Halo-Vest Traction Management
Halo-vest traction immobilizes a patient’s head and neck after traumatic injury to the cervical vertebrae as well as helping to prevent further injury to the spinal cord. It also can be used postoperatively to allow for bone healing. An orthopedic surgeon or neurosurgeon applies halo-vest traction, with assistance from a nurse. The procedure typically occurs in the emergency department, a specially equipped room, or the operating room after surgical reduction of vertebral injuries.
The halo-vest traction device consists of a metal ring that fits over the patient’s head and metal bars that connect the ring to a plastic vest that distributes the weight of the entire apparatus around the chest. When in place, halo-vest traction allows the patient greater mobility than other forms of cervical traction. (See Halo-vest traction device.)
Equipment
Halo-vest traction unit ▪ halo ring ▪ gowns ▪ masks ▪ eye shields ▪ cervical collar or sandbags ▪ plastic vest ▪ board or padded headrest ▪ tape measure ▪ halo ring conversion chart ▪ clippers ▪ 4″ × 4″ sterile gauze pads ▪ antiseptic solution ▪ gloves ▪ sterile gloves ▪ Allen wrench ▪ four positioning pins ▪ multiple-dose vial of 1% lidocaine (with or without epinephrine) ▪ alcohol pads ▪ 3-mL syringe ▪ 25G needles ▪ five sterile skull pins (one more than needed) ▪ torque screwdriver ▪ sheepskin vest liners ▪ cotton-tipped applicators ▪ medicated powder or cornstarch ▪ sterile water or normal saline solution ▪ soap ▪ basin of warm water ▪ washcloth ▪ towel ▪ Optional: hair dryer, analgesics.
Most facilities supply packaged halo-vest traction units that include software (jacket and sheepskin liners), hardware (halo, head pins, upright bars, and screws), and tools (torque screwdriver, two conventional wrenches, Allen wrench, and screws and bolts).
Preparation of Equipment
Obtain a halo-vest traction unit with halo rings and plastic vests in several sizes. Vest sizes are based on the patient’s chest and head measurements. Check the expiration date of the prepackaged tray, and check the outside covering for damage to ensure the sterility of the contents. Then gather the equipment at the patient’s bedside.
Implementation
Verify the doctor’s order.
Gather the necessary equipment
Conduct a preprocedure verification to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.1
Verify that the laboratory and imaging studies have been completed as ordered and that the results are in the patient’s medical record. Notify the doctor of any unexpected results.1
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
Provide privacy.
Assisting with Halo Application
Confirm that the doctor has obtained informed consent and make sure that the form is in the patient’s medical record.6,7
Obtain baseline vital signs and perform neurologic and pulmonary assessments.
Check the support that was applied to the patient’s neck on the way to the health care facility. If necessary, apply the cervical collar immediately or immobilize the head and neck with sandbags. Keep the cervical collar or sandbags in place until the halo is applied.8 This support will then be carefully removed to facilitate application of the vest. Reassure the patient.
Remove the headboard and any furniture at the head of the bed to provide ample working space. Then carefully place the patient’s head on a board or on a padded headrest that extends beyond the edge of the bed.
Nursing Alert
To prevent further injury to the spinal cord, never put the patient’s head on a pillow before applying the halo.
Elevate the bed to a working level that gives the doctor easy access to the front and back of the halo unit.
Stand at the head of the bed and see if the patient’s chin lines up with his midsternum, indicating proper alignment. If ordered, support the patient’s head in your hands and gently rotate the neck into alignment without flexing or extending it. Ask another nurse to help you with the procedure.
Have the assisting nurse hold the patient’s head and neck stable while the doctor removes the cervical collar or sandbags. This support should be maintained until the halo is secure while you assist with pin insertion.
Conduct a time-out immediately before starting the procedure to perform a final assessment that the correct patient, site, positioning, and procedure are identified and, as applicable, that all relevant information and necessary equipment are available.9 The doctor measures the patient’s head with a tape measure and refers to the halo ring conversion chart to determine the correct ring size. (The ring should clear the head by 5/8″ [1.6 cm] and fit ½″ [1.3 cm] above the bridge of the nose.)
The doctor selects four pin sites: ½″ above the lateral one-third of each eyebrow and ½″ above the top of each ear in the occipital area. He also takes into account the degree and type of correction needed to provide proper cervical alignment.
Trim the hair at the pin sites with clippers to facilitate subsequent care and help prevent infection.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
