Bowel activity usually returns within the first week. As soon as bowel sounds are heard
on auscultation, the patient is given a high-calorie, high-protein, high-fiber diet, with
the amount of food gradually increased. The nurse administers prescribed stool
softeners to counteract the effects of immobility and analgesic agents. A bowel
program is instituted as early as possible.
Providing Comfort Measures
A patient who has had pins, tongs, or calipers placed for cervical stabilization may have
a slight headache or discomfort for several days after the pins are inserted. Patients
initially may be bothered by the rather startling appearance of these devices, but usually
they readily adapt to it because the device provides comfort for the unstable neck. The
patient may complain of being caged in and of noise created by any object coming in
contact with the steel frame of a halo device, but he or she can be reassured that
adaptation to such annoyances will occur.
The Patient in Halo Traction
The areas around the four pin sites of a halo device are cleaned daily and observed for
redness, drainage, and pain. The pins are observed for loosening, which may contribute
to infection. If one of the pins becomes detached, the head is stabilized in a neutral
position by one person while another notifies the neurosurgeon. A torque screwdriver
should be readily available in case the screws on the frame need tightening.
The skin under the halo vest is inspected for excessive perspiration, redness, and skin
blistering, especially on the bony prominences. The vest is opened at the sides to allow
the torso to be washed. The liner of the vest should not become wet, because dampness
causes skin excoriation. Powder is not used inside the vest, because it may contribute to
the development of pressure ulcers. The liner should be changed periodically to
promote hygiene and good skin care. If the patient is to be discharged with the vest,
detailed instructions must be given to the family, with time allowed for them to return
demonstrate the necessary skills of halo vest care (Chart 63-9).
Monitoring and Managing Potential Complications
Thrombophlebitis
Thrombophlebitis is a relatively common complication in patients after SCI. DVT
occurs in a high percentage of SCI patients, placing them at risk for PE. The patient
must be assessed for symptoms of thrombophlebitis and PE: chest pain, shortness of
breath, and changes in arterial blood gas values must be reported promptly to the
physician. The circumferences of the thighs and calves are measured and recorded
daily; further diagnostic studies are performed if a significant increase is noted. Patients
remain at high risk for thrombophlebitis for several months after the initial injury.
Patients with paraplegia or tetraplegia are at increased risk for the rest of their lives.
Immobilization and the associated venous stasis, as well as varying degrees of
autonomic disruption, contribute to the high risk and susceptibility for DVT (Farray,
Carman & Fernandez, 2004).
Anticoagulation is initiated once head injury and other systemic injuries have been
ruled out. Low-dose fractionated or unfractionated heparin may be followed by long-
term oral anticoagulation (ie, warfarin) or subcutaneous fractionated heparin injections.
Additional measures such as range-of-motion exercises, thigh-high elastic compression
stockings, and adequate hydration are important preventive measures. Pneumatic
compression devices may also be used to reduce venous pooling and promote venous