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PELVIC HOLDER
SINGLE PATIENT USE
NON-STERILE
NOT MADE WITH NATURAL RUBBER LATEX
RX ONLY FEDERAL U.S.A. LAW RESTRICTS THIS DEVICE TO SALE OR
USE BY OR ON THE ORDER OF A PHYSICIAN OR PROPERLY
LICENSED PRACTITIONER.
IMPORTANT INFORMATION
Please read all instructions, warnings,
and cautions before use. Correct
application is essential for proper functioning
of the product. Use only on the person it was
provided to by a healthcare professional and
only for the use it was intended.
INTENDED USE
The DeRoyal® Pelvic Holder is intended to be
used to help keep the patient positioned in
wheelchair and prevent forward sliding or
getting up unassisted.
CONTRAINDICATIONS
• DO NOT use on a patient who is or may
become highly aggressive or agitated.
• Never use on a patient whose I.V. or wound
site could be compromised by the device.
WARNINGS
• Improper application or use of device may
result in serious injury or death.
• Always secure straps to a portion of the
wheelchair that moves with the patient.
• Always keep straps out of patient’s reach.
• Inspect the t of the product on the patient
to ensure t is proper. DO NOT OVERTIGHTEN.
Check regularly to ensure breathing and
circulation are not compromised.
CAUTIONS
• A physician or properly licensed practitioner
(a “prescriber”) who is familiar with the
use and purpose of this product must t
it to the user. The prescriber has a duty
to provide wearing instructions and risks
related to the use of this product to other
healthcare practitioners treating the
users and the users themselves, including
duration of use. The instructions provided
in this sheet do not supersede hospital
protocol or direct orders of the prescriber.
• Inspect product for damaged or missing
components before use.
• Discontinue use and consult your prescriber
if the product or its components break or
become damaged, or cleaning is no longer
sucient to sanitize product.
• The support should be worn over patient’s
clothing. Consult prescriber immediately
if patient experiences sensation changes,
unusual reactions, swelling or increased
pain while using this product. Discontinue
use if pressure injuries develop.
• Take special care if the user is diabetic or
has poor circulation. These users may have
decreased skin sensitivity and are at greater
risk for poor peripheral circulation and
pressure injuries.
INSTRUCTIONS FOR USE
1. Measure the width of the patient’s waist,
hip bone to hip bone, to determine the
appropriate size.
2. Place the pelvic holder on the center of the
seat of the wheelchair with straps to the
side.
3. Position the patient on the seat, making
sure the pelvic holder is between the legs.
NOTE: Make sure the patient is as far back in
the seat as possible.
4. Bring the front portion between the legs
and place along the patient’s waist.
5. On each side, tie the two inner straps
together as if tying a shoe lace. NOTE: Do
not over-tighten. Two ngers should t
between the device and the patient to
ensure circulation is not compromised.
6. Secure the outer straps by bringing them
down and behind the wheelchair back.
Secure the straps to the wheelchair tilt bars
using quick release ties.
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QUICK RELEASE TIES
Wrap the strap(s) around the anchor once.
Take the loose end of the strap(s) and create
a loop. Cross the loop over the other strap(s)
that is wrapped around the anchor and feed
it through opening as if tying a shoelace.
Hold that loop and create another loop with
the loose strap(s) and feed it through the
rst loop. Pull the nal loop and the strap(s)
attached to the cu in opposite directions to
form a quick release tie.
SIZE LENGTH
Small 16” (40.64 cm)
Medium 16 ½” (41.91 cm)
Large 17 ½” (44.45 cm)
CLEANING AND/OR MAINTENANCE
Hand wash with a mild detergent in lukewarm
water. Air dry prior to wearing. Inspect the
product after washing to ensure it is intact.
If the product is damaged or cleaning is
insucient, do not use it and replace it with a
new one.
STORAGE AND TRANSPORT CONDITIONS
KEEP DRY
KEEP AWAY FROM SUNLIGHT
In addition to the competent authority in the
country where the patient resides, serious
incidents must be reported to DeRoyal
Industries, Inc.
Manufactured by:
DeRoyal Industries, Inc.
200 DeBusk Lane
Powell, TN 37849 USA
888.938.7828 or (001) 865.938.7828
www.deroyal.com
PART#0-712 I REVISED 4/2023
©2023 DEROYAL INDUSTRIES, INC.
All Rights Reserved. DeRoyal and the DeRoyal logo,
are trademarks or registered trademarks
of DeRoyal Industries, Inc.
WARRANTY
DEROYAL® PRODUCTS ARE WARRANTED
FOR NINETY (90) DAYS FROM THE DATE OF
SHIPMENT FROM DEROYAL AS TO PRODUCT
QUALITY AND WORKMANSHIP. DEROYAL’S
WRITTEN WARRANTIES ARE GIVEN IN LIEU OF ANY
IMPLIED WARRANTIES, INCLUDING WARRANTIES OF
MERCHANTABILITY OR FITNESS FOR A PARTICULAR
PURPOSE.
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