Application and Maintenance of Extrication Collar

Application and Maintenance of Extrication Collar
Spinal or Suspected Spinal
Injury:
Application and Maintenance of
Extrication Collar
Approved by:
Vice President and Chief Medical Officer; and
Vice President and Chief Operating Officer
NOTE:
Corporate Policy & Procedures
Manual
Number: VII-B-165
Date Approved
October 21, 2015
Date Effective
November 6, 2015
Next Review (3 years from Effective
Date)
November 2018
This procedure is based on recommendations for Stifneck™ collars. If your site uses a
different type of collar - follow the manufacturer’s recommendations for that collar.
Purpose
To provide guidelines for the sizing and safe application of the extrication collar.
To provide guidelines for the care of patients who require an extrication collar.
Goals
To provide C-spine motion restriction for patients with suspected or confirmed spinal
cord injury.
Applicability
This policy and the corresponding procedures apply to all Covenant Health facilities and
the staff and physicians who assess or care for patients with a suspected or confirmed
spinal injury
*Please see attached algorithm addendums for procedure
modifications for Sites/Units which may not have adequate resources
to perform this procedure as outlined.*
Education/
Training
Requirements
Spine Management education program.
Procedure
Gather Equipment
•
•
•
•
Soaker or folded flannel (may or may not be in use under the patient’s head)
Head Supports (i.e. rolled towels) Note: Sandbags are not recommended
Extrication Collar
Appropriate personal protective equipment (PPE)
Designate Roles
a)
Two staff is required for collar application, more if the patient is restless or
confused as well as to ensure tight fit of collar.
b)
If the patient is intubated – coordinate timing of procedure with Respiratory
Therapy for assessment and possible re-taping and or repositioning of the
endotracheal tube.
Spinal or Suspected Spinal Injury:
Application and Maintenance of Extrication Collar
Date Effective
Nov. 6, 2015
Policy No.
VII-B-165
Page 2 of 7
c)
Designate one person as the Leader (known as Person A – refer to Spinal, or
Suspected Spinal, Injury - Logrolling Technique procedure). This person is in
charge of:
• Maintaining immobility of the patient’s head and neck
• Directing the overall procedure
• Instructing the patient through the procedure.
d)
A second staff member will be designated as Person B. His or her role is to
properly size and apply the collar.
Assessment
a)
Review the mechanism of injury that has affected the patient and the indication
of the need for the C-spine collar.
b)
Assess patient’s ability to understand and cooperate with the procedure.
c)
Ensure the bed is flat or the patient is residing on a flat surface (eg. floor). The
patient must be in the supine position and in good alignment.
d)
Apply appropriate PPE.
d)
Remove patient neck and ear jewellery. Compression points and skin
redness/breakdown may occur with prolonged collar wear.
Prepare Patient for Collar Application
Sizing the Collar
Proper sizing is critical for C-spine stability. A collar which is too short may not provide
adequate support, while a collar which is too tall may cause hyperextension of the
cervical spine.
Collar sizing is two fold – measure the patient’s neck and measure a component of the
collar.
•
Patient – the key dimension on the patient is the distance between imaginary
lines drawn across the top of the shoulders where the collar will sit and the
bottom plane of the patient’s chin (mandible).
•
Collar – the key dimension is the distance between the sizing post and the lower
edge of the rigid plastic encircling band (not the foam padding).
1. Person A maintains immobility of the patient’s head holding it in a neutral position by
placing his or her hands on each side of the head, with thumbs along the mandible
and fingers behind the patient’s head on the occipital ridge. Person A - explains the
procedure to the patient and instructs the patient as to their role; i.e.:
Spinal or Suspected Spinal Injury:
Application and Maintenance of Extrication Collar
•
•
•
•
Date Effective
Nov. 6, 2015
Policy No.
VII-B-165
Page 3 of 7
Patient is to only communicate verbally or by blinking the eyes
Patient is not to assist with the procedure – explain that the collar can be
applied, adjusted/removed without patient movement
Inform patient that an assistant (Person B) will fit the collar around the
patient’s neck and may push down on the bed slightly to allow the collar to
slide more easily
Assess patient’s motor and sensory status prior to and after collar
application and / or collar care (report any changes to physician)
2. Person B obtains the extrication collar. Using his or her fingers as reference,
measures the distance from the patient’s shoulder to the bottom of the chin. Then
using his or her fingers will match and compare the dimensions (4 size options) on
the collar identifying the appropriate size for the specific patient.
3. The collar is assembled by moving the sizing post at the two sides of the collar and
then pushing the locking fastener on both sides of the collar all the way in. Press
firmly; the fastener should click into place. Ensure both sides are positioned and
locked at the same level.
4. Before applying the extrication collar, pre-curve the collar. Flex the collar sharply
inward until you can touch your thumb to your fingers. This will pre-form the collar
into a cylinder to simplify application.
Application of the Collar
1. With the patient’s head held in neutral alignment by Person A, Person B will slide the
back portion of collar behind the patient’s neck. Ensure that the Velcro loop is folded
inward onto the foam padding to prevent it from collecting any debris. When the
Velcro is visible, position the chin piece by sliding the collar up the chest wall.
Ensure that the patient’s chin is well supported by the chin piece and that the chin
extends far enough onto the chin piece to at least cover the central fastener.
Difficulty in positioning the chin piece may indicate the need for collar adjustment.
2. Once positioned, hold the collar by using the trach hole as an anchor point while
pulling laterally to tighten. When properly positioned, secure the Velcro.
3. Person A should now remove his or her handholds on the patient’s chin and occiput
from inside the collar and place in corresponding position outside the collar. Recheck the position of the patient’s head and collar for proper alignment – readjust
and tighten as required.
4. Person B should now place head supports on either side of patient’s head as Person
A removes hand held head support.
5. Person A completes and documents an assessment of sensory and motor status.
Refer to Spinal Signs Measurement Procedure.
6. Remove PPE and complete hand hygiene.
Spinal or Suspected Spinal Injury:
Application and Maintenance of Extrication Collar
Date Effective
Nov. 6, 2015
Policy No.
VII-B-165
Page 4 of 7
ALERTS:
1. Be sure to maintain neutral head, neck and body alignment
throughout this procedure.
2. Contact Rehabilitation Medicine for sizing and application of a
Philadelphia® Collar within 24 hours.
Extrication Collar Care
Gather Equipment
•
•
•
•
•
Soaker or folded flannel (may or may not be in use under the patient’s head)
Head Supports (i.e. rolled towels) Note: Sandbags are not recommended
Skin care supplies (one wet and one dry face cloth, 1 towel, soap, shaving
supplies as appropriate)
Thin Hydrocolloid dressing for areas of redness or abrasions (if required)
Appropriate personal protective equipment (PPE)
Designate Roles
a) Determine number of staff required – two is usually sufficient, more if the patient
is restless or confused or if patient needs to be repositioned prior to or during
collar care.
b) If the patient is intubated – coordinate timing of procedure with Respiratory
Therapy for assessment and possible re-taping and or repositioning of the
endotracheal tube.
c) Designate one person as the Leader (known as Person A – refer to Spinal, or
Suspected Spinal, Injury - Logrolling Technique procedure). This person is in
charge of:
• Maintaining immobility of the patient’s head and neck.
• Directing the overall procedure.
• Instructing the patient through the procedure.
d) A second staff member will be designated as Person B. Their role is to open
and clean the collar, perform skin care, and re-apply the collar.
Assessment
a)
Review the C-Spine Management – Patient Care Orders for collar care order
and any restrictions.
b)
Collar care is to be completed minimum of q12h or q shift.
Spinal or Suspected Spinal Injury:
Application and Maintenance of Extrication Collar
Date Effective
Nov. 6, 2015
Policy No.
VII-B-165
Page 5 of 7
c)
Assess patient’s ability to understand and cooperate with the procedure.
d)
Assess and document patient’s motor and sensory status prior to and after
collar care (report any changes to physician or nurse practitioner). See Spinal
Signs Measurement Procedure.
e)
Ensure the bed is flat, the patient is supine and in good alignment.
Prepare Patient for Collar Care
a)
Person A - explain the procedure to the patient and instructs the patient as to
their role; i.e.
• Patient is to only communicate verbally or by blinking the eyes.
• Patient is not to assist with the procedure – explain that the collar can be
applied, adjusted/removed without patient movement.
• Inform patient that an assistant (Person B) will fit the collar around the
patient’s neck and may push down on the bed slightly to allow the collar to
slide more easily.
• Assess patient’s motor and sensory status prior to and after collar care
(report any changes to physician).
Prepare the Bed Area for Collar Care
a)
Apply PPE.
b)
Remove headboard.
c)
Raise and position bed to facilitate Person A to take head control and access
neck area. Ensure brakes are locked.
d)
Have skin care supplies within easy reach.
Open the Collar
a)
Person A maintains immobility of the head by placing his or her hands on each
side of the patient’s head with thumbs along the mandible and fingers behind the
head on the occipital ridge.
b)
Person B removes the head supports. If a soaker is under the patient’s head,
Person B shifts the soaker up to the level of the occipital ridge.
c)
If the patient is restless, Person B places head supports on either side of Person
A’s hands.
d)
Person A tells the patient that the collar will be opened and maintains C-Spine
alignment while Person B opens the front of collar by undoing the Velcro strap –
Spinal or Suspected Spinal Injury:
Application and Maintenance of Extrication Collar
Date Effective
Nov. 6, 2015
Policy No.
VII-B-165
Page 6 of 7
do not completely remove.
Person B - Wash the Collar
a)
Wash the collar with a wet soapy face cloth.
b)
Rinse the collar with lukewarm water and dry with a towel.
c)
Squeeze towel against Velcro pieces to absorb water until Velcro pieces are dry
to touch.
d)
Take note of any loose Velcro or loose reinforcements.
Person B - Wash the Patient’s Neck
a)
Wash the front of the patient’s neck.
b)
Gently pull the face cloth back and forth while holding each side of the face cloth.
c)
Shave the patient (as appropriate).
d)
Dry the neck thoroughly.
e)
Take note of any reddened areas and apply thin hydrocolloid dressing as
required.
f)
If the patient is intubated Respiratory Therapy to assess and reposition ETT as
required.
Person B - Re-Apply the Collar
a)
For reapplication of extrication collar, see steps in previous section.
b)
Remove PPE and complete hand hygiene.
Documentation
Related
Documents
•
Document that collar application and/or collar care has been provided.
•
Document areas of skin redness or breakdown and nursing management provided.
•
Document and report any changes in motor/sensory status.
Procedures related to this Procedure:
• Spinal, or Suspected Spinal, Injuries, #VII-B-150
• Spinal, or Suspected Spinal, Injury – Logrolling Technique – With C Spine
Spinal or Suspected Spinal Injury:
Application and Maintenance of Extrication Collar
•
•
•
•
•
Date Effective
Nov. 6, 2015
Policy No.
VII-B-165
Page 7 of 7
Precautions, #VII-B-155
Spinal, or Suspected Spinal, Injury – Logrolling Technique – Without C
Spine Precautions, #VII-B-160
Spinal, or Suspected Spinal, Injury – Collar Care – Philadelphia® Collar,
#VII-B-170
Spinal, or Suspected Spinal, Injury – Surface to Surface Transfer, #VII-B-175
Spinal, or Suspected Spinal, Injury – General Care of the Patient,#VII-B-180
Spinal, or Suspected Spinal, Injury – Spinal Signs Measurement, #VII-B-185
Spine Management Specialized Clinical Competency Education package
References
Extrication Collar Instruction Sheet. Revive Healthcare Training 2006.
Revisions
June 6, 2014
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