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Journal of Neuroscience Nursing:
doi: 10.1097/JNN.0b013e3181e1d0ec
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Developing a Standard of Care for Halo Vest and Pin Site Care Including Patient and Family Education: A Collaborative Approach Among Three Greater Toronto Area Teaching Hospitals

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GENERAL PURPOSE STATEMENT: To provide the professional registered nurse with an overview of nursing care for patients in a halo vest.

LEARNING OBJECTIVES: After reading the preceding article and taking the following test, you should be able to:

1. Describe the halo brace and its application.

2. Identify complications associated with the halo brace.

3. Explain the nursing care of a patient in a halo vest with pin sites.

1. A halo brace is used to perform all of the following functions except

a. immobilize the head and neck following a cervical fracture.

b. immobilize the chest following a thoracic vertebral fracture.

c. allow bone healing postoperatively.

d. reduce spinal misalignment preoperatively.

2. The typical treatment time for the halo traction is up to

a. 4 weeks.

b. 8 weeks.

c. 12 weeks.

d. 24 weeks.

3. Contraindications for applying a halo crown include all except

a. skull fractures.

b. chest trauma.

c. obesity.

d. young age.

4. After halo application, halo pins should be re-torqued to 6-8 pounds/inch2

a. within the first 2-4 hours.

b. every 24 hours.

c. within the first 24-48 hours.

d. after the first week.

5. When properly positioned, the upper edge of the anterior vest should

a. cover the sternal notch.

b. be 1 inch below the sternal notch.

c. be 2 inches below the sternal notch.

d. be 3 inches below the sternal notch.

6. After the halo vest is applied, adjustments to improve alignment will be based on

a. the patient's feedback regarding comfort and fit.

b. results of cervical spine x-rays.

c. results of a cranial x-ray.

d. comparative measurements of the vest relative to the cervical spine.

7. Which is not a common complication of the halo brace?

a. pin site infections

b. pins loosening or dislodging

c. skin breakdown

d. dysphagia

8. Which statement about pin loosening is accurate?

a. It occurs in 36%-60% of patients with a halo vest.

b. It is thought to be due to trauma to bone at the tip of the pin.

c. It is not generally a cause of infection.

d. It is the least common complication of a halo brace.

9. When cellulitis or continuous infection occurs at a pin site,

a. the pin should be replaced in a new site.

b. the pin should be loosened slightly.

c. the pin should be tightened slightly.

d. topical antibiotics should be applied every 8 hours.

10. Ring migration and/or loss of immobilization should initially be managed by

a. retightening the pins.

b.immobilization of the cervical spine with a hard collar.

c. replacement of the pins.

d. refitting the vest.

11. Which statement is not correct about skin breakdown from a halo brace?

a. Craniofacial and sternal sites are the most common places for skin breakdown.

b. It can be prevented by adequate padding, turning and repositioning.

c. Refitting of the vest may be required to minimize pressure areas.

d. Daily care includes meticulous skin care and assessment for early signs of irritation.

12. Dysphagia is best managed by

a. upper endoscopy and esophageal dilation.

b. a diet limited to full liquids or soft foods.

c. halo adjustment.

d. loosening the vest during meals.

13. Dural punctures while using a halo brace

a. can occur when loose pins are not sufficiently tightened.

b. usually are a result of trauma to the halo.

c. typically do not lead to serious consequences.

d. usually heal within 4-5 weeks.

14. Unless crusted or draining, pin site care should be performed

a. once per shift in the hospital.

b. daily when in the hospital.

c. once every other day in the hospital and when home.

d. once a week when home.

15. The authors recommend that pin sites be cleansed with

a. hydrogen peroxide-soaked gauze.

b. soap and water and application of triple antibiotic ointment.

c. a cotton tip applicator or gauze soaked with normal saline.

d. normal saline on gauze using forceps to loosen crusting.

16. Hair washing recommendations include

a. protecting the halo crown, pins, and bars with plastic or a towel.

b. placing the patient prone in bed.

c. gently bringing the patient's head out over the top of the mattress.

d. using a dry shampoo to avoid water.

17. Which is not a sign that the halo pins may be loose?

a. dysphagia

b. discharge and/or drainage

c. tracking

d. pain at the site

18. Chest compressions for CPR on a patient in a halo brace should be performed by

a. placing the heels of the hand directly on the anterior portion of the vest.

b. positioning the hands for abdominal thrusts.

c. loosening the bolts to completely remove the vest.

d. rotating the anterior portion of the vest away from the body to expose the sternum.

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© 2010 American Association of Neuroscience Nurses


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