Introduction

A halo vest is a metal brace that assists in stabilizing the cervical spine. Typically prescribed for patients with neck fractures or dislocation of the cervical spine, the halo vest helps stabilize the cervical spine as it heals over an 8-to-12-week period of time. Nursing care is important for this patient population due to the risk for infection, skin breakdown, and cervical spine injury. Safety considerations and patient and caregiver education should be a top priority as the nurse cares for this patient (1).

Indications For Use

The halo vest can be ordered for various patient diagnoses and medical concerns. It is commonly used for gross stability, post-op stabilization of the cervical vertebrae, or to support an unstable cervical spine after a fracture. Most commonly used after a neck fracture or dislocation, the halo vest is worn for 8 to 12 weeks. The halo vest ensures the range of motion of the cervical spine is limited to allow for healing (2). 

Nursing Care

The halo vest requires appropriate nursing care. With three areas of concern in mind, the nurse caring for a patient with a halo vest should pay special attention to the skin under the vest and on the coccyx, as well as appropriate pin care. Finally, the nurse should be aware of and support the attachment of the halo vest wrench (3).

Skin breakdown under the vest may occur because of the ongoing use of the vest. Additional pressure from the vest applies at the waist and shoulder where the straps attach. Similarly, the nurse should be mindful of potential skin breakdown on the coccyx, as patients with the halo vest may be more inclined to sit or lie during the day during their healing period. To prevent skin breakdown under the vest and at the coccyx, the nurse should conduct regular skin assessments, as well as educate the patient on the importance of keeping the skin clean and dry. The nurse should also provide education regarding changing positions at least every 2 hours to reduce pressure injuries or using a seat cushion to relieve pressure from the added weight of the halo vest on the coccyx (3).

Pin care is also important, as the pins are screwed directly into the patient’s skull. These pins can be a point of access for infection to occur and enter the patient’s bloodstream, putting patients at risk for sepsis in severe cases. Proper pin care also prevents skin breakdown at the site of insertion. Using a 1:2 peroxide to saline solution mix, pins should be cleaned at least once daily. Do not apply antibiotic or antiseptic ointments unless ordered by the provider. Proper documentation of pin care ensures that the once-daily cleaning is occurring, and the site is monitored closely for skin breakdown or infection (3).

Lastly, the nurse should check regularly that the vest wrench is attached to the front of the vest in case of an emergency. The wrench can tighten or loosen the components of the vest to ensure the proper support of the cervical spine. This assessment should also be documented daily (3).

Safety Considerations

In addition to keeping the skin clean and dry, regular pin care to prevent infection, and always having the wrench available, there are some additional safety considerations the nurse should be aware of (2):

• The rods should not be twisted or pulled.
• The patient should not bend or twist their neck.
• The vest and pins should not be loosened by anyone besides a medical professional with a provider’s order to do so.
• The patients should limit their physical activity, including not lifting anything weighing more than 5 pounds.
• The patient should avoid crowds to prevent accidental hitting, pulling, or twisting of the halo vest.
• Proper body mechanisms should be followed, including avoiding bending over at the waist.
• Lastly, patients should not complete activities that put pressure on the neck.

Because of the risk associated with spinal cord injuries, the patient should be educated on the importance of reporting concerning signs and symptoms of worsening or progressing disease.  Patients should be advised to contact their provider immediately if (2):

• Pain does not go away.
• Sensation changes or worsens, such as numbness or tingling.
• Decreased range of motion in the arms or legs
• Feeling the need to adjust the vest or pins.
• Loosening of the pins
• Any neck movement
• Redness, swelling, or drainage at the pin site or under the vest.
• Any “clicking” sensation with movement.
• A burning sensation when cleaning under the vest with rubbing alcohol

Patient and Family Education

It is important to equip the patient with proper education and resources about their medical condition. In addition to education about skin breakdown, pin care, proper storage, and access to the wrench, safety considerations, and reporting to the provider, below are additional items of education (2):

Care at Home 

Home care instructions include (4):

• It may be painful for the first few days after placement.
  • May experience soreness in the neck and back.
  • Some experience pain in the forehead when chewing or yawning.
  • Pain medication will be prescribed for patients after placement.
• Patients may tire easily.
  • Should take regular breaks and rest periods throughout the day.
• Patients will feel top-heavy
  • May need time to adjust.
  • Patients should be advised to maintain spatial awareness.
• Never scratch under the vest with a hard object; use a thin towel instead.

Diet 

Dietary instructions include (2):

• It is important for patients to maintain their weight during the use of halo vests.
  • Any weight loss or weight gain may reduce the proper fitting of the vest.
  • Weight gain can cause additional pressure to the spine, chest, and pressure points.
• May have difficulty swallowing.
  • Eat in an upright position.
  • Cut food into small pieces.
  • Eat small bites.
  • Chew food well.

Clothing and Shoes 

Instructions regarding clothing include (2):

• No clothing under the vest
  • For patients wanting to wear bras, speak with the provider first.
• Wear clothing with full-length zippers or buttons and Velcro straps.
• Larger than normal neck sizes
  • To fit around the halo vest
• Use a scarf around the head, neck, and ears.
  • For warmth, wind, or sun protection.

Instructions regarding shoes include (2):

• Wear shoes with appropriate traction/grip.
• Do not wear high heels.

Sleeping 

Sleeping instructions include (2):

• Do not sleep on your stomach.
• Put a rolled pillow or other support at the nape of the neck.
  • Or on the side of the neck for side sleepers
  • Should support neck, no pressure applied.
• Elevate the head of the bed or use a wedge.

Getting In and Out of Bed 

Instructions for getting out of bed include (2):

• Lie on your back with both knees bent.
• Bring your arms toward the edge of the bed.
• Drop your legs off the bed.
• With your arms, push your torso up to a sitting position.

Instructions for getting into bed include (2):

• Sit back on the bed.
• Lean to the side and lower your trunk to the bed.
• Lift both legs off the floor onto the bed.
• Roll onto your back.

Transportation 

Instructions regarding transportation include (2):

• Do not operate heavy machinery, bicycles, or other vehicles.
• Always wear a seatbelt

Instructions for getting in and out of a car (2):

• Back into the seat, bending slightly forward at the waist.
• Pivot hips and move legs into the car until facing forward.

Instructions for exiting a car (2):

• Turn and place your feet on the ground outside the car door.
• Slightly bend forward at the waist and move into a standing position.

Bathing 

Instructions for bathing include (2):

• Do not shower; sponge bathe instead.
• Cleaning under the vest:
• Roll up the thin towel, dampen it with water and rubbing alcohol.
  • Feed the towel under the vest.
  • Pull the ends of the towel back and forth.
• Do not use powder or soap.

Instructions for washing hair (4):

• Wait until the provider gives permission to wash hair.
• Bend over the sink, and use a handheld pitcher to rinse hair.
• No tints, dyes, sprays, or conditioners in hair.

Other Activities 

Instructions for sexual intercourse include (2):

• Speak with the provider first.
• Avoid positions that put stress or pressure on the halo vest.
• Avoid pushing or pulling on the rod.

Instructions for school and work (2):

• Speak with the provider before returning to school or work.
• Ensure proper setup at work or school.
• Keep the computer screen at eye level.
• Support arms and elbows at a 90-degree angle.
• Raise the writing surface if needed.

Removal of Halo Vest 

Instructions for removal of halo vest (4):

• This will occur after X-rays indicate that healing is complete and the provider orders removal.
• May feel lightheaded and dizzy upon removal.
• The neck muscles may be weak, so use the cervical collar for support.
• Timeline to return to normal activities.

Conclusion

Appropriate nursing care for a patient with a halo vest is important to ensure cervical spine healing, prevent infection, and reduce skin breakdown. The nurse caring for this patient should expect to assist patients for 8-12 weeks. During this time, the nurse should place priority on educating the patient and the patient’s family or caregivers on the appropriate care of the halo vest and pins. Through proper education and resources provided, the patient can heal and return to their normal activities of daily living.