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

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Procedure Rationale assessing strength and movement of all limbs, using the Nepean Hospital Neurological Observation Chart. Sensory function should be assessed by lightly pinching the patient’s skin, or lightly dabbing with ice, starting at the shoulder level and working down both sides of the extremities. Record the highest level of function on each side. Ask the patient to close their eyes during the examination. If there are any major changes in the previously mentioned observations, there should be immediate notification of the Neurosurgical team. If prompt assessment by the Neurosurgeon is not available call 42222 and ask for the Medical Emergency Team. Patients undergoing reduction of cervical fracture or dislocation can usually be lifted using a Jordan frame and lifter, with inline traction maintained. If the traction weight is removed then a cervical collar should be applied, the neck immobilised with sandbags, and manual traction maintained by a senior medical staff or senior registered nurse. Confirm with the neurosurgeon if this is appropriate for the patient. For patients whose cervical spine is simply being immobilised (i.e. a fracture is not being reduced) a hard collar can be applied, traction removed, and the patient can be log rolled or lifted on a Jordan frame in the standard way. Supervision by a senior medical officer or senior registered nurse is required. Confirm with the neurosurgeon if this is appropriate for the patient. Most patients in cervical traction can be safely log rolled without removing traction, but alignment of head, neck and body must be maintained. Supervision of this alignment should be undertaken by a senior medical officer or a senior registered nurse. Confirm with neurosurgeon if this is appropriate for the Wentworth Area Health Service Care of Cranio-cervical Traction the traction and alignment of the neck, leading to neurological deficit. Using the chart standardises the assessments. Any change could mean dislodgement of the traction and alignment of the neck, leading to neurological deficit. Each side needs to be recorded, as there may be unilateral sensory function loss. Delay in assessing changes in a patient with a cervical spine fracture can lead to quadriplegia, respiratory and cardiac arrest. If the patient with a cervical spine fracture is moved in an unsafe manner, damage to the cervical spine and quadriplegia may result. If the patient whose cervical spine is being immobilised is moved in an unsafe manner, damage to the cervical spine and quadriplegia may result. If the patient whose cervical spine is being immobilised, is moved in an unsafe manner, damage to the cervical spine and quadriplegia may result.
Procedure Rationale patient. A “hard” collar of the correct size for the patient should be available at the bedside of every patient in cervical traction. Wentworth Area Health Service Care of Cranio-cervical Traction If any movement of the patient is required, or any problems with the traction occur the hard collar is easily accessible to place on patient. References McCarthy, L. 1998 Safe handling of patients on cervical traction. Nursing Times 94, 14, 57-59. Smeltzer, S.C., and Bare, B.G. 2000 Brunner and suddarth’s textbook of medicalsurgical nursing. 9 th ed, Lippincott, Philadelphia. Unit 14 “Neurologic Function” pages 1688-1694 Cotler, J.M., Herbison, G.H., Nasuti, J.J., Ditunno, J.F., An, H. and Wolff, B.E. 1993. Closed reduction of traumatic spine dislocation using traction weights up to 140 pounds. Spine. 18, 3, 386-390. Choo, J.H.N., Liu, W.Y. and Kumar, V.P. 1996. Complications from Gardner-Wells tongs. Injury 27, 7, 512-513. AUTHORISED BY A McLean, V McCartan COMMITTEE RESPONSIBLE ICU Management Committee DATE REVISED December 2004 DATE EFFECTIVE December 2006 REVIEW DATE December 2006
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