Métodos de ajuste flexible basados en otras aproximaciones

a. Date and time of brace application

b. Patient neuro assessment prior to and after procedure c. Patient tolerance of procedure

NEUROSURGERY GUIDELINE

NEUROSURGERY SERVICE Halo Brace – Anterior Chest Skin Care St. Joseph’s Hospital &

Medical Center PAGE 1 of 2

July 1984 April 2010

ORIGINAL DATE REVISED

PURPOSE: To provide guidelines for removing anterior chest plate and providing skin and respiratory care for the patient in a halo brace.

GUIDELINES:

A. Patients who are at risk for pulmonary compromise, atelectasis, secretion retention and pneumonia should be chest-percussed on a routine basis.

B. Skin should be checked on a routine basis for breakdown beneath the chest plate. C. A physician’s order is required.

D. Schedule procedure before meals or at least one hour after meals to prevent vomiting or aspiration. Discontinue tube feedings one-half hour prior to the procedure. Feedings may be reinstated after the procedure.

EQUIPMENT: Wash Cloths Towels

Rubbing Alcohol PROCEDURES:

A. Coordinate time of care with Respiratory therapist B. Explain the procedure to the patient.

C. Provide privacy and support to the patient. D. Obtain necessary supplies.

E. Place head of bed flat.

F. Using the wrench fastened to the chest plate, unscrew bolts at each end of the halo post on the front of the chest vest. Place bolts in a secure place.

G. Unbuckle the buckles on the shoulders and loosen the Velcro at the bottom of the vest. Loosen both the red Velcro straps and the small white ones in the center.

H. Loosen the front and back sheepskin liners by pulling the Velcro fasteners apart on each side of the patient’s vest and slide the vest off.

I. Cleanse the skin with soap and warm water; dry thoroughly. Do not apply lotion or powder to skin under the brace. Observe any red areas on the skin and

massage, especially the bony prominence and rib cage. If redness is present, rub skin with alcohol.

J. If skin breakdown has occurred:

u Apply transparent dressing after cleansing skin thoroughly and allow drying for two minutes.

u Notify the wound care nurse of any skin breakdown and document the assessment.

u After proning is complete, call Hangar Orthotic’s technician for brace adjustment if necessary.

J. At this point, place the patient in postural drainage (if the patient can tolerate it) and percuss the lobes of the lungs.

K. If time and patient tolerance permit, leave the vest off for 20 – 30 minutes, reminding the patient not to move or sit up during this time.

L. Place the front vest onto the chest, fastening the front and back liners together again with the Velcro. Make sure the liners are smooth, without wrinkles, and tight.

NEUROSURGERY GUIDELINE

NEUROSURGERY SERVICE Halo Brace – Proning & Skin Care St. Joseph’s Hospital &

Medical Center PAGE 1 of 1

July 1984 April 2010

ORIGINAL DATE REVISED

PURPOSE: To provide guidelines for proning patients and providing skin and respiratory care for the patient in a halo brace.

GUIDELINES:

A. Patients at risk for pulmonary compromise, atelectasis, secretion retention and pneumonia should be proned on a regular basis. (Recommendation is once a week).

B. A physician’s order is required to do this procedure.

C. Schedule procedure before meals or at least one hour after meals to prevent vomiting or aspiration. Discontinue tube feedings ½ hour prior to the procedure. Feedings may be reinstated after the procedure.

D. The qualified respiratory therapist (if patient is on a respirator) and three other personnel should be summoned for help during this procedure.

E. During this entire procedure, the respiratory therapist is responsible for airway control and monitoring. If at any time the patient experiences respiratory distress or a change in neurological status, abort the procedure, put the plate back on and turn the patient back over.

F. To maintain the same traction, the brace must be replaced in the same manner as it was removed.

G. Pin sites are to be cleaned with ½ strength hydrogen peroxide and normal saline, every shift.

TRAUMA GUIDELINE TRAUMA SERVICE Intra-abdominal Pressure Monitoring St. Joseph’s Hospital &

Medical Center Page 1 of 2

March, 2001 April 2010

(Original Date) REVISED

PURPOSE:

To provide a means of measuring intra-abdominal compartment pressures.

Massive intestinal edema often follows laparotomy for major trauma where there has been prolonged shock. Crystalloid resuscitation, capillary leakage due to activated inflammatory mediators and reperfusion injury all contribute to this tissue swelling. Combined with intraabdominal packing or retroperitoneal hematomas this may render the abdomen difficult or impossible to close. If the abdomen is closed, intra-abdominal pressure may rise to a level (> 25 cmH2O) where it leads to significant cardiovascular, respiratory, renal, and cerebral dysfunction (Brohi,2000).

INDICATIONS:

Post operative patients with a distended or tense abdomen on examination.
Patients with organ dysfunction consistent with abdominal

compartment syndrome
Oliguria

Elevated Peak Inspiratory Pressures
Decreased cardiac function

Unexplained acidosis
Elevated ICP

Patients with abdominal packing

Patients with open abdomens, especially if they have an IV bag closure and are in the early post-operative period, may still develop abdominal

compartment syndrome. It may be important to monitor bladder pressures on these patients.

Patients who have not had an operation but have received large volumes of fluid resuscitation

Supplies Needed:

500cc bag of Normal Saline IV solution
60cc syringe with luer lock tip

Foley catheter clamp or tube clamp
2 - 18 ga. Needle

Pressure monitoring bag and tubing
HP Monitoring cable

Alcohol Wipes