[marcibz123]

looking for standards of care for pin care in external fixators. can anyone help?

[jenksb]

I have seen pin site care done a few different ways. I was taught to cleanse around the pin site with a solution of half peroxide and half sterile normal saline, using a new sterile cotton tipped applicator for each pin site. Then rinse each site with sterile normal saline on a separate sterile cotton tipped applicator. Allow the sites to dry. Some prefer to cleanse the site with sterile normal saline only. I have read in some sources that no oinment should be applied to the sites, although many physicians still prefer to have antibiotic ointment or betadine ointment applied around the pin sites. Cover with sterile gauze sponges. Pin site care should be done daily or BID and prn if they have drainage.

It is my experience that each doctor has their own preference. I would recommend that you ask the docs at your facility what they recommend. If they have varying opinions, they may want to write out their own pin site care orders for each patient rather than having one method used for every patient.

[truern]

After six months on an ortho floor, I can do pin care in my sleep

Using half strength hydrogen peroxide and sterile saline, cleanse around each pin with sterile cotton tipped applicators. If there's alot of gunk, use a damp sterile gauze 2X2 to scrub gently to remove it. Rinse around each pin with sterile saline, again using sterile c-t applicators. Apply sterile vaseline gauze, making sure to have contact with pin and skin.

[alyca]

I am in the process of working with some other nurses and educators in my trauma hospital to make a pin care guideline. We are starting a study that will hopefully be published in the next year or so. Reviews of the literature available out there show that there are a huge variety of ways to do pin care, and no clear answer as to which is best at preventing pin site infections. Our old standard was the 1/2 NS and 1/2 peroxide mixture with sterile QTips, then a 4x4 gauze wrapped around as a barrier afterwards, done twice a day. Other ways to do this are to use just saline, or chlorhexidine, or to do nothing at all. Some studies indicate that doing NO pin care can actually DECREASE the risk of infection, as compared to peroxide, etc. But.....nothing is conclusive (and therefore we are starting a study). We get TONS of ex-fixes here, and mostly only have infection issues if they are the thigh pins in spanning ones or pelvic pins, especially on bigger patients.

So....my answer is that there IS NO tried and true PROVEN method that is best, and it is mostly MD specific as to what you want to do. Although, our MD's generally just write "pin care BID' and let us figure out what to do with that...........

[milly]

dont know if its much good, but i had two ex fixes myself, and i had them in for 13 months, i was taught to shower ever day with it, cleanse each pinsite with a cotton wool swab with normal boiled water allow to dry. and part of my physio was to swim with my fixator, and in the13 months i only got 2 very mild infections which cleared up in a few days.............

[P_RN]

http://www.orthonurse.org/images/PDF/PinCare2005.pdf
The national association for orthopaedic nurses (naon) has published their study. This is the Gold Standard of pin care.

[RoxannMM]

I myself have had external fixators. Let me say what a treat. I was probably 13 years old when I had my OREF. I was born with a disorder called hpyophosphatemic ricket which caused me to have bowed legs. So I had them "staighten." Pin care after a while had become very routine. In the hospital we used sterile saline with cotton tipped applicator. We also used I think it was called "ZEROFORM" it was like a gauze material coated in ABX onitment, It worked great to help the healing process. AT home we used hydrogen peroxide for daily pin care. The thing I like the most about the fixators was at home I was able to get a bath and merge the fixator in water. This probably is standard care but it worked for me.


I hope to be able to apply my knowledge of it when I start as a GN on an ORTHO unit June 5th