Critical Procedure - Pelvic binder application

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For all procedures, ask yourself, 'does this need to be done 'now vs later'? And should this be done by 'me vs someone else?' Very often the answers will be 'now' and 'me' - so read on!

Pelvic binder application


Description

How to apply a pelvic binder for suspected fractured pelvis.

Indications

Absolute:

  • The haemodynamically unstable patient with a mechanically unstable pelvis.
  • The haemodynamically unstable patient with a suspected pelvic fracture.

Relative:

  • Haemodynamically normal patients with unstable pelvic fractures, for pain control and reducing movement during transfers.

Contraindications

Relative:

  • open wound of pelvis that the binder might prevent from being packed/managed.

Equipment

Commercial pelvic binder such as the SAM Sling, a neoprene belt or the Pelvigrip - if you have one of these, follow the instructions.
Improvised - bed sheet (or similar), KED or vacuum mattress.

Procedure

pelvic binder imageCommercial pelvic binder - follow the manufacturers instructions.

Improvised.  Tie a bed sheet (or similar) around the greater trocanters.  Apply firm, but not over-tight, force.  You are aiming for consistent, firm inwward pressure but not to overly compress the pelvis.

Altenatives include using a KED (Kendrick Extraction Device) or a vacuum mattress, firmly secured

Potential pitfalls

Not applying the binder early - haemostasis is paramount.
Binder applied too tightly or not tight enough.
The creation of pressure areas that could cause necrosis.
Insecure fastening of the binder.
Delaying the application of a pelvic binder in favour of awaiting external fixator application (pelvic binders work as well as external fixators).
Regarding the pelvis as fully stable once the binder is applied - this is incorrect and log rolls or other moves that stress the pelvis, should be avoided if possible.

"Plan B"

Be prepared to re-fix the pelvic binder if it becomes loose.
Think about accessing blood transfusion capability.
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Last modified: Thursday, 3 March 2016, 10:16 PM