Care of Cranio-cervical Traction - Intensive Care & Coordination ...

Care of Cranio-cervical Traction 

Desired Outcome 

Patients will not suffer any, or any further, spinal cord damage 

Wentworth Area Health Service 


Purpose 

Cranio-cervical traction using Gardner-Wells tongs is used in the Nepean Hospital for the 

treatment of some acute cervical spine injuries. Placement of the tongs will normally be 

undertaken in the Operating Theatre or the Intensive Care Unit. The procedure is 

intended for short-term treatment of cervical spine injuries while definitive surgery or 

immobilisation with other devices such as a halo vest is being planned. 

Most commonly Gardner-Wells tongs will be used. However a Halo Ring may be applied 

for initial cervical traction if Halo Vest immobilisation is planned after acute fracture 

stabilisation. 

Authorisation 

Neurosurgeon 

Neurosurgical Registrar 

Indications and Contra Indications 

• For the reduction of cervical spine fractures or dislocations. 

• To maintain good alignment of reduced cervical spine fractures or dislocations. 

• To immobilise the cervical spine and prevent spinal cord injury, or avoid further 

spinal cord injury. 

Risks and Precautions 

Risk Precaution 

Patients suffer further neurological 

damage. 

Keep collar on at all times. 

Maintain neck alignment. 

Use the following procedures when 

caring for these patients. 

If there are any changes in patient’s 

condition, notify the neurosurgeon 

immediately.

Resources 

Neurosurgeon 

Neurosurgical Registrar 

Senior Medical Officer 

Senior Registered Nurse 

Steps 

Procedure Rationale 

The procedure will usually be performed 

by the Neurosurgeon, in the Intensive 

Care Unit or in the Operating Theatre. It 

is performed under local anaesthetic, 

although light sedation may be required. 

The patient will need to be placed onto a 

“traction” bed, and informed consent 

must be obtained. After clipping the hair 

at the insertion site, the area is 

anaesthetised and a small cut made into 

the skin on both sides of the head 

(usually 4cms above the external 

auditory meatus). The Tongs are then 

screwed into place and traction applied 

as ordered by the Neurosurgeon. 

As previously mentioned, the patient 

must be transferred to a “traction” bed. 

This must be done using the Jordan 

Frame, registrar and four other people. 

The registrar will support the head and 

neck while two staff stabilise the frame 

while in the air, one staff to move out the 

ICU bed and replace it with the traction 

bed, and one staff to work the lifter. 

Once the tongs are in situ, care must be 

taken with the tongs. 

The pin sites should be cleaned with half 

strength Chlorhexidine/Normal Saline 

daily and left uncovered if dry If the pin 

sites are moist then cover them with dry 

gauze. 

The two “locking” nuts should be checked 

at least twice a day to ensure they are 

firmly screwed on. 

The spring-loaded pin on one side should 

be protruding 1 to 2 mm from the centre. 

This should be checked at least twice a 



Using the Jordan lifter is the safest way 

to move these patients. The registrar will 

support the neck to prevent movement 

that may cause spinal damage. 

This is to reduce the risk of infection. 

This is to prevent the tongs’ screws from 

loosening. 

This pin should be checked because if 

loose, could lead to the traction slipping 

and the tongs tearing the scalp. Also




day. If this pin is not protruding 1 to 2 mm traction will be lost leading potentially to 

then the tongs are too loose. 

spinal cord injury. 

The traction itself will be set up by either This to ensure the traction is set up 

the Neurosurgeon or senior 

correctly, and to reduce the risk of spinal 

Physiotherapist. The Neurosurgeon cord damage. 

should apply the initial weight to the 

traction. Any further modifications to the 

traction set up should be ordered and 

documented in the progress notes by the 

Neurosurgeon and carried out by either 

the Neurosurgeon himself, a senior 

Physiotherapist or by a senior member of 

the Nursing staff 

For simple cervical immobilisation 10lbs 

(4.5kg) of weight is usually sufficient. For 

reduction of fracture or dislocation, an 

initial weight of 10lbs is used and 

increments of 5lbs (2.2kg) are added. 

This will vary from patient to patient and 

will be ordered by the Neurosurgeon and 

documented in the progress notes 

Directly after the initial traction is applied, This is to check that the traction applied 

and between any addition of weight, the is correct for that patient, and that the 

cervical spine should be x-rayed and cervical is in the alignment required. 

careful assessment of the patient’s 

neurological status attended. 

Ensure the weight is hanging freely. To ensure the patient is receiving the 

correct traction that was order by the 

Neurosurgeon. 

Ensure the ropes are knotted firmly and This is to prevent the traction from 

ends taped. 

coming undone. 

Ensure counter-traction is applied (the 

entire bed may be tipped slightly) 

Ensure the angle of pull is as directed by The position of the pins and the direction 

the Neurosurgeon. 

of the pull will decide if the patient’s neck 

is in slight flexion or slight extension. 

More commonly the neck will be held in a 

neutral position. This will be determined 

by the Neurosurgeon. 

Patients having cervical traction placed, Spinal Shock represents loss of reflex, 

or who already have the traction in place motor, sensory and autonomic activity 

should be carefully monitored for below the level of the spinal cord injury. 

changes in motor or sensory function. The heart rate and blood pressure will fall 

and parts of the body below the level of 

the lesion are paralysed and without 

sensation. This can be assessed 

Motor function should be tested by Any change could mean dislodgement of


assessing strength and movement of all 

limbs, using the Nepean Hospital 

Neurological Observation Chart. 

Sensory function should be assessed by 

lightly pinching the patient’s skin, or 

lightly dabbing with ice, starting at the 

shoulder level and working down both 

sides of the extremities. Record the 

highest level of function on each side. 

Ask the patient to close their eyes during 

the examination. 

If there are any major changes in the 

previously mentioned observations, there 

should be immediate notification of the 

Neurosurgical team. If prompt 

assessment by the Neurosurgeon is not 

available call 42222 and ask for the 

Medical Emergency Team. 

Patients undergoing reduction of cervical 

fracture or dislocation can usually be 

lifted using a Jordan frame and lifter, with 

inline traction maintained. If the traction 

weight is removed then a cervical collar 

should be applied, the neck immobilised 

with sandbags, and manual traction 

maintained by a senior medical staff or 

senior registered nurse. Confirm with the 

neurosurgeon if this is appropriate for the 

patient. 

For patients whose cervical spine is 

simply being immobilised (i.e. a fracture 

is not being reduced) a hard collar can be 

applied, traction removed, and the patient 

can be log rolled or lifted on a Jordan 

frame in the standard way. Supervision 

by a senior medical officer or senior 

registered nurse is required. Confirm with 

the neurosurgeon if this is appropriate for 

the patient. 

Most patients in cervical traction can be 

safely log rolled without removing 

traction, but alignment of head, neck and 

body must be maintained. Supervision of 

this alignment should be undertaken by a 

senior medical officer or a senior 

registered nurse. Confirm with 

neurosurgeon if this is appropriate for the 



the traction and alignment of the neck, 

leading to neurological deficit. Using the 

chart standardises the assessments. 

Any change could mean dislodgement of 

the traction and alignment of the neck, 

leading to neurological deficit. 

Each side needs to be recorded, as there 

may be unilateral sensory function loss. 

Delay in assessing changes in a patient 

with a cervical spine fracture can lead to 

quadriplegia, respiratory and cardiac 

arrest. 

If the patient with a cervical spine fracture 

is moved in an unsafe manner, damage 

to the cervical spine and quadriplegia 

may result. 

If the patient whose cervical spine is 

being immobilised is moved in an unsafe 

manner, damage to the cervical spine 

and quadriplegia may result. 

If the patient whose cervical spine is 

being immobilised, is moved in an unsafe 

manner, damage to the cervical spine 

and quadriplegia may result.


patient. 

A “hard” collar of the correct size for the 

patient should be available at the bedside 

of every patient in cervical traction. 



If any movement of the patient is 

required, or any problems with the 

traction occur the hard collar is easily 

accessible to place on patient. 

References 

McCarthy, L. 1998 Safe handling of patients on cervical traction. Nursing Times 94, 

14, 57-59. 

Smeltzer, S.C., and Bare, B.G. 2000 Brunner and suddarth’s textbook of medicalsurgical 

nursing. 9 th ed, Lippincott, Philadelphia. 

Unit 14 “Neurologic Function” pages 1688-1694 

Cotler, J.M., Herbison, G.H., Nasuti, J.J., Ditunno, J.F., An, H. and Wolff, B.E. 1993. 

Closed reduction of traumatic spine dislocation using traction weights up to 140 

pounds. Spine. 18, 3, 386-390. 

Choo, J.H.N., Liu, W.Y. and Kumar, V.P. 1996. Complications from Gardner-Wells tongs. 

Injury 27, 7, 512-513. 

AUTHORISED BY A McLean, V McCartan 

COMMITTEE 

RESPONSIBLE 

ICU Management Committee 

DATE REVISED December 2004 

DATE EFFECTIVE December 2006 

REVIEW DATE December 2006

Care of Cranio-cervical Traction - Intensive Care & Coordination ...

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