Atlas collar

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide staff on fitting and applying Atlas collars in children.

General

Atlas collars are an orthotic device that assists in immobilising the cervical vertebra by maintaining the patient’s head in a neutral position, whilst at the same time promoting patient comfort.

The application and removal of the Atlas collar (or other immobilising orthotic device) has the potential to render the cervical spine unstable and as such should only be performed by appropriately trained staff as per the guidelines set out below.

Indications

Full spinal precautions are implemented for patients with a suspected spinal injury until further orders are documented in the progress notes by the appropriate medical staff.

The initial care of a patient with an actual or potential spinal injury is to stabilise the spine and prevent further neurological injury by maintaining straight alignment of the vertebrae.

Preparation

Staff

Initial Sizing and application of the Atlas collar (+/- removal of the transport immobilisation device) is to be attended only by:

  • Orthopaedic Registrar or Consultant
  • Appropriately trained Emergency Department Medical and Nursing Staff
  • A trained Orthotist after a referral for a collar has been completed.

Subsequent re-sizing of Atlas Collar to be attended by:

  • Orthopaedic Registrar or Consultant
  • Appropriately trained Emergency Department Medical and Nursing Staff
  • A trained Orthotist after  a referral for a collar has been completed

Changing of an Atlas Collar (without changing the size of the collar) to be attended by:

  • Appropriately trained Nursing Staff to ensure hygiene and skin integrity are maintained. This would usually be done on the ward but may also need to be attended to in the Emergency Department.

Sizing and application of a soft collar to be attended by:

  • Appropriately trained Nursing Staff upon the written request of the Orthopaedic Team

Cessation of Cervical Immobilisation therapy to be attended by:

  • Nursing staff upon the written request of the Orthopaedic Team

Procedure

Positioning and technique

The correct sizing of the Atlas Collar is important for effective immobilisation and patient comfort. The patient’s head is to be maintained in a neutral alignment at all times.

Measuring using the Atlas Collar Sizing Guide (recommended method)

Children < 1 to 5+ years

Refer to the Atlas Collar Sizing Guide and select the appropriate size collar.

 Age Size Colour  Atlas collar sizing chart
 <1 year
 Infant Short
 White
 <1 year
 Infant Regular
 Black
 1 – 3 years
 Child Tot
 Grey
 3 – 5 years
 Child Short
 Pink
 Over 5 years
 Child Regular
 Aqua

Older children and teenagers

Experience has shown that the Child Regular collar is suitable for many older children. The method described below (i.e. using the Atlas collar sizing guide) may be helpful in sizing a collar for taller children and teenagers.

While maintaining manual in-line stabilisation and ensuring the patient’s head and neck are in the neutral position, place the Atlas collar sizing guide card on the highest point of the trapezius. Sight an imaginary perpendicular line from the lowest point of the chin back to the guide and select the appropriate size collar. As per instructions on the card. 

Atlas collar sizing guide

Alternative sizing method (older children and teenagers)

Height: while maintaining manual in-line stabilisation and ensuring the patient’s head and neck are in the neutral position, measure the vertical distance from the highest point of the trapezius to the lowest point of the chin. This measurement corresponds to the height of the collar. If the patient’s measurement falls between two consecutive sizes, apply the smaller size first.
Size  Colour Height
 Adult X-Short  Purple  1.5"
 Adult Short  Blue  2.25"
 Adult Regular  Orange  3"
 Adult Tall  Green  3.75"
 Adult X-Tall  Yellow  4.5"

Application of the Atlas Collar

  • The Atlas collar is a two-piece design consisting of a front and a back piece (packaged as a set, labelled front and back). Two people will be required:  the first person to provide cervical spine immobilisation and a second person who is competent in fitting and positioning the collar.
  • When applying the collar, always maintain the patient’s head in a neutral position. The first person will be required to manually stabilise the patient’s neck with a head hold:
    • Ensure the patient is lying in a supine position, arms by their side and head in a neutral position.
    • Ensure the bed is at the correct height for the person holding the head.
    • Hands are placed on lateral portions of the patient’s head, fingers spread around the mandible and back of neck, and thumbs on the patient’s cheek. (Emergency Department use only)
    • The forearm is used to stabilise the lateral aspect of the head.
  • Firm pressure must be applied to restrict possible neck movement.
  • The second person applies the collar:
    • Gently slide the back of the collar under the patient’s neck (press gently on the mattress to create more room to manoeuvre the collar).
    • Centre the back of the collar under the patient’s neck, ensuring the Velcro straps are above the shoulders.
    • Apply the front of the collar using a sweeping, upward motion from the sternum, ensuring the collar is centred below the chin.
    • Wrap the wings of the collar around the patients neck so the collar conforms to the patient’s neck
    • Hold the front piece of the collar in one hand while applying the Velcro straps. Ensure central placement with the front half of the collar overlapping the back half. 
    • Always maintain neck stabilisation whilst positioning and securing the front of the collar.

Post-procedure

  • Confirm success
  • Following placement of the Atlas collar, ensure the patient’s neck is in correct alignment.
  • The Atlas collar should sit comfortably below the chin and ears.

Aftercare

  • Removing an Atlas Collar (for example, to attend to pressure injury management or fitting / changing of the collar) requires two people:
    • Ensure the patient is supine.
    • The first person holds the patient’s head and maintains neck stabilisation to allow the second person to undo the velcro and remove the front half of the collar
    • The second person gently slides the back half of the collar out from under the patient’s neck (press gently on the mattress to create more room to manoeuvre the collar).
    • The first person must always maintain neck stabilisation whilst the new collar is applied.

Bibliography

  1. Ossur-Library, How to fit a collar: https://assets.ossur.com/library/36202/Miami%20Jr%20Sizing%20and%20application%20instructions.pdf (external link)


Endorsed by:  Director, Emergency Department  Date:  Jan 2018


 Review date:   Jan 2021


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