Positioning craniectomy patient

[bostongirl128]

Hi, just thought I would give this a shot and ask if anyone has any tips or suggestions. I have a patient that was in a car accident with a traumatic brain injury and had the left half of her skull removed to relieve pressure and swelling. She is going to have the portion of skull put back in place in a few weeks however, in the mean time, it's been super difficult to position her in bed because she naturally leans her head to that side. We have tried positioning pillows and foam objects around her neck to try and get her from leaning on that side. Keep in mind this patient is in a semi-conscious state and has a trachestomy so positioning is also difficult while trying to maintain her airway.

Any helpful positioning tips would be greatly appreciated!!!

[guest769224]

Are you monitoring ICP's?

General guideline, if ICP's are >20, then you need to keep body in full alignment, use pillows, wedges, and rolled towels to keep trouble areas in their place. If ICP's are controlled, it's usually not as important to keep the patients whole body straight.

You might also try asking for some sedation if regular interventions don't work.

[AJJKRN]

At my hospital on the trauma Med-Surg floor we get these pts out of the ICU without any ICU/ICP monitoring.

Usually the patient has a helmet fitted to protect the crani side until the skull is replaced/healed that is used at anytime the patient is out of bed (like trying to work with physical therapy) or going to be on that side or is just having really active/sporadic movements.

Best to just try and not position to affected side if at all possible and curious if getting a specially-fitted helmet would help ease your concerns.

As far as ICP monitoring on a Med-Surg floor it's kinda like watching a baby's fontanel. If it's bulging = probably not good, if it's sunken in = probably not good...if they're vomiting = again probably not good. Having a wide pulse pressure, irregular breathing, and bradycardia = definitely not good!