Care of Cranio-cervical Traction - Intensive Care & Coordination ...

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Resources Neurosurgeon Neurosurgical Registrar Senior Medical Officer Senior Registered Nurse Steps Procedure Rationale The procedure will usually be performed by the Neurosurgeon, in the Intensive Care Unit or in the Operating Theatre. It is performed under local anaesthetic, although light sedation may be required. The patient will need to be placed onto a “traction” bed, and informed consent must be obtained. After clipping the hair at the insertion site, the area is anaesthetised and a small cut made into the skin on both sides of the head (usually 4cms above the external auditory meatus). The Tongs are then screwed into place and traction applied as ordered by the Neurosurgeon. As previously mentioned, the patient must be transferred to a “traction” bed. This must be done using the Jordan Frame, registrar and four other people. The registrar will support the head and neck while two staff stabilise the frame while in the air, one staff to move out the ICU bed and replace it with the traction bed, and one staff to work the lifter. Once the tongs are in situ, care must be taken with the tongs. The pin sites should be cleaned with half strength Chlorhexidine/Normal Saline daily and left uncovered if dry If the pin sites are moist then cover them with dry gauze. The two “locking” nuts should be checked at least twice a day to ensure they are firmly screwed on. The spring-loaded pin on one side should be protruding 1 to 2 mm from the centre. This should be checked at least twice a Wentworth Area Health Service Care of Cranio-cervical Traction Using the Jordan lifter is the safest way to move these patients. The registrar will support the neck to prevent movement that may cause spinal damage. This is to reduce the risk of infection. This is to prevent the tongs’ screws from loosening. This pin should be checked because if loose, could lead to the traction slipping and the tongs tearing the scalp. Also
Wentworth Area Health Service Care of Cranio-cervical Traction Procedure Rationale day. If this pin is not protruding 1 to 2 mm traction will be lost leading potentially to then the tongs are too loose. spinal cord injury. The traction itself will be set up by either This to ensure the traction is set up the Neurosurgeon or senior correctly, and to reduce the risk of spinal Physiotherapist. The Neurosurgeon cord damage. should apply the initial weight to the traction. Any further modifications to the traction set up should be ordered and documented in the progress notes by the Neurosurgeon and carried out by either the Neurosurgeon himself, a senior Physiotherapist or by a senior member of the Nursing staff For simple cervical immobilisation 10lbs (4.5kg) of weight is usually sufficient. For reduction of fracture or dislocation, an initial weight of 10lbs is used and increments of 5lbs (2.2kg) are added. This will vary from patient to patient and will be ordered by the Neurosurgeon and documented in the progress notes Directly after the initial traction is applied, This is to check that the traction applied and between any addition of weight, the is correct for that patient, and that the cervical spine should be x-rayed and cervical is in the alignment required. careful assessment of the patient’s neurological status attended. Ensure the weight is hanging freely. To ensure the patient is receiving the correct traction that was order by the Neurosurgeon. Ensure the ropes are knotted firmly and This is to prevent the traction from ends taped. coming undone. Ensure counter-traction is applied (the entire bed may be tipped slightly) Ensure the angle of pull is as directed by The position of the pins and the direction the Neurosurgeon. of the pull will decide if the patient’s neck is in slight flexion or slight extension. More commonly the neck will be held in a neutral position. This will be determined by the Neurosurgeon. Patients having cervical traction placed, Spinal Shock represents loss of reflex, or who already have the traction in place motor, sensory and autonomic activity should be carefully monitored for below the level of the spinal cord injury. changes in motor or sensory function. The heart rate and blood pressure will fall and parts of the body below the level of the lesion are paralysed and without sensation. This can be assessed Motor function should be tested by Any change could mean dislodgement of
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Care of Cranio-cervical Traction - Intensive Care & Coordination ...

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