Cervical Collars

Information for Patients, Families and Carers

For a video showing you or your carer how to manage your collar please visit: https://youtu.be/J5DxTm0TqgU
If you are a clinician or medical professional please visit: https://youtu.be/XMkWDmjJf7w

What is the purpose of the collar?

A hard collar is a device designed to maintain the alignment of your neck and limit movement of your neck. It supports the spinal column and other supporting structures such as ligaments and muscles from loads and stresses that can cause pain and movement of the neck bones. It is designed to support your neck while the ligaments and bones heal.

The collar will maintain your neck in the proper position while it is healing. Not being able to turn or shake your head may seem unusual, but limiting the motion of your neck is an important part of your treatment and will prevent further damage.

It is most commonly used to manage spinal fractures but can also be used for other reasons, such as supporting the neck after surgery.

How long will I need to wear it?

You are advised to wear your collar all of the time, day and night. The length of time you have to wear your collar will depend on your injury and the time it takes for the ligaments and bones to heal.

When you leave hospital you will be given an appointment to see your consultant in the outpatient department to review your progress.

If you have not received an appointment then please contact the ward.

Please continue to wear the collar unless advised otherwise by your consultant.

Wearing the collar

The collar should be tight but comfortable. If the collar is not on tight enough it will not support your injury and you may experience pain or risk further damage to your neck. If worn too loose it may also rub and can cause skin soreness and irritation.

The collar should be kept on at all times throughout the day and night unless you have received different instructions from your nurse, physiotherapist or consultant.

It should be removed at least 3 times a week for checking your skin and exchanging the pads for clean ones. You should wash around the collar daily.

You will need assistance of 2 people to do this and you should not remove the collar yourself.

You may sleep with one single pillow underneath to support the neck and prevent pressure damage.

The collar will only limit movement within your neck, not eliminate it completely. It is important that you monitor your posture to prevent slouching, and avoid any heavy lifting and carrying.

The pads within the collar are removable and can be hand washed. They should be fully dry prior to wearing them and the collar should not be worn without them.

Bathing and showering are not permitted unless you are given special instruction from your consultant.

If you feel you may need guidance with washing and dressing, please discuss this with the Occupational Therapist on the ward prior to your discharge.

The collar will restrict your ability to move freely and see your feet. Using an armchair may be easier to stand/ sit down and will put less strain on your neck. Take care when walking and when going down the stairs.

Remove things that may cause you to fall, such as rugs and electrical cords. Use nonslip bathmats, grab rails and a shower chair in your bathroom if you feel that this is necessary.

Arrange handy items so that they are easy to access, and tidy everything else away.

You should not drive a car until out of the collar. Avoid sitting in the front seat with an airbag.

You should postpone sexual activity until your follow up appointment unless your surgeon specifies otherwise.

Getting out of bed

When moving from a lying to standing position, use your arm and leg muscles to keep your body in proper alignment. Follow advice from your Physiotherapist about exercise.

Roll onto your side and swing your legs over the edge of the bed, whilst pushing up with your arms.

If you are sitting in preparation to stand please sit for a moment before standing to ensure you do not become dizzy.

Movement

Initially after your hospital admission your neck may be sore as you move; this may increase over the first couple of days but will then improve. You should aim to walk short distances little and often to ensure your muscles do not stiffen up.

Once you are home try to increase the distance you walk daily always paying attention to your posture.

How to fit the collar

There are many different types of collars that can be fitted depending on the type of your injury and your body size and shape.

An experienced healthcare professional will measure and fit you with the most suitable collar for your shape and size.

They will then teach you how to apply it and ensure that it fits correctly.

You will then be taught and monitored on your application of the collar.

You will be advised on the removal of the collar for washing, depending on your individual circumstances this maybe in the sitting or lying position. You will be advised on the most appropriate position for your condition.

You will also be taught how to take care of your collar and practice how to use the collar before you are discharged. Any problems or concerns you may have can be directed to the healthcare professional looking after you.

Starting position

You will need to lie on your bed, keeping your head in a neutral position, not turned to the side and looking straight up and place their arms by your side and keep your legs uncrossed.

The following instructions should be followed by the person supporting you.

1. Prepare the collar:

Roll the back panel like a hand towel, and the front panel bend the sides in. You can also bend the small tabs on the back panel, allowing it to form to your own body shape.

2. Position the back panel:

With one person stabilising the neck as shown below. Position the back panel under the crevice of the neck. Push down on the back panel with one hand and push it under the patient’s neck until the back panel is centred under the neck. When the back panel is in the correct position the ends of the Velcro straps should come to the same position on each side.

3. Position the front panel:

Flare sides of front panel outwards. Place the centre of the front panel in line with the centre of the chin, so that the collar is lying flush with the tip of the chin. Hold firmly in place with one hand on the front. Push the sides of the front panel up over the shoulder muscles and around the neck towards the ears.

4. Attaching the front panel:

While holding the front panel with one hand, attach the Velcro straps so that one side of the Velcro lies directly over the other side of the Velcro. Keeping your thumb hooked into the opening at the front, you can then tighten the Velcro one side at a time, ensuring you wrap the front panel around the side of the neck. Make sure it does not get caught on the window at the back. It is often easier to pull the back panel outwards then forwards to tighten.

5. Final Checks:

The chin should be flush with the end of collar chin piece. The nose and chin should be aligned vertically through the centre of the collar at the front. The back panel should be centred, check this by comparing where the ends of the Velcro straps lie. There should be no plastic parts of the collar in contact with the skin and ensure that there is an overlap of the collar lining. There should only be one finger width between the neck and collar behind the ear on each side. If there is more than one finger width then the collar will need tightening.

Managing the collar

When you leave hospital you will have at least one complete hard collar and two sets of soft collar linings.

Washing the soft foam pads

Proper cleaning of the collar pads will help prevent rashes and skin irritation.

You will be provided with an extra set of pads to allow clean pads to be interchanged.

Remove the collar and pads as shown above and wash the pads with mild hand soap and water.

Lay the pads on a clean, dry towel and gently pat out the moisture and leave to air dry.

The pads are then reattached to the collar with Velcro and adjusted as needed to make sure that no plastic touches the skin.

Pressure Areas

It is known that cervical collars can cause pressure sores or ulcers. Wearing a collar increases local skin temperature and can cause excess skin perspiration in and around the area. Constant moisture can cause skin breakdown.

In patients with moist skin, skin breakdown is increased, compared to those with dry skin.

Common areas that are at risk of rubbing or pinching include the bottom of the ear and skin on top of the shoulders, where the two halves of the collar overlap.

To prevent pressure ulcers the following precautions need to be taken:

• Keep the skin clean, dry and cool
• Remove the collar; inspect the skin regularly particularly at the bony prominences. The usual pressure points are chin, collar bone, ear lobes and back of the head
• Maintain good hygiene under the collar. Clean the skin under the collar daily, wash with warm soapy water and dry thoroughly. Do not apply powder or lotions
• Change pads if they become wet.

If you have any concerns regarding your skin integrity then contact your GP or practice nurse immediately.

What happens next?

If you experience any of the following please seek medical help.

• Severe neck pain
• Weakness, tingling or loss of feeling in your face, arms or legs
• Loss of bowel or bladder function
• Broken skin areas/ pressure sores
• If the collar breaks or is damaged in anyway.

Contact the ward you were on for advice on the contact numbers provided.

Useful contacts:

Doncaster Royal Infirmary: 01302 366666
Orthotics department: 01302 644217
Physiotherapy: 01302 644209
Occupational Therapy: 01302 644209

Patient Advice & Liaison Service (PALS)

The team are available to help with any concerns, complaints or questions you may have about your experience at the Trust. Their office is in the Main Foyer (Gate 4) of Doncaster Royal Infirmary. Contact can be made either in person, by telephone or email.

The contact details are:

Telephone: 01302 642764 or 0800 028 8059
Email: dbth.pals.dbh@nhs.net

Images provided by Össur