NURSING PATIENT CARE POLICY & PROCEDURE
April 30, 2015
Nursing Manual (Red)
Policy #: 5.10
Title: Cervical Traction
To assist in the application of cervical traction devices and to maintain continuous
traction to the cervical spine. To cleanse the skin area around the pin insertion sites.
A. Keep the cervical collar in place until tong/halo ring application is complete,
cervical spine films have been obtained and reviewed, and an order is written to
remove the cervical collar.
B. Successful treatment is dependent on continuous traction. Do not disconnect
traction without notifying physician.
C. If MRI imaging is anticipated, verify that the cervical apparatus and equipment
used are safe for the MRI. If uncertain of MRI compatibility, consult with
A. Rotorest bed or traction set-up for regular bed (wedge type)
B. Cervical fixation device:
1. Tongs, MRI compatible Gardner-Wells (wrapped and labeled from
Central Service [CS]) or
2. Halo ring (from orthotics department)
E. Prep kit with hair clippers or scissors
F. Prep solution (Chloraprep™)
G. 3 mL syringe with 25 gauge needle
H. Local anesthetic (usually lidocaine)
J. Gloves, sterile
K. Container for solution, sterile
L. Applicators, sterile
N. Sterile normal saline
A. The physician will apply either Gardner-Wells tongs or a halo ring as a cervical
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B. Confirm need for bed and ensure order has been placed, so the vendor can deliver
it as soon as possible. Call CS if there are specific delivery instructions.
1. If the patient is on a standard mattress, disconnect the air pump. Use of the
alternating air pump is contraindicated with an unstable fracture.
C. Clip hair, if needed. Hair is usually clipped one inch in diameter above the ears
only. The remaining hair provides protection from pressure areas on posterior
D. Perform a neurological assessment every 5 minutes during the insertion of the
device, including level of consciousness, movement or intact function in arms and
legs, mastication, and eyelid closure.
E. Assist physician as necessary.
1. Confirm size with physician. Devices are available in small, regular and
2. The physician will prep and anesthetize the skin then position and insert
the cervical traction device.
3. Attach rope and correct pounds of weight as ordered to achieve desired
4. The angle of pull of the rope on the cervical traction device is always in a
neutral position (in the same plane as the vertebral column) unless
otherwise ordered by physician.
5. Weights should be free hanging and not resting on anything. If resting on
furniture, floor, or frames, traction is decreased and consequently
ineffective. Avoid sudden movements of the traction equipment or patient.
6. Adjust position of patient so knot is at least two inches from head of frame
7. Head of bed should remain flat or may be placed in reverse
Trendelenburg’s position to provide counter-traction and assist in
maintaining patient’s position.
8. Anticipate a bedside confirmatory radiograph of cervical spine to verify
F. Monitor pin sites for hemostasis immediately after the procedure. Monitor and
report any increased pain at the insertion site, neck or shoulders.
G. Document procedure and assessments in patient’s clinical record.
V. PATIENT MONITORING AND CARE
A. Continue to monitor neurological status as ordered, including level of
consciousness, movement and sensation in arms and legs, mastication, and eyelid
closure. Notify physician of any deterioration. Monitor for complications related
to immobility (e.g., pneumonia, deep vein thrombosis, ileus, or skin breakdown).
B. If cervical traction is lost, maintain manual cervical spine immobilization, place in
rigid cervical collar and notify physician.
C. Determine schedule for cleaning pin insertion sites. (Physician orders treatment
and schedule, usually every shift.)
D. Starting at insertion site, scrub area with Chloraprep™ applicators, one minute
each. Hold applicator and squeeze wings, releasing solution onto sponge pad.
Press sponge against skin and apply Chloraprep™ using a back and forth friction
scrub. DISCARD applicator after one-time use. DO NOT repeat cleansing with
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same applicator over same area. Allow to air dry completely. Do not wave, blot or
E. Note and report to physician any drainage, inflammation of skin, edema, patient
complaint of pain, or loosening/slipping of pin site.
F. If hair has started to grow around pin sites, clip area to make it easier to clean and
G. Hair may be washed with pins in place. Perform pin site care after shampooing.
H. Continue site care after pins are removed until sites are well healed.
I. Document monitoring and care in patient’s clinical record.
A. American Association of Critical Care Nurses (2011). AACN procedure manual
for critical care (6th Ed.). Philadelphia, PA: WB Saunders Co.
B. Smith, D. A. (2009). Tongs or open-back halo for cervical traction. In J.A. Proehl
(Ed.). Emergency nursing procedures (4th Ed., pp. 483-488). St. Louis, MO:
VII. REVIEWED BY
Clinical Nurse Specialist, Emergency Department
Clinical Nurse Specialist, Neurosurgery
Clinical Nurse Specialist, Trauma Life Support Center
Nursing Patient Care Policy and Procedure Committee, April 2015
Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer