Skeletal traction and pin site care

Daytonite, BSN, RN · Nov 2, 2008

skeletal traction exerts a pulling force on the spine, pelvis or long bones to reduce a fracture, correct a deformity, correct a contracture or decrease muscle spasms. skeletal traction involves inserting a pin or wire through a bone so that weight can be applied to the end of the bone.

https://allnurses.com/forums/f205/open-closed-reduction-220690.html - open and closed reduction

care of the patient in skeletal traction (page 313, nurse's 5-minute clinical consult: procedures from lippincott williams & wilkins)

"show the patient how much movement he's allowed and instruct him not to adjust equipment.
tell the patient to report any pain or pressure from traction equipment
at least once per shift, make sure traction equipment connections are tight.
check for impingements, such as ropes getting caught between pulleys.
inspect equipment to assure correct alignment.
inspect the ropes for fraying.
make sure ropes are positioned properly in the pulley track.
make sure all rope ends are taped above the knot.
inspect traction weights regularly to make sure they hang freely. weights that touch the floor, bed, or each other reduce traction.
about every 2 hours, check the patient for proper body alignment and reposition as needed.
assess neurovascular integrity based on the patient's condition, hospital routine, and practitioner's orders.
provide skin care, encourage coughing and deep-breathing exercises, and assist with ordered range-of-motion exercises for unaffected extremities.
apply elastic support stockings, if ordered.
check elimination patterns and provide laxatives, as ordered.
for a skeletal traction patient, make sure protruding pin or wire ends are covered with cork.
check pin sites and surrounding skin regularly for signs of infection.
special considerations:
- if the ropes break, arrange weights so they don't hang over the patient.
- placing a flat pillow under the extremity may help as long as it doesn't alter the line of pull
[*]teaching:
- explain the procedure and why it is needed.
- teach the patient diversional activities within the limits of the traction.
- reinforce the need for bed exercises to prevent muscle deterioration in unaffected extremities.
[*]document:
- the amount of traction weight used daily.
- note the application of additional weights and the patient's tolerance.
- document equipment inspections.
- record routine checks of neurovascular integrity.
- note skin condition.
- document respiratory status.
- record elimination patterns.
- note condition of the pin site(s) and care given."

on pin care (page 313, nurse's 5-minute clinical consult: procedures from lippincott williams & wilkins)

"using sterile technique, put on gloves
clean pin site and surrounding skin with cotton-tipped applicator dipped in ordered antiseptic.
apply antimicrobial ointment to pin sites, if ordered."

some other things that were addressed in nurse's 5-minute clinical consult: treatments from lippincott williams & wilkins, page 374-375

"pads, slings, or pushers may be used with traction.
emphasize (with patient) the importance of maintaining proper body alignment after traction equipment is set up.
administer medications as ordered.
provide comfort measures.
provide meticulous skin care.
monitor vital signs.
monitor intake and output.
monitor for complications of immobility:
- pressure ulcers
- muscle atrophy
- contractures
- urinary stasis and calculi
- pneumonia
- thrombophlebitis
- depression
[*]teaching:
- show the patient how to use the overhead trapeze to reposition without injury.
- review the signs and symptoms of infection with the patient and his family."