The cap change procedure is a sterile one; therefore, all individuals who are not essential to the procedure should be asked to wait outside the room. The patient’s recent head injury makes the Trendelenburg position, which is standard for this procedure, contraindicated. The patient’s head should also not be turned for this same reason. The patient should perform a Valsalva maneuver prior to the cap being removed, if able. Taking a deep breath during cap removal places the patient at risk for air entrainment.