Applying a Two Piece Cervical Collar

Goal: The patient’s cervical spine is immobilized, preventing further injury to the spinal cord.

1. Review the medical record and nursing plan of care to determine need for placement of a cervical collar. Identify any movement limitations.

2. Gather the necessary supplies and bring to the bedside stand or overbed table.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient.

6. Assess patient for any changes in neurologic status. (See Chapter 2 for assessment details.)

7. Place the bed at an appropriate and comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Lower the side rails as
necessary.

8. Gently clean the face and neck with a mild soap and water. If the patient has experienced trauma, inspect the area for broken glass or other material that could cut the patient or the nurse. Pat the area dry.

9. Have a second caregiver in position to hold the patient’s head firmly on either side above the ears. Measure from the bottom of the chin to the top of the sternum, and measure around the neck. Match these height and circumference measurements to the manufacturer’s recommended size chart.

10. Slide the flattened back portion of the collar under the patient’s head. The center of the collar should line up with the center of the patient’s neck. Do not allow the patient’s head to move when passing the collar under the head.

11. Place the front of the collar centered over the chin, while ensuring that the chin area fits snugly in the recess. Be sure that the front half of the collar overlaps the back half. Secure Velcro straps on both sides. Check to see that at least one finger can be inserted between collar and patient’s neck.

12. Raise the side rails. Place the bed in lowest position. Make sure the call bell is in reach.

13. Reassess the patient’s neurologic status and comfort level.

14. Remove PPE, if used. Perform hand hygiene.

15. Check the skin under the cervical collar at least every 4 hours for any signs of skin breakdown. Remove the top half of the collar daily and cleanse the skin under the collar. When the collar is removed, have a second person immobilize the cervical spine.