• The nurse needs to be knowledgeable about the anatomy and physiology of the spinal column, the special anatomy of the cervical vertebrae, the spinal cord, the cervical spinal nerves, and their areas of peripheral innervation. In addition, the nurse must understand the pathophysiology and manifestations of spinal cord injury, including the concepts of primary and secondary spinal cord injury and spinal shock.

• The nurse needs to be knowledgeable of the signs and symptoms of new spinal cord injury or extension of recent spinal cord injury, including impairment of motor and sensory function, respiratory function, and autonomic nervous system function that results in loss of vasomotor tone.

• The nurse needs to be knowledgeable of treatment options available to manage cervical injuries, including cervical spine traction with tongs or a halo ring. Tongs consist of a body with one pin attached at each end (see Fig. 97-2). Tong pins are applied to the outer table of the cranium on both sides of the skull.³ A halo ring device is also used for management of cervical injuries. This device is a graphite ring that is attached to the skull with four stabilizing pins (two anterior and two posterolateral; see Fig. 98-1). The pins are threaded through holes in the ring, screwed into the outer table of the skull, and locked into place. This device can be attached to traction or vest struts/posts.²

• Once inserted, the cervical device (tongs or halo ring) requires special care of the skin at the pin insertion sites (pin site care) to prevent and monitor for infection. Because the pins are inserted through the skin and into the bone, local infections can develop and proliferate and may result in cranial osteomyelitis. Loosening of the pins may also occur.3–6

• Various cleansing agents for pin site care have been used, including, but not limited to, 2% chlorehexidene solution, hydrogen peroxide, sterile normal saline solution, antibacterial soap and water, alcohol, and povidone-iodine. None have been found superior.^5,7–10

• Generally, pin sites do not require a dressing unless excessive drainage occurs at the site.

• Pin sites should be inspected for infection, although the frequency of this inspection has not been clearly identified. Definitive guidelines for the frequency of pin site care, cleansing agents, removal of crust, and the application of dressings have not been established and depend on institutional policies.^7,