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26.4 Positioning for suspected/confirmed cervical spinal instability: pelvic twist to right

See Figure 26.12. This procedure is for cervical and upper thoracic spinal injuries only. It is contraindicated in the presence of thoracolumbar or pelvic trauma.

Essential equipment

  • Collar or spinal brace
  • Foam wedge or pillows

Optional equipment

  • Equipment required for the purpose of the log roll, for example clean sheets, hygiene equipment, pads or pressure care

Pre‐procedure

ActionRationale

  1. 1.
    Explain and discuss the procedure with the patient.
    To ensure that the patient understands the procedure and gives their valid consent (NMC [214], C).
  2. 2.
    Wash hands thoroughly or use an alcohol‐based handrub.
    To reduce the risk of contamination and cross‐infection (Fraise and Bradley [83], E).
  3. 3.
    Ensure that the bed is at the optimum height for handlers. If two handlers are required, try to match handlers’ heights as far as possible.
    To minimize the risk of injury to the practitioner (Smith [274], C).
  4. 4.
    Ensure there are three people available to assist with the procedure.
    To ensure a co‐ordinated approach to the move. E

Procedure

  1. 5.
    The lead practitioner stands at the head and places their hands firmly on the patient's shoulders.
    To take responsibility for providing instructions and ensuring all other practitioners are ready before commencing the manoeuvre. E
    To prevent movement of unstable cervical spine. E
  2. 6.
    A second practitioner positions themselves on the left side of the bed to which the patient will be turned.
    To ensure a co‐ordinated approach to the move. E
  3. 7.
    The third practitioner assists the second practitioner to lift the patient's leg to allow them to place their left hand under the leg to the right hip and their right hand under the patient's lumbar region.
    To prevent an angle of more than 30°. E
  4. 8.
    The patient's left hip is then upwardly rotated by the second practitioner.
    The second practitioner's hands provide a barrier against friction during the turn. E
  5. 9.
    Both the lead and second practitioners maintain their position while the third practitioner places a folded pillow beneath the patient's left buttock above the sacrum. Place an additional pillow under the patient's upper buttock if required.
    To prevent undue pressure risk to sacral/buttock region (Harrison [105], C).
  6. 10.
    Place two pillows below the patient's left leg.
    To support the left leg. E
  7. 11.
    Position a pillow at the foot end of the bed.
    To minimize the risk of foot drop (Harrison [105], C).

Post‐procedure

  1. 12.
    In the event of a worsening of pain or neurological symptoms, reassessment by the medical team.
    To ensure clinical status is maintained (Harrison [105], C).
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