Logroll Guideline R CP RNSH

Royal North Shore Hospital - Intensive Care Unit Manual
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Procedure for log-rolling a patient with a cervical spine injury (or suspected injury)
1. Document Authorisation
Document Title Document Applies to: Owner Contact Number EMAIL Version Expiry Date Date Created Last Modified Last Authorized Authorized by Manual No. Procedure for log-rolling a patient with cervical spine injury (or suspected injury) ICU Roz Elliott 9926-6086 rmelliot@doh.health.nsw.gov.au 1.0 2005-03-20 2004-03-20 2004-03-20 2004-03-20 Dr R Raper
2.

Aims
to prevent spinal cord injury and/or ascension of injury to prevent the development of pressure sores to facilitate assessment of the patient's dorsal surface to minimise manual handling risks
3.
Standard
All patients will be safely log-rolled (2 hourly) with no adverse events such as spinal cord injury, ascension of injury or development of pressure sores.
4.
1. 2. 3. 4.
Prepare personnel and resources

Obtain collar if required. Obtain linen. Obtain wash bowl with water, hygiene and personal care equipment. Adjust the bed to the correct height for all personnel.
5.
Organise personnel
1. Identify how many people will be required to roll patient (Five for a patient with traction and four without). 2. Organise a skilled team to assist with the roll. 3. Ensure team wear gloves, goggles and aprons with arm protection for the head hold person. 4. Check understanding of the team members roles as follows:
Procedure for log-rolling a patient with cervical spine injury (or suspected injury) Ver.1.0 Expiry 2005-03-20
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5.1 Head Hold Person

Must be a registered nurse or medical officer. This person manages cervical spine alignment and is in control of the roll. They must ensure all members of the team are ready before proceeding and should give clear instructions. Whilst the head hold person takes their position assistance is required to minimize head movement.
Head hold without traction
Photo 1: Shows 'head hold person' at the head of the bed with their hands alongside the head gripping the shoulders whilst another person performs a shoulder brace to prevent head movement. Head hold with traction Head hold person gentlely inserts their hands from the side
Traction person minimises head movement
A third person applies a shoulder brace
Photo 2: The traction person minimizes head movement as the 'head hold person' slides their hands under the head from the side of the bed. A third person applies the shoulder brace.
5.2 Traction person (where required)

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The traction person takes all instructions from the 'head hold' person and is responsible for ensuring the traction rope is aligned with the patients nose by moving the traction device in the direction that the patient is being rolled. This person cannot leave the traction device to participate in any other activity during the roll. When instructed the traction person releases the screws which secure the traction roller and says clearly traction off. Likewise traction on is clearly stated when the screws are retightened following instruction. Never support the weight of the traction as further spinal cord damage can result. The purpose of the traction weight is to maintain alignment of the fractured vertebrae.
Photo 3: Shows the traction person releasing the screws of the traction roller on instruction. Note the correct position of the head hold person's hands.
5.3 Chest person

Should be the tallest person in the team who places hands over the patients shoulder and lower back (See Photo 4).
5.4 Hip person

This person is responsible for ensuring the lower spine is not twisted during the roll. Places one hand near the lower hand of the 'chest' person on the patient's lower back and the other under the patients thigh (See Photo 4). A pillow may be inserted between the patients legs to maintain alignment.
5.5 Leg person

Each patient must be assessed on an individual basis for manual handling risks. A leg person is required for tall or heavy patients or those in plaster. The weight of the leg should be supported from underneath.
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Photo 4: Shows the correct positions for each of the personnel described in the previous section
5.6 Hygiene person

The hygiene person is responsible for maintaining safety of the lines and artificial airway during the roll. When the patient is balanced on their side, the tubing can be supported on the ventilator arm at which time patient assessment and hygiene needs can be attended. The skin assessment is performed, which includes the skin under the collar (occiput).
6.
The rolling procedure
When the equipment is obtained, the patient is prepared and the personnel understand their roles the procedure for log-rolling is as follows: 1. The procedure is explained to the patient and the cervical collar is applied (if required). 2. The personnel take their positions as described previously. 3. The head hold person indicates to the traction person to release the traction (where appropriate). The traction person says 'traction off'. 4. The head hold person says we will all roll on 'three'. The count is made and all personnel roll the patient together on 'three'. Where appropriate the traction person rolls the traction device in the direction of the patient's roll, keeping the traction rope in alignment with the patients nose. 5. The hygiene person reassures the patient and supports the lines and airway until the patient is in a stable position on their side.
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Photo 5: Shows a patient without traction in a stable position on their side. Note the alignment of the spine and the position of the head hold person's hands
Photo 6: Shows the patient with traction in a stable position on their side. Note that the traction is in alignment and the correct position of the head hold person's hands
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6. The patient's skin integrity is assessed with particular attention paid to the occipital region under the collar. This should be assessed for integrity, oedema, pain and non-blanching redness. Hygiene needs are met.
Photo 7 and 8: Show skin assessment under the collar 7. The head hold person asks if everyone is ready. When ready, the head hold person states we will roll back on 'three'. The count is made and everyone rolls together (the traction is also moved back where applicable). 8. The hygiene person reduces creasing by gently pulling on the sheets as the patient is lowered. 9. The head hold person states 'traction on' (where applicable). The traction person ensures the traction rope is in line with the patient's nose and tightens the screws. 'Traction on' is then stated loudly. 10. All personnel stay in place while the head hold person checks alignment. Where traction is being used the traction person performs this role.
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Photo 9: Shows traction person at the head of the bed checking the patient's alignment (other personnel not shown) 11. If the patient is not in alignment they must be rolled to the other side using the procedure as above. 12. If the legs and hips are not aligned the hip can be slighted flicked using the sheet IF THERE IS NO SUSPICION OF THORACIC OR LUMBAR INJURY. The patient is braced during this procedure and the head hold person remains in control. The person holding the torso braces the shoulders. All personnel stay in place while the head hold person checks alignment. Where traction is being used the traction person performs this role.
Photo 8: Shows the correct procedure for the hip 'flick' (ONLY TO BE PERFORMED IF THORACO-LUMBAR CLEARANCE IS DOCUMENTED) 13. If the patient is in alignment the head hold person gives permission for the personnel to release their grip sequentially from the legs up. 14. The head hold person only removes hands while the shoulders are braced by a second person. A third person supports the head to minimize movement.
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15. Adverse events are reported to the Nursing Unit Manager and Medical Officer immediately. The procedure is documented on the flow chart and the Waterlow score is recorded.
7.
Acknowledgements
The following people assisted in the development of this document: Thank you to Jo Hides for taking the photographs. Thank you to Syad Abdaly, Elizabeth Davidson, Matthew Tinker, Mary-Anne Phillips and Erin Walmsley for modeling. Thank you to Barry Spiers and Rochelle McKnight for their editing. Thank you to Phil Johnston for formating advice.

Logroll Guideline R CP RNSH

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Royal North Shore Hospital - Intensive Care Unit Manual

Prepare personnel and resources

Royal North Shore Hospital - Intensive Care Unit Manual

5.1 Head Hold Person

Head hold without traction

Traction person minimises head movement

A third person applies a shoulder brace

5.2 Traction person (where required)

Royal North Shore Hospital - Intensive Care Unit Manual

5.3 Chest person

5.4 Hip person

5.5 Leg person

Royal North Shore Hospital - Intensive Care Unit Manual

5.6 Hygiene person

The rolling procedure

Royal North Shore Hospital - Intensive Care Unit Manual

Royal North Shore Hospital - Intensive Care Unit Manual

Royal North Shore Hospital - Intensive Care Unit Manual

Royal North Shore Hospital - Intensive Care Unit Manual

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