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TRACTION

TRACTION

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Published by: api-3822433 on Nov 26, 2009
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03/18/2014

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TRACTION
1. TRACTION

a. the application of a pulling force to a part of the body
b. used to minimize muscle spasms
c. to reduce, align, and immobilize fractures
d. to reduce deformity
e. to increase space between opposing surfaces \u2013 for someone w/lower back pain
f. prevent soft tissue damage \u2013 a broken bone or slipped disc impinging upon soft tissue &/or nerves
g. can be applied in more than 1 direction \u2013 when this is done, one of the lines counteracts the other
h. the effects of traction are evaluated w/x-rays
i. used for short-term intervention

2. PRINCIPLES

a.coun tert rac tion must be used to achieve effective traction \u2013 this is the force acting in opposite direction
b. usually the person\u2019s body weight and bed position adjustments supply the needed countertraction
c. traction must be continuous to be effective
d. SKELETAL traction is never interrupted
e. weights are not removed unless intermittent traction is ordered
f. Factors affecting the pull

1. patient must be in good body alignment in the CENTER of the bed when traction is applied
2. ropes must be unobstructed
3. weights must hang free and not rest on bed or floor
4. knots in rope or the footplate must not touch the pulley or foot of bed

3. TYPES OF TRACTION
a. Straight or Running traction \u2013 applies the pulling force in a straight line w/body part resting on bed (Buck\u2019s Traction)
b. Balanced Suspension traction \u2013 supports the affected extremity off the bed, and allows for some patient movement

without disruption of the line of pull
4. METHODS OF TRACTION
a. Skin traction
b. Skeletal traction
5. SKIN TRACTION

a. used to control muscle spasms and to immobilize an area before surgery b. a weight is used to pull on traction tape or a foam boot attached to the skin c. amount of weight applied must not exceed tolerance of skin (duh!)

1. 4.5 - 7 lbs \u2013 extremity (book says 4.5-8)
2. 10-20 lbs \u2013 pelvic traction \u2013 depends on pt\u2019s weight
d. Examples

1.Cervical head halter
a. used to treat neck, shoulders, upper arm, fingers pain & numbness
b. C 4,5,6 \u2013 most common area of cervix
c. Look for pressure points
d. teach patient about pressure points

2. Pelvic Belt
a. to treat back pain
b. intermittent pelvic sling which releases back, hip, and leg pain

3.Buck\u2019s Traction \u2013 lower leg
a. used BEFORE surgical fixation
b. inspect skin for abrasions and circulatory problems before applying boot
c. clean and dry
d. To Apply \u2013 one nurse elevates and supports the extremity under the patient\u2019s heel and knee while

another nurse places the foam boot under the leg, with the heel down into the boot. Velcro

straps around the leg.
e. Traction tape overwrapped w/elastic bandage in a spiral fashion may be used instead of boot
f. avoid excessive pressure over malleolus, fibula \u2013 prevents ulcers, nerve damage
g. pass the rope affixed to the spreader or footplate over pulley fastened to the end of the bed \u2013 attach

weight \u2013 usually 3-5 lbs
h. NO HOB \u2191 - flat \u2013 no big pillows under leg either
e. This is an intermittent traction \u2013 can take off to inspect and clean skin
f. Complications
1. skin breakdown

a. from irritation by contact of skin w/tape or foam & shearing forces
b. Elderly @ \u2191 Risk
c. identify sensitive, fragile skin during the initial assessment
d. closely monitor for reaction
e. remove boots to inspect skin, ankle, Achilles tendon 3/day \u2013 A second nurse is needed to support

the extremity during inspection and skin care f. palpate area under traction tape for skin tenderness g. provide back care q 2 hrs \u2013 prevents pressure ulcers

2. nerve pressure
a. from pressure on peripheral nerves
b.Footdrop if pressure is applied to peroneal nerve at point at which it passes around the neck of the

fibula, just below the knee
c. question patient about sensation
d. have patient move toes, foot
e.Dorsiflexing the foot \u2013 functioning peroneal nerve
f. Weakness of dorsiflex, or foot movement and inversion of foot \u2013 pressure on nerve
g.Plantar flextion \u2013 functioning tibial nerve
h. investigate c/o burning sensation under bandages or boot

i. Call DR!!
3. circulatory impairment

a. S&S - cold skin temp, \u2193 pulses, slow cap refill, bluish skin
b. assess circulation of foot or hand within 15-30 min after skin traction is applied
c. then assess q 1-2 hrs
d. active foot exercises q hour while awake

4. DVT \u2013 calf tenderness, swelling, + Homan\u2019s
g. Interventions
1. avoid wrinkling and slipping of the traction bandage
2. maintaincountertraction
3. proper positioning \u2013 leg in neutral position
4. no turning from side to side \u2013 can shift position slightly w/assistance
6. SKELETAL TRACTION

a. applied directly to the bone w/a metal pin or wire (Steinmann pin, Kirschner wire)
b. the pin is inserted into bone distal to fracture \u2013 avoiding nerves, BV, muscles, tendons, joints
c. Femur, Tibia, Cervical Spine fractures
d. Tongs applied to head \u2013 Gardner-Wells or Vinke tongs \u2013 for cervical spine fractures
e. 15-25 lbs \u2013 weights applied initially must overcome the shortening spasms \u2013 once muscles relax, the traction weight

is reduced
f. usually Balanced traction
g.Thomas splint w/Pearson attachment \u2013 fractures of femur \u2013 overbed frame is used
h. Russell\u2019s \u2013 fracture of tibia
i.Dunlop\u2019s \u2013 fracture of humerus, forearm, elbow
j.Halo vest \u2013 cervical neck problem \u2013 neck stays in alignment \u2013 can be mobile

k. Nursing Interventions

1. maintain effective traction
a. check to see if ropes are in wheel grooves
b. no fraying of ropes
c weights hang freely
d. knots in rope are secure
e. evaluate position of patient \u2013 slipping down in the bed results in ineffective traction
f.Never remove weights from skeletal traction \u2013 unless a life-threatening situation occurs

2. maintain position

a. maintain alignment of body
b. position foot to avoid Footdrop
c. foot can be supported w/ortho devices

3. prevent skin breakdown
a. check elbows \u2013 he may reposition himself w/elbows
b. check heels
c. encourage trapeze bar for moving
d. assess pressure points - Lower extremity traction apparatus, you need to check ischial tuberosity,

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