Miami J Collar

General

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 neutral alignment of the vertebrae.

Preparation

Staff

Initial sizing and application of the Miami J 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 the Miami J collar is 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 revision has been completed

Changing of a Miami J collar (without changing the size of the collar) is to be attended by:

• Appropriately trained nursing staff to perform a thorough skin inspection and 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
• Appropriately trained Emergency Department Medical and Nursing Staff once clinically cleared.

Procedure

Positioning and technique

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

If deciding between two consecutive sizes, try the smaller size first but use the largest size that fits comfortably and maintains desired treatment position.

Measuring using the Miami J Collar Sizing Guide

Refer to the Miami J & Miami JR Collar Sizing Guide Appendix 1 and the table below to select the appropriate size collar. 

Miami J collar size quick reference chart 

Application of the Miami J Collar

• When applying the collar, always maintain the patient’s head in a neutral position. Manually stabilise the patient’s neck with a head hold.
• To prevent pressure on the child’s chin or occiput and to maintain appropriate airway and cervical spine alignment, thoracic padding should be considered on supine patients aged under 8 years of age. Padding may be made from folded sheets / blankets but must be of appropriate height to offset the occipital prominence.
• Ensure the bed is at the correct height for the person holding the head.
• Ensure the patient is lying in a supine position, arms by their side and head in a neutral position. (i.e. nose in line with umbilicus). 
• 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. 
• Firm pressure must be applied to restrict possible neck movement.

Second person - Application of the collar

• Slide the back portion of the collar under the child’s neck and centre it, you may need to press gently on the mattress to create more room to manoeuvre the collar.  If log rolling the child, you may position the back of the collar before returning the child into the supine position. 
• Make sure that the blue padding does not fold away from the edge of the plastic. Long hair should be placed outside of the plastic. 
• Take the front piece and flare the sides out, slide it up the chest and scoop up under the chin.
• The sides of the front piece should be oriented up, off the shoulder and towards the ears.
• While holding the front securely, curl the ends snugly against the child’s neck. Place the front of the collar inside the back. Apply the Velcro straps, tightening one side at a time to an equal length on both sides. 
• Velcro straps must be aligned symmetrically and oriented “blue-on-blue” to the front adhesive sections. When the collar is correctly fit, there should be equal amounts of excess Velcro overhanging the front blue adhesive sections.
• Confirm a correct fit. Collar application must be secure to ensure proper fit. If the child can slip his/her chin inside the collar or turn their head from side to side, it is a clear indication that it is not correctly fitted. It is nearly impossible to fit a properly sized collar too tight!
• Perform a set of neurovascular observations immediately following collar application.
• Attend to pressure area care every 2 hours.

Changing the Miami J Collar

•  The Miami J collar may need to be removed to change the collar or the pads or for pressure injury prevention.
• 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.
• Use appropriately trained staff to perform a log roll to provide pressure care and for patient repositioning. (See Spinal Precautions – Clinical Practice Manual (internal WA Health only) ).