health services code c.8 title: cervical collar (rigid

Approved: October 3, 2018

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HEALTH SERVICES

CODE C.8

TITLE: Cervical Collar (Rigid) Application,

Manual Head Stabilization and Log

Roll for Actual or Potential Cervical

Spinal Injury

A. Head Hold

B. Log Roll

C. Application of Rigid Spinal Collar

D. Changing Collar Pads and Skin

Care in Lying Position

E. Changing Collar Pads and Skin

Care in Sitting Position

CATEGORY: RN – General

LPN – Advanced Practice

PURPOSE

To guide nurses in the management of cervical spine trauma (i.e. application and care of cervical collar, head hold and log roll techniques) of a patient with actual or suspected spinal injury.

NOTE: Up to six nurses may be required to work together in order to undertake routine

turning and positioning of patients with actual or potential cervical spinal injury.

NURSING ALERT:

Any patient with a mechanism of injury consistent with major trauma criteria should be evaluated for a cervical spine (c-spine) injury. They should be placed in a rigid collar and on a firm surface, until evaluation has been completed by a Practitioner.

Wherever there is a reasonable suspicion of acute spinal cord injury, the aim is to maintain full spinal alignment during any moving and handling activity. Careful handling, positioning and turning can prevent or significantly reduce secondary spinal cord trauma, patient pain and discomfort, and the potential for skin damage.

Refer to Appendix B for LPN Advanced Practice certification guidelines.

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A. Head Hold

EQUIPMENT 1. PPE

NOTE: The team leader for any maneuver will always be identified as the person in the

position closest to the patient’s head, from where the patient’s alignment

throughout the maneuver can be monitored.

PROCEDURE

1. Perform hand hygiene.

2. Don PPE.

3. Explain the procedure to the patient.

4. Provide analgesic if necessary.

5. Position self at head of the bed.

6. Place hands either side of patient’s head.

7. Spread your fingers wide.

8. Slide both hands downwards so that your thumbs rest either below the patient’s jaw or above the

clavicle and your fingers are spread behind the patient’s neck (encompassing C7) (as seen in Image 1).

9. Bring your forearms together at the back of the patient’s head.

10. Raise the bed to an optimal height (based on TLR) prior to log rolling the patient.

Harrison, P. (2007)

Image 1

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B. Log Roll

EQUIPMENT 1. PPE 2. Pillows/Wedges (ensure there is enough to maintain patient’s body alignment after log roll

completed)

PROCEDURE


2. Don PPE.

3. Explain procedure to patient.


5. Position patient’s arms across their chest.

6. Assess the need for a pillow in between lower limbs for support during log roll in order to maintain

alignment.

7. Position team leader at the head of the bed, to allow for proper hand position for head hold as described in section A (shown in Image 1).

8. Place their hands on patient’s shoulder and hip, the second nurse supports patient’s upper body.

9. Place their hands on patient’s hip and lower leg, the third nurse supports patient’s abdomen.

NOTE: The second and third nurse may be required to cross arms, in order to provide

adequate stability to the spine during log roll (as shown in Image 2).

NOTE: Providing adequate spinal stability may require a fourth nurse.

Harrison, P. (2007)

2nd

Nurse

3rd

Nurse

4th

Nurse

Image 2

http://www.google.ca/imgres?imgurl=https://c1.staticflickr.com/3/2049/1809796599_c0f39e146d_n.jpg&imgrefurl=https://www.flickr.com/photos/scrumcapscourse/1809796599&h=160&w=240&tbnid=a-8Z68ppC2myBM:&docid=EFEVN15jlmnMbM&ei=eP7NVfDTIcfyaJzDqtgF&tbm=isch&ved=0CFIQMyhPME84ZGoVChMI8O-rweeoxwIVRzkaCh2coQpb

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NOTE: Ensure the team is ready by having the team leader (head holder) coordinate

the roll.

10. Turn the patient on the team leader’s count, ensure the patient is in neutral alignment by avoiding any rotational movements of individual spinal segments.

NOTE: Alignment of nose, chin and sternum maintenance is ensured by the team leader.

Harrison, P. (2007)

NOTE: Ensure the patient’s upper leg is kept in alignment with the lower leg during and

after the log roll. 11. Position pillows to support the upper leg and place pillows/wedges to maintain proper body

alignment while the patient is on their side.

NOTE: Team lead will hold the patient’s head until supports are in place. 12. Place a folded towel or flannel under the patient’s head to maintain neutral alignment (as shown in

Image 3).

13. Release manual head hold.

14. Document.

C. Application of Rigid Spinal Collar

EQUIPMENT 1. PPE 2. Two piece spinal collar (Vista Aspen Collar #311519), see Appendix A for manufacturer’s

guidelines with pictures

Upper Leg

Image 3

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PROCEDURE


2. Don PPE.



5. Instruct patient not to move or turn head.

6. Remove any clothing or jewelry before fitting collar, collars must be fitted against bare skin.

7. Set front panel to the lowest setting by pulling out the dial to unlock and turning dial counter

clockwise.

8. Pre-form the back ends of the side panels so they are slightly curved.

NOTE: Prior to fitting any collar, patient’s head must be manually held in place, may require

2 care providers. Fingers must encompass as much of the patient’s head as

possible to properly maintain alignment.

9. Ensure the patient’s head is held in place while gently feeding the back piece of the collar into

position behind the patient’s neck (press the collar into the mattress while sliding the collar into position to prevent friction with the patient’s skin).

10. Pull the sides of the front panel apart. Position the bottom of the panel on patient’s sternal notch.

11. Move the front panel up and under the chin in a straight line.

12. Hold the collar against patient’s chest, pull out the dial to unlock and turn it clockwise to raise chin piece until the collar is supporting patient’s chin.

13. Release the dial to lock the collar position.

14. Attach the Velcro strap on each side while holding the front panel in place.

15. Tighten Velcro straps equally to ensure a snug symmetrical fit.

16. Ensure that back of chin piece is not pressing inward on patient’s throat. If chin piece is causing pressure on the throat, lift the back ends of the side panels up and off the trapezius muscles.

17. Release manual head hold.

18. Document.

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NOTE: Collar assessment for correct fit is to be done minimally every 4 hours (unless

otherwise ordered by the Practitioner) and includes:

Chin is cupped

Ears are clear

Adam’s apple is clear

Front piece is resting on sternum

Sides of back piece overlap the front piece

Velcro straps are evenly placed

Collar is centred

Neck is in neutral alignment

D. Changing Collar Pads and Skin Care in Lying Position

NOTE: For unpredictable patients and when c-spine has not been cleared, keep head in

neutral position by using the head hold and log roll techniques described in

Sections A&B.

EQUIPMENT 1. PPE 2. Extra set of collar pads 3. Mild soap & water 4. Wash cloth & towel

NOTE: Collar pads are to be changed and cleaned once a day and PRN. Clean the plastic

shell of the collar at least once a week or more often if soiled.

NOTE: TWO sets of pads should always be available.

PROCEDURE


2. Don PPE.


4. Place patient in supine position.

5. Instruct patient not to move or turn head.

6. Open Velcro fasteners on both sides of the collar and remove front panel.

7. Assess the neck and chin for skin breakdown.

8. Cleanse the face gently, front of neck and chin with mild soap and water and thoroughly dry with

towel.

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9. Remove the old pads from the front panel of the collar.

10. Clean the plastic (if needed) with mild soap and water, thoroughly dry with towel.

11. Replace front panel pads with clean pads.

12. Assess and cleanse back of neck gently with water and mild soap and let dry.

13. Position the bottom of the front panel on the patient’s sternal notch.

14. Move the front panel up and under the chin in a straight line.

15. Re-fasten Velcro on both sides and ensure correct fit (head and neck in neutral alignment as described in Section C).

16. Turn patient onto side.

NOTE: For unpredictable patients and when c-spine has not been cleared, keep head in

neutral position by using the head hold and log roll techniques described in Section

A & B.

17. Open Velcro fastener on one side of the collar and pull the back panel of the collar away from the

neck.

18. Assess the back of the neck for skin breakdown.

19. Cleanse back of neck gently with mild soap and water and thoroughly dry with towel.

20. Remove the old pads from the back panel of collar.

21. Clean the plastic (if needed) with mild soap and water and thoroughly dry with towel.

22. Replace back panel pads with clean pads. 23. Reapply the back panel of the collar overlapping the sides of the front panel, re-fasten Velcro on

both sides and ensure correct fit as described in Section C. See appendix A for instructions on fastening.

NOTE: Ensure back panel overlaps the sides of the front panel.

24. Clean the soiled pads using mild soap and water.

NOTE: Do not use any bleach or detergents.

25. Rinse the pads well in clean water, squeeze out the excess water, lay pads flat to dry.

NOTE: Pads will air dry in 6-8 hours.

NOTE: Do not use hair dryer to dry collar pads.

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NOTE: Refer to CEAC 1045 for patient teaching on wearing a cervical collar when

discharged from hospital.

E. Changing Collar Pads and Skin Care in Sitting Position

EQUIPMENT 1. PPE 2. Extra set of collar pads 3. Mild soap & water 4. Wash cloth & towel

NOTE: Collar pads are to be changed and cleaned once a day and PRN (unless otherwise

ordered by the Practitioner). Clean the plastic shell of the collar at least once a

week or more often if soiled.

NOTE: TWO sets of pads should always be available.

PROCEDURE


2. Don PPE.


4. Place patient in sitting position with hands in their lap.

5. Instruct patient to keep their head and neck straight.

6. Open Velcro fasteners on both sides and remove the front and back panel of the collar.

NOTE: The patient’s head must remain still and straight for the entire duration the collar is

removed. 7. Assess the skin on the front and back of the neck and chin for skin breakdown.

8. Cleanse the face, front and back of neck and chin gently with mild soap and water and thoroughly

dry with towel. 9. Remove the old pads from the front panel of the collar.

NURSING ALERT:

A Practitioner’s order is required to change the collar pads and perform skin care in a sitting position. Order will only be received on stable non traumatic cervical injuries.

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11. Replace front panel pads with clean pads.

12. Position the bottom of the front panel on the patient’s sternal notch.

13. Move the front panel up and under the chin in a straight line. 14. Instruct the patient to hold the front panel in place, keeping their elbow tucked in.

15. Remove the old pads from the back panel.


17. Replace back panel pads with clean pads.

18. Place the back panel of the collar behind the neck.

NOTE: Ensure back panel overlaps the sides of the front panel.

19. Secure the Velcro fasteners on both sides.

20. Ensure correct collar fit (as described in Section C).

21. Clean soiled pads using mild soap and water.

NOTE: Do not use any bleach or detergents.

22. Rinse pads with clean water, squeeze out excess water, lay pads flat to air dry.

NOTE: Pads will air dry in 6-8 hours.

NOTE: Do not use hair dryer to dry collar pads. 26. Remove back piece of collar and replace old pads with new or clean pads.

27. Re-fasten collar and ensure placement correct (head and neck in neutral alignment). See appendix

A for instructions on fastening.

NOTE: Ensure back piece of the collar overlaps the side of the front piece.

NOTE: Refer to CEAC 1045 for patient teaching on wearing a cervical collar when

discharged from hospital.

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REFERENCES American College of Surgeon’s Committee on Trauma (ACS). (2008). Advanced Trauma life Support Manual for Physicians (8

th edition). American College of Surgeons Press, Chicago.

Aspen Medical Products. (2013). “Aspen® collar instruction sheet” [Online]. Retrieved from http://www.aspenmp.com/images/product-instructions/aspen-collar-instruction-sheet.pdf. Harrison P. (2007). Managing Spinal Cord Injury: The first 48 Hours. Spinal Injuries Association. Milton Keynes. Hawkins, S., Stone, K., & Plummer, L. (2000). A holistic approach to turning patients. Nursing Standard, 14(3), 52-56. Hickey, J. (2009). The clinical practice of neurological & neurosurgical nursing (6

th ed.).

Philadelphia, PA: Lippincott, Williams & Wilkins. Kirshblum, S., Campagnolol, D., & DeLisa, J. (2002). Spinal cord medicine. Philadelphia, PA: Lippincott, Williams & Wilkins. Kirshblum, S. (2009). Medical Management and Complications of Spinal Cord Injury. Spinal Cord Injuries: Management and Rehabilitation, Retrieved from http://sciencedirect.com Page, P., Gumm, M., Kennedy, M. et al. (2013). Management of the Patient with Spinal Precautions. Trauma Service Guidelines. The Royal Melbourne Hospital. Schub,T. & Schub, E. (2015). Logrolling a Patient. Cinahl. Retrieved from Nursing Reference Center. Tymianski, D., Sarro, A., & Green, T. (2012). Navigating neuroscience nursing a Canadian perspective. Pembroke, ON: Pappin Communications. Wagner, K., Johnson, K., & Harderin-Pierce, M. (2013). High-acuity nursing (6

th ed.). Boston, MA:

Pearson.

Written by: Lindsay Dusselier, CNE-SICU, Sarah Harder, CNE-5A, Kim Hunt, CNE-6A, Date: November 2016 Revised by: Stacey Mittermayr, CNE- 5A, Kim Hunt, CNE-6A Date: July 2018 Approved by:

Date:

Regina Qu’Appelle Health Region Health Services

Nursing Procedure Committee

3Oct18 Keyword(s): Log Roll

http://www.aspenmp.com/images/product-instructions/aspen-collar-instruction-sheet.pdf

http://sciencedirect.com/

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APPENDIX A

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APPENDIX B

Achieving and Maintaining Competence

LPNs on initial certification are required to review the learning module, review the nursing

procedure, successfully pass the equiz and perform a return demonstration. To maintain

competence the LPN must complete the learning module, nursing procedure, equiz and perform a

return demonstration annually.

health services code c.8 title: cervical collar (rigid

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