Step by step instructions for each team member when lifting or repositioning patients with suspected or known spinal injury.

Transcription

1 PURPOSE Step by step instructions for each team member when lifting or repositioning patients with suspected or known spinal injury. POLICY STATEMENTS Repositioning or lifting a patient with a suspected or known spinal injury requires a team approach with clear roles and responsibilities of all team members and clear communication among team members to prevent further damage to spinal cord and promote patient comfort. PRACTICE LEVEL/COMPETENCIES Competencies: for being the team leader to lift or reposition a patient with a c-spine injury or to lift/reposition a patient with an L- or T-spine injury include the ability to: perform a motor and sensory neurological exam describe and demonstrate how to stabilize the cervical spine during repositioning of the patient with a known or suspected cervical spine injury describe and demonstrate how to log-roll, lift or reposition a patient with a known or suspected spinal injury instruct team members on correct technique for assisting with repositioning and log-rolling a patient with a known or suspected spinal injury DEFINITIONS Head Rolls: Rolled towels or blankets placed against either side of a patient s head, used to maintain proper spinal alignment of the head and neck. Note: sand bags are not recommended for this purpose. Proper Spinal Alignment: Patient s head and neck are in neutral position: ie. no hyper flexion/ extension or rotation, and the chin is in alignment with the sternal notch and umbilicus. Traction: Method used to realign spinal bones using weights. Eg. Halo traction. PROCEDURES Cervical Spine (C-Spine) Injury, Lesion or Post C-spine Surgery Team Leader Responsibilities 1. DETERMINE if you have the competencies to be the team leader to lift or reposition a patient with a cervical spine (c-spine) injury. NOTE: If unfamiliar with the technique, contact Emergency Department charge nurse for assistance. 2. GATHER equipment: a. Sliding sheet with blue sliding surface CC BC Children s Hospital Child & Youth Health Policy and Procedure Manual Page 1 of 5

2 b. Head Rolls 3. OBTAIN assistance of 2 to 5 staff members and PROVIDE instruction on lifting and repositioning techniques as needed a. A minimum of three staff members are required to reposition patients with c-spine injuries. b. Factors such as size of the patient, presence of additional injuries, patient s predicted ability to tolerate repositioning, and the need to transfer influence number of staff required to assist. 4. IDENTIFY patient and EXPLAIN procedure. 5. ENSURE the bed is flat. 6. POSITION patient s arms, or ask patient to cross their arms over their lower abdomen or pelvis to discourage any attempt by the patient to assist with the turn. NOTE: Crossing arms onto the chest/abdomen minimizes shoulder movement while allowing arms to be out of the way of the turn. Allowing patients to assist in turning may cause twisting of the spine, potentially increasing the damage caused by the injury. 7. POSITION any tubes and drains to ensure no unnecessary traction or compression occurs during turning/repositioning. 8. ENSURE splints/devices are in place to support any other injuries if present. 9. ENSURE patient is in proper spinal alignment prior to repositioning. 10. PERFORM a motor/sensory exam prior to repositioning to determine neurological status to provide baseline information. 11. DIRECT lift team members to their positions. 12. ASSIGN additional staff as required to move the lower limbs. NOTE: Legs must be moved in unison with the spine to maintain spinal alignment and to reduce patient discomfort. 13. CONFIRM with the lift team members that the lifting sheet extends from the patient s shoulders to lower limbs. NOTE: The purpose of the lifting sheet is to firmly support the entire length of the spine. 14. FIRMLY HOLD the patient s shoulders at the mid-clavicular area with forearms held tightly to the patient s head and neck to form a rigid cradle. 15. INSTRUCT one of the lift team members to remove head rolls once you have firm control of the head - never remove stabilizing aids until the head is controlled. 16. ENSURE patient s arms are relaxed on abdomen. 17. CALL the lift on a count. 18. ENSURE alignment is maintained throughout the lift. 19. VERIFY that the patient is in proper spinal alignment. CC BC Children s Hospital Child & Youth Health Policy and Procedure Manual Page 2 of 5

3 20. PERFORM a motor and sensory status assessment immediately following repositioning to determine if any change has occurred during the procedure. 21. RELEASE head if post procedure motor and sensory status is satisfactory and replace stabilizing aids. 22. ELICIT feedback from the patient regarding their comfort and sense of alignment. 23. ENSURE all tubes, lines or leads are positioned correctly. NOTE: If patient is connected to spinal traction, refer to Halo traction reference care plan. 24. DOCUMENT on appropriate record(s): a. Date, time b. Repositioning/lift performed c. Spine immobilized (c-spine) d. Number of assistants present e. Patient s before and after motor and sensory assessment f. How the patient tolerated the procedure g. Analgesia/antiemetics administered h. Patient/family education, if appropriate Lift Team Member Responsibilities 1. POSITION yourselves on either side of patient between shoulder and hip level. 2. ROLL edges of the lifting/sliding sheet inward and GRASP next to the patient s body with one hand at shoulder level and one hand at hip level. NOTE: Holding the lifting sheet close to the patient increases stability during lifting. Lifting with palms facing up is a stronger position for the lifting team members. 3. Staff member assigned to move the lower limbs should SLIDE his/her arms under the patient s thighs and calves. 4. COLLABORATE with the team leader as he/she directs the lift team members on the count of to LIFT and MOVE the patient. NOTE: maximum coordination in this way is imperative to ensure maintenance of proper spinal alignment when the patient is moved. 5. LIFT patient only enough to marginally clear the mattress and move to desired location on the bed. NOTE: Marginal clearance prevents both shearing friction on the skin and loss of spinal alignment during the lift. L-Spine/T-Spine Injury, Lesion or Post Spinal Surgery 1. DETERMINE if you have the competencies to lift or reposition a patient with a t-spine or l-spine injury. 2. GATHER equipment: o Sliding sheet with blue sliding surface 3. OBTAIN assistance of one or two additional staff members. NOTE: Factors such as size of the patient, presence of additional injuries, patient s predicted ability to tolerate repositioning, and the need to transfer influence whether you can perform a 2-person or 3 person lift. 4. IDENTIFY patient and EXPLAIN procedure. 5. ENSURE the bed is flat. CC BC Children s Hospital Child & Youth Health Policy and Procedure Manual Page 3 of 5

4 6. POSITION patient s arms, or ask patient to cross their arms over their lower abdomen or pelvis to discourage any attempt by the patient to assist with the turn. NOTE: Crossing arms onto the lower abdomen or pelvis minimizes shoulder movement while allowing arms to be out of the way of the turn. Allowing patients to assist in turning may cause twisting of the spine, potentially increasing the damage caused by the injury. 7. POSITION any tubes and drains to ensure no unnecessary traction or compression occurs during turning/repositioning. 8. ENSURE splints/devices are in place to support any other injuries if present. 9. ENSURE patient is in proper spinal alignment prior to commencing the turn. 10. PERFORM a motor/sensory assessment prior to repositioning to determine neurological status to provide baseline information. 11. POSITION one staff member on each side of the bed between shoulder and hip levels. ASSIGN the third staff member to move lower limbs as needed. 12. CONFIRM that the lifting sheet extends from the patient s shoulders to buttocks. NOTE: The purpose of the lifting sheet is to firmly support the entire length of the spine. 13. ROLL edges of the lifting/sliding sheet inward and GRASP next to the patient s body with one hand at shoulder level and one hand at hip level. NOTE: Holding the lifting sheet close to the patient increases stability during lifting. Lifting with palms facing up is a stronger position for the lift team members. 14. Staff member assigned to move the lower limbs should SLIDE his/her arms under the patient s thighs and calves. 15. Team leader to CALL the lift on a count and in unison, LIFT and MOVE patient. NOTE: maximum coordination in this way is imperative to ensure maintenance of proper spinal alignment when the patient is moved. 16. LIFT patient only enough to marginally clear the mattress and move to desired location on the bed. NOTE: Marginal clearance prevents both shearing friction on the skin and loss of spinal alignment during the lift. 17. ENSURE alignment is maintained throughout the lift. 18. PERFORM a motor/sensory assessment immediately following repositioning to determine if any change has occurred during the procedure. 19. ELICIT feedback from the patient regarding their comfort and sense of alignment. 20. ENSURE all tubes, lines or leads are positioned correctly. NOTE: If patient is connected to spinal traction, refer to Halo traction reference care plan. 21. DOCUMENT on appropriate record(s): a. Date, time b. Repositioning/lift performed (2 or 3 person lift) c. Spine immobilized (t-spine or l-spine) d. Patient s before and after motor/sensory assessment e. How the patient tolerated the procedure f. Analgesia/antiemetics administered g. Patient/family education, if appropriate CC BC Children s Hospital Child & Youth Health Policy and Procedure Manual Page 4 of 5

5 REFERENCES BC Children s Hospital (2007). Spinal precautions: Care of patient with a known or suspected acute spinal injury: cervical, thoracic or lumbar. Vancouver: Author. Calgary Regional Health Authority, (2000). Positioning of an adult patient with a known or suspected acute spinal injury: c-spine, t-spine, l-spine logrolling. In: Nursing Policy and Procedure Manual. Calgary. Author. Chung, S., et. al. (2011). Trauma Association of Canada Pediatric Subcommittee National Pediatric Cervical Spine Evaluation Pathway: Consensus Guidelines. The Journal of TRAUMA Injury, Infection, and Critical Care, 70(4): Cook, B., Fanta, K., & Schweer, L. (2003). Pediatric cervical spine clearance: Implications for nursing practice. Journal of Emergency Nursing. 29(4): Emergency Nurses Association. ENPC Provider Manual 2nd Edition Chapter 6 Pediatric Trauma, Freeborn, K. (2005). The importance of maintaining spinal precautions. Critical Care Nursing Quarterly. 28(2): Fries, J. (2005). Critical Rehabilitation of the patient with spinal cord injury. Critical Care Nursing. 28(2), Groeneveld, A. (2001). Logrolling: Establishing consistent practice. Orthopedic Nursing. 20(2):45-49 Hayes, J.S. & Arriola, T. (2005). Pediatric spinal injuries. Pediatric Nursing 31(6): McCarthy, C. & Oakley, E. (2002). Management of suspected cervical spine injuries the paediatric perspective. Accident and Emergency Nursing. 10: Platzer, P., Jaindl, M., Thalhammer, G., Dittrich, S., Kutscha-Lissberg, F., Vecsei, V. & Gaebler, C. (2007). Cervical spine injuries in pediatric patients. J Trauma. 62(2): Pullen, R. L. (2004). Logrollling a Patient. Nursing. 34(2):22. Skellett, S., Tibby, S.M., Durward, A. & Murdoch, I.A. (2002). Immobilization of the cervical spine in children. BMJ. 324: Tilt, L., Babineau, J., Fenster, D., Ahmad, F. and Roskind, C.G. (2012). Blunt Cervical Spine Injury in Children. Emergency and Critical Care Medicine, 24(3): Tze, N., Robinson, C. & Juneau, M. (2004). Sharing our best. Back breaking business; the implementation of a spinal education program. Journal of Trauma Nursing. 11(1): CC BC Children s Hospital Child & Youth Health Policy and Procedure Manual Page 5 of 5