Spinal Precautions & Log Rolling

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Outline

Overview

Purpose
1. Patients in spinal precautions should be kept flat (0 degrees at the hips) at all times to prevent twisting, bending, or turning the spine
2. C-spine precautions should be held during any movements or turning
3. Log-Rolling is used to turn patients to the side while stabilizing their spine
  1. True log-rolling with c-spine precautions requires 3 people to turn and one person to wash or change linens, etc.

Nursing Points

General

Supplies needed
1. Cervical collar in place if needed
2. 3-4 team members
3. Draw sheet

Nursing Concepts

1. Steps and Nursing Considerations for Log Rolling (without cervical-spine precautions)
  1. Perform hand hygiene
  2. Explain procedure to patient
  3. Have the patient cross their arms across their chest, if not contraindicated
  4. Prep – Staff member #1
    1. Stand next to patient’s shoulder
    2. Place one hand one patient’s shoulder on the opposite side
    3. Place other hand on patient’s upper thigh on the opposite side
  5. Prep – Staff member #2
    1. Stand next to patient’s hip
    2. Place one hand on the patient’s upper hip bone on the opposite side
    3. Place other hand behind patient’s knee on the opposite side
    4. **Arm should cross over Staff member #1’s arm
  6. Designate one person to be in charge – usually person #1.
  7. Person #1 counts to 3
  8. On 3 – both staff members lift/pull patient towards them together, maintaining alignment in spine
  9. Staff member #3 can then perform back/skin/perineal care or linen change
  10. When it’s time to lay the patient back, Staff Member #1 counts to 3 again, and both lower the patient back to flat together
  11. Repeat on opposite side if necessary to complete a linen change or other procedure
With Cervical Spine precautions
1. Staff Member #1 holds C-spine and is in charge of counting/controlling the movements
2. Staff Member #2 and #3 log roll as above
3. Staff Member #4 does the patient care

Patient Education

Importance of holding still and letting the staff members do all the work so that they don’t twist/turn at the spine

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Transcript

In this video we’re going to talk about some mobility when it comes to patients in spinal precautions. Remember they can’t bend, twist, or turn, so we HAVE to be so careful when we’re moving them. If they’re also in c-spine precautions, make sure you also have someone holding c-spine.

Now, if you check out our positioning lesson in Fundamentals, we talk about reverse trendelenburg. Reverse trendelenburg is a great position for patients in spinal precautions to get their head up without bending them at the waist.
Now, let’s say you need to roll this patient who is just in spinal precautions, maybe to wash their back or change their sheets. You’ll lay them back flat and raise the bed to a working height. Then, you will need THREE staff members. Two to do the log roll turn and one to do the patient care.
One staff member stands next to patient’s shoulder and places one hand on patient’s shoulder on the opposite side, then places their other hand on patient’s upper thigh on the opposite side.
Then, another staff member stands next to the patient’s hip and places one hand on the patient’s upper hip bone on the opposite side and places their other hand behind patient’s knee on the opposite side. You’ll see that the staff members arms should cross over each other.
Have the patient cross their arms over their chest if they can. Then, the staff member closest to the head will be the one in charge of the turn. So they’ll count to 3. On 3, both staff members will gently turn the patient towards themselves together. The whole goal here is to prevent twisting and turning in the back. So you don’t just pull as hard as you can!
Then the third staff member can wash the back or change the sheets or whatever needs to happen. Then, when it’s time to roll back, the staff member in charge is going to count to 3 again.
On 3, both staff members will gently turn the patient back down onto the bed at the same time, without twisting or turning the patient.

Then, of course, if you need to you can repeat this on the other side.
If the patient is in c-spine precautions, you’d also have someone holding c-spine and THEY would be the one in charge of counting.

We hope that was helpful, remember to NOT twist or turn the patient. Be gentle!

Now, go out and be your best selves today. And, as always, happy nursing!