Caring for a Patient in Halo Traction

Goal: The patient maintains cervical alignment.

1. Review the medical record and the nursing plan of care to determine the type of device being used and prescribed care.

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 the patient for possible need for nonpharmacologic, pain-reducing interventions or analgesic medication before beginning. Administer appropriate prescribed analgesic. Allow sufficient time for analgesic to achieve its effectiveness before beginning the procedure.

7. Place a waste receptacle at a convenient location for use during the procedure.

8. Adjust bed to comfortable working height, usually elbow height of the caregiver if the patient will remain in bed (VISN 8 Patient Safety Center, 2009). Alternatively, have the patient sit up, if appropriate.

9. Assist the patient to a comfortable position that provides easy access to the head. Place a waterproof pad under the head if patient is lying down.

10. Monitor vital signs and perform a neurologic assessment, including level of consciousness, motor function, and sensation, per facility policy. This is usually at least every 2 hours for 24 hours, or possibly every hour for 48 hours.

11. Examine the halo vest unit every 8 hours for stability, secure connections, and positioning. Make sure the patient’s head is centered in the halo without neck flexion or extension. Check each bolt for loosening.

12. Check the fit of the vest. With the patient in a supine position, you should be able to insert one or two fingers under the jacket at the shoulder and chest.

13. Put on nonsterile gloves, if appropriate. Remove patient’s shirt or gown. Wash the patient’s chest and back daily. Loosen the bottom Velcro straps.

14. Wring out a bath towel soaked in warm water. Pull the towel back and forth in a drying motion beneath the front. Do not use soap or lotion under the vest.

15. Thoroughly dry the skin in the same manner with a dry towel. Inspect the skin for tender, reddened areas or pressure spots. Lightly dust the skin with a prescribed
medicated powder or cornstarch.

16. Turn the patient on his or her side, less than 45 degrees if lying supine, and repeat the process on the back. Close the Velcro straps. Assist the patient with putting on a new shirt, if desired.

17. Perform a respiratory assessment. Check for respiratory impairment, such as absence of breath sounds, the presence of adventitious sounds, reduced inspiratory
effort, or shortness of breath.

18. Assess the pin sites for redness, tenting of the skin, prolonged or purulent drainage, swelling, and bowing, bending, or loosening of the pins. Monitor body
temperature.

19. Perform pin-site care. (See Skills 9-19 and 9-20.)

20. Depending on physician order and facility policy, apply the antimicrobial ointment to pin sites and apply a dressing.

21. Remove gloves and dispose of them appropriately. Raise rails, as appropriate, and place the bed in the lowest position. Assist patient to a comfortable position.

22. Remove additional PPE, if used. Perform hand hygiene.