Some of you may recall Shayna’s e-mail last winter stating that we are to remove hard cervical collars and switch to a softer collar (i.e., Philly or Miami J) immediately upon a patient’s arrival to PICU. Shayna’s e-mail also stated that these collars were available in ED or adult ICUs. However, I found the adult ICUs only have S-M-L adult collars and the ED actually does not carry pediatric size collars at all. Julie ordered infant and child sized soft collars that are located in PICU storeroom (south wall, top shelf). Per Julie, the adult collars come in S-M-L sizes, but also have 3 different lengths for the front piece of the collars.
Julie will be requesting sizing information from the company providing the collars so we have guidance about what size to use. This will be posted in PICU storeroom.
The other related issue is timing for the hard collars to be changed to a philly/soft collar or Miami J-type collar. Often the patient’s c-spines can be cleared relatively soon. It may not be cost-effective to change a hard collar to a soft one only to remove soft collar within an hour or two when C-spines are clinically cleared. Dr. Kiragu and Julie offered the following guidelines:
- It continues to be a goal to get the patient out of the hard collars ASAP.
- There are two parts to clearing c-spines:
- First, the patient’s CT needs to be read by radiology (radiographically cleared).
- Second, the patient needs to be assessed by a Trauma Surgery or Neurosurgery MD (clinically cleared).
- If your patient is awake, alert and moving around, they are a candidate for quick removal of the collar. You should persistently encourage the MDs (trauma surgery or neurosurgery) to assess the patient’s C-spines and either remove the collar entirely or order appropriate subsequent collar, if still warranted.
- If your patient is not alert or otherwise has altered mental status, it will take the MDs longer to clinically clear the patient. It should continue to be your priority to get the patient out of a hard collar, but it can wait a bit longer (up to 24 hours). Until your patient’s c-spines have been clinically cleared, monitor skin closely and communicate with the MDs responsible for patient about changing patient to Philly collar if quick clearance of the spines cannot be assured.
- In no event should the patient be in the hard collar after PICU rounds each day, or beyond 24 hours since placement.
- If you are uncertain about how to maintain c-spines as you change out collars, please call on the surgery residents to assist you, both as an extra set of hands, but also to ensure c-spines are held properly during transitions w/collars.