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CS95
A Targeted Response to Cervical Collar-Related Decubiti
By Betty Cole, RN, Oregon Health and Science University, Portland, OR
Purpose: Care of the trauma patient includes cautious immobilization of the cervical spine until cleared by diagnostic imaging. However, rigid collars quickly put patients at risk for decubiti if they are not removed or changed in a timely manner. Poorly fitted collars, delays in clearing the cervical spine, and prolonged collar use in the presence of a spinal fracture all have a cumulative effect on increasing the incidence of pressure ulcers.
Description: During a one-month observational period, our institution’s wound care specialists made regular observations of 12 trauma patients immobilized in Philadelphia cervical collars. Eight developed occipital pressure ulcers; 25% required surgical intervention at an average cost of $24,575. In an effort to reduce the high incidence of occipital decubiti, staff members in our 17-bed trauma/neuro ICU collaborated to change practice and reduce the incidence of this serious complication. Now, upon ICU arrival, rigid collars are removed and the neck is thoroughly cleaned to remove any debris. Careful inspection at this time aids in the detection of other possible injuries, such as bruising over the carotid area. The pre-hospital collar is discarded and replaced with a high-tech Aspen collar as soon as possible. Proper patient fit, using the Aspen’s cervical collar-sizing guide, helps to reduce the incidence of decubiti. In addition, this collar contains pads that are replaceable and can be washed frequently. Daily collar care, including cleansing of the neck and checking for pressure areas, is performed ever 24-hours or more often if indicated.
Evaluations/Outcomes: Since instituting this new protocol there has been a markedly decreased incidence of pressure ulcers in patients who require prolonged cervical collar immobilization. While the cost of the new collars is significantly greater than previously, the savings related to a drop in the number of occipital decubiti has more than compensated.
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