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PROCEDURE
102
Cervical Traction Maintenance
Jennifer Massetti
PURPOSE: Once cervical traction has been established, the nurse cares for the
patient who is immobilized on complete bed rest. Traction must be maintained on a
continuous basis until realignment and stabilization with surgical management or
orthoses is attained or healing is completed.
PREREQUISITE NURSING
KNOWLEDGE
• The nurse must be knowledgeable about the anatomy and
physiology of the spinal column, the anatomy of the cervi-
cal vertebrae, the spinal cord, the cervical spinal nerves,
and the area of peripheral innervation.
• It is important that the nurse understands the pathophysiol-
ogy and manifestations of spinal cord injury, including
ascending edema, spinal shock, and neurogenic shock.
Continual assessment of changes in motor, sensory, and
respiratory associated with ascending edema, spinal shock,
and neurogenic shock is essential in the care of the patient
requiring cervical traction.
• After the cervical tongs are inserted, traction is applied by
adding weights to a rope and pulley or cable and bracket
alignment device attached to the tongs (see Fig. 100-1 ).
Additional weight may be added gradually, followed by
radiographic imaging. The physician uses serial radio-
graphs of the cervical spine to assist in determining the
optimal amount of traction (measured in pounds) needed
to reduce a fracture and provide optimal alignment. Exces-
sive traction may cause stretching of and damage to the
spinal cord; the addition of weight to the traction is
managed by the physician.
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• Once the traction is in place, the patient is maintained on
strict bed rest. For facilitation of turning, the patient may
be placed on a special bed or turning frame.
• The principles of skeletal traction are the foundation of
management of any patient in cervical traction. One must
follow key points: (1) never raise/lift the traction weights,
(2) never disconnect the traction, (3) never allow the trac-
tion weights to rest on the fl oor, and (4) never allow other
objects to compromise freely hanging weights.
EQUIPMENT
• Cervical traction system in place, including rope and
pulley system or cable and bracket alignment device and
weights for the RotoRest™ Delta Kinetic™ Therapy Bed
(see Figs. 99-1 , 102-1 ).
• Pillows
Additional equipment, to have available as needed, includes
the following:
• Positioning devices or protective dressings
• Specialty bed
PATIENT AND FAMILY EDUCATION
• Explain the procedure and the reason for the traction.
Rationale: Patient and family anxiety may be decreased.
• Explain the patient ’ s role in maintaining the traction.
Rationale: Patient cooperation is elicited. The nonintu-
bated patient should be communicating with the team
during traction if he or she feels any changes in sensation,
new or worsening pain, or new or worsening change in
motor function.
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• Explain how the patient ’ s basic needs will be met during
the confi nement to bed and the maintenance of traction.
Rationale: The patient and family are reassured that the
patient will be cared for and his or her needs met.
PATIENT ASSESSMENT AND
PREPARATION
Patient Assessment
• Conduct a complete neurological assessment that includes
motor strength of the major muscles and sensory function.
(Assess light touch, pain, and proprioception. Note the
highest dermatome level with impaired sensation.) Assess
deep tendon refl exes (biceps, triceps, patellar, and Achil-
les), superfi cial refl exes, and cranial nerves. Rationale:
Baseline data are established for determination of any
change in neurological function.
• Assess the patient ’ s vital signs. Rationale: Baseline data
are provided for comparison with assessments after
insertion.
• Inspect the scalp for abrasions, lacerations, or sites of
infection. Rationale: Any potential sites of infection that
may contraindicate the insertion of a cervical fi xation
device into the infected area are identifi ed.
• Assess the patient ’ s comfort. Rationale: Spinal injuries
are often painful. Changes in pain in the head or neck or
