logroll guideline r cp rnsh

Royal North Shore Hospital - Intensive Care Unit Manual Page:1

Procedure for log-rolling a patient with a cervicalProcedure for log-rolling a patient with a cervicalspine injury (or suspected injury)spine injury (or suspected injury)

1. Document AuthorisationDocument Title Procedure for log-rolling a patient with cervical spine

injury (or suspected injury)Document Applies to: ICUOwner Roz ElliottContact Number 9926-6086EMAIL [email protected] 1.0Expiry Date 2005-03-20Date Created 2004-03-20Last Modified 2004-03-20Last Authorized 2004-03-20Authorized by Dr R RaperManual No.

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. Prepare personnel and resources1. Obtain collar if required.2. Obtain linen.3. Obtain wash bowl with water, hygiene and personal care equipment.4. Adjust the bed to the correct height for all personnel.

5. Organise personnel1. 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


5.1 Head Hold PersonMust be a registered nurse or medical officer. This person manages cervical spinealignment and is in control of the roll. They must ensure all members of the team areready before proceeding and should give clear instructions. Whilst the head holdperson 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 handsalongside the head gripping the shoulders whilst another person performsa shoulder brace to prevent head movement. Head hold with traction

Photo 2: The traction person minimizes head movement as the 'head holdperson' slides their hands under the head from the side of the bed. A thirdperson applies the shoulder brace.

5.2 Traction person (where required)


Traction personminimises headmovement

Head holdperson gentlelyinserts theirhands from theside

A third personapplies a shoulderbrace


The traction person takes all instructions from the 'head hold' person and isresponsible for ensuring the traction rope is aligned with the patient’s nose bymoving the traction device in the direction that the patient is being rolled. Thisperson cannot leave the traction device to participate in any other activity during theroll. When instructed the traction person releases the screws which secure thetraction roller and says clearly ‘traction off’. Likewise ‘traction on’ is clearly statedwhen the screws are retightened following instruction. Never support the weight ofthe traction as further spinal cord damage can result. The purpose of thetraction weight is to maintain alignment of the fractured vertebrae.

Photo 3: Shows the traction person releasing the screws of the tractionroller on instruction. Note the correct position of the head hold person'shands.

5.3 Chest person

Should be the tallest person in the team who places hands over the patient’sshoulder and lower back (See Photo 4).

5.4 Hip person

This person is responsible for ensuring the lower spine is not twisted during theroll. Places one hand near the lower hand of the 'chest' person on the patient'slower back and the other under the patient’s thigh (See Photo 4). A pillow may beinserted between the patient’s 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 weightof the leg should be supported from underneath.



Photo 4: Shows the correct positions for each of the personnel described inthe previous section

5.6 Hygiene person

The hygiene person is responsible for maintaining safety of the lines and artificialairway during the roll. When the patient is balanced on their side, the tubing canbe supported on the ventilator arm at which time patient assessment and hygieneneeds can be attended. The skin assessment is performed, which includes theskin under the collar (occiput).

6. The rolling procedureWhen the equipment is obtained, the patient is prepared and the personnelunderstand their roles the procedure for log-rolling is as follows:

1. The procedure is explained to the patient and the cervical collar is applied (ifrequired).

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 tractionperson rolls the traction device in the direction of the patient's roll, keeping thetraction rope in alignment with the patient’s nose.

5. The hygiene person reassures the patient and supports the lines and airwayuntil the patient is in a stable position on their side.



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'shands

Photo 6: Shows the patient with traction in a stable position on their side. Notethat the traction is in alignment and the correct position of the head holdperson's hands



6. The patient's skin integrity is assessed with particular attention paid to theoccipital 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 holdperson states “we will roll back on 'three'”. The count is made and everyonerolls together (the traction is also moved back where applicable).

8. The hygiene person reduces creasing by gently pulling on the sheets as thepatient is lowered.

9. The head hold person states 'traction on' (where applicable). The tractionperson ensures the traction rope is in line with the patient's nose and tightensthe 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.



Photo 9: Shows traction person at the head of the bed checking the patient'salignment (other personnel not shown)

11. If the patient is not in alignment they must be rolled to the other side using theprocedure as above.

12. If the legs and hips are not aligned the hip can be slighted ‘flicked’ using thesheet IF THERE IS NO SUSPICION OF THORACIC OR LUMBAR INJURY.The patient is braced during this procedure and the head hold person remainsin control. The person holding the torso braces the shoulders. All personnelstay in place while the head hold person checks alignment. Where traction isbeing used the traction person performs this role.

Photo 8: Shows the correct procedure for the hip 'flick' (ONLY TO BEPERFORMED IF THORACO-LUMBAR CLEARANCE IS DOCUMENTED)

13. If the patient is in alignment the head hold person gives permission for thepersonnel to release their grip sequentially from the legs up.

14. The head hold person only removes hands while the shoulders are braced bya second person. A third person supports the head to minimize movement.



15. Adverse events are reported to the Nursing Unit Manager and Medical Officerimmediately. The procedure is documented on the flow chart and theWaterlow score is recorded.

7. AcknowledgementsThe 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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