because the fastenings bear more load on these gowns, check that the fabric around the studs is reinforced and does not tear after repeated opening and closing.
Combining shoulder openings with other features
Shoulder openings are an add-on rather than a gown type of their own. They can be combined with:
- a back-opening gown, the most common combination
- a wrap-around gown, for more coverage at the back
- patient tops, for mobile patients who still have lines in
Adding features adds cost and complexity, so decide which wards really need them. Some hospitals use shoulder-opening gowns as the standard across all inpatient wards to simplify stock; others keep them for specific units and stock a simpler gown elsewhere. Your choice depends on how many of your patients have lines in at any time and how much you value a single stock line.
Testing before bulk
- Ask for a sample in your chosen fabric and fastening.
- Have nurses change the sample on a colleague with a dummy IV line in each arm.
- Time the change and compare it with your current gown.
- Wash the sample several times and repeat the test, checking stud strength and fabric around the fastenings.
- Ask for feedback on comfort when lying on the shoulder.
Wear trials are covered in more detail in patient gown sample wear trials.
Checklist
- One or both shoulders opening
- Opening runs far enough down the sleeve to clear the arm
- Fastening type and number, closely spaced
- Reinforcement around fastenings
- Non-metal fastenings for gowns that may go to MRI, confirmed by the imaging team
- Sleeve length to suit cannula sites and blood pressure checks
- Base design: back-opening, wrap-around or top
- Sample tested with dummy lines and after washing
Ordering shoulder-opening gowns
MISHAREN makes reusable patient gowns to order in back-opening, wrap-around and shoulder-opening styles, with ties, press studs or a mix, short or long sleeves, and cotton or poly-cotton fabric. MRI gowns can be specified without metal fastenings on request. A sample is approved before bulk.
Find out more on the patient gowns page or request a quotation.