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RETURN DEMO FORMAT :

1) DEFINITION OF TRACTION

 TRACTION IS AN ACT OF PULLINGOR DRAWING WHICH IS ASSOCIATED WITH

COUNTERTRACTION.

 TRACTION MEANS THAT A PULLING FORCE IS APPLIED TO A PART OF THE BODY OR AN

EXTREMITY WHILE A COUNTERTRACTION PULLS IN THE OPPOSITE DIRECTION.

2) PURPOSES FOR INDICATION OF TRACTION

 To maintain good body alignment

 To lessen muscle pain and spasm

 To reduce fracture

 To prevent and correct deformity

 To provide support

 To provide immobilization

3) PARTS OF AN ORTHOPEDIC BED

 Balkan frame with firm mattress and different bars

 Fracture board

 2 horizontal bars

 1 diagonal bar

 4 vertical bars

 2 straight or cross bars

 1 curve bar

 3 pulleys- that is the 1st pulley is in line with the inguinal area

the 2nd pulley is line with the patient’s knee

the 3rd pulley in line with the 1st and 2nd pulley

 overhead trapeze

4) TRACTION EQUIPMENTS :

 Steinmann’s pin holder

 Steinmann’s pin

 Thomas splint where thigh is placed; half ring for the lower extremities

Full ring for the upper extremities

 Brown splint

 Pearson’s attachment – where leg is placed

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 Rest splint

 Screws

 Foot board to prevent foot drop

 Paper clips to substitute for safety pins

 5 slings for adult, and 4 if used for children

2 long slings – thigh and 3 short slings - leg

 3 ropes - the shortest will be your thigh rope

The longer one will be your traction rope

The longest will be your suspension rope

 2 weight bags

Heavier bag – traction weight - 10% of body weight

Suspension weight – 50% of traction weight

5) ACTUAL APPLICATION WITH PREPARATORY PHASE :

 Verify doctor’s order regarding affected extremity – Right or Left

And weights to be used, traction and suspension

 Explain procedure to reduce anxiety, and to gain the client’s trust and cooperation.

 Assemble equipment

Application :

 Get the thigh rope- the shortest

 Measure medial to inguinal area, knee to inguinal area or knee to greater trochanter

 Then measure also rope to middle of Thomas splint, this is where you will now place the screw

 Attach screw to Thomas splint

 Get the rest splint. Attach Thomas splint and Pearson’s attachment to rest splint, making sure the
Pearson’s attachment is under

 Get the slings. Start applying from medial to lateral.

 The smooth surface should in contact with the patient to avoid friction. Any contact with the skin may
cause bedsore. If it’s too long fanfold and then clamp.

 The 2 longer ones should be placed on the thigh part, and the 3 shorter ones on the Pearson’s attachment.
Make sure it’s not too tight or loose.

There should be at least 1” interval between each sling to provide ventilation.

 Next, get the thigh rope (shortest) and tie it on the medial side of the Thomas splint. Make a slip knot on
the leather part of the ischial rest and not on the steel. Tie it temporarily on the Pearson’s screw to avoid
dangling.

 Insert prepared traction set up. 3 persons are needed. Make sure the first pulley is in line with the inguinal
area. The second in line with the knee and the third in line with 1 st and 2nd pulley.

 Simultaneously at the count of 3, ask patient to hold on to the trapeze, flex the unaffected leg as
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Nurse A will insert

Nurse B will use manual traction and lift towards the toe.

Nurse C will slight lift the affected extremity.

 Using the longer rope, tie a slip knot on the steinmann’s pin holder then Insert it on the 3 rd pulley.

 Using the heavier weight, tie traction rope to the traction weight bag. Tie securely. Consume the remaining
part of the rope to avoid dangling.

 Explain to the patient that he will experience a slight pain because of the pulling force.

 Remove the end of the thigh rope on the lateral side and tie it on the lateral aspect of the ischial ring with a
slip knot.

 Get suspension rope and attach to the mid part of the thigh rope, make a slipknot and insert on 1 st pulley.

 Get suspension weight bag, insert suspension rope on suspension weight bag. Hang it first so it won’t fall.
Insert it on the 2nd pulley. Suspension rope is outside the traction rope but inside the rest splint so it won’t
sway.

 Elevate rest splint.

 Make a clove hitch knot over the rest splint and close it with a clove hitch knot on the Thomas splint.

 And another clove hitch knot on the Pearson’s attachment and close it with a knot and consume.

 Remove the rest splint.

 Hang suspension bag

 Apply foot board.

 Make a ribbon knot on each side.

 And at the bottom part, a ribbon knot after the first sling, again on each side.

6) Check efficiency of traction.

 Instruct patient at the count of 3, to hold onto the trapeze bar, bend the knee, raise the buttocks.

 Swing patient forward, backward and side to side to again check the efficiency of traction.

7) Principles of Traction :

 There must be an opposite pull or countertraction.

 Follow an established line of pull that is the line of pull must be in line with the deformity.

 It must be free from any friction.

 Weight should be hanging freely. Ropes must be hanging along groove of pulley.

 Check for wear and tear of pulley; knots should be away from pulley.

 Be applied to a patient in supine or dorsal recumbent position.

8) Transport or removal

 Hang the suspension weight bag on the first pulley.

 Apply rest splint.

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 The last rope you tied should be the first to be removed which is the suspension rope.

 Remove suspension weight.

 Remove knot on the Pearson and from the lateral side of the Thomas splint.

 Temporarily anchor it on the Pearson’s screw.

 Apply manual traction.

 Remove thigh rope from weight bag tie it on the rest splint.

 Make a clove hitch knot on the rest splint and another on the Thomas and Pearson’s attachment.

 Patient is now ready for transfer.

 Instruct conscious patient to start with unaffected side at the count of 3.

9) Nursing Care and Complications :

 Provide comfort to patient

 Check for any inconvenience or discomfort.

 Provide personal hygiene cephalocaudal. Start with unaffected extremity, keep it dry.

 For the back, remove sling one at a time, sponge, keep dry then get a new sling.

Complications :

 For any infection from Steinmann’s pin, inspect dressing 2-3 times a week.

 Provide daily aseptic technique on dressing use Povidone Iodine.

 For Muscle atrophy, promote ROM exercises on unaffected side

 For the affected side, static quadricep exercises.

 Contraction relaxation techniques for the thighs to prevent muscle atrophy.

 Flexion extension exercises for the feet.

 Check for impaired blood circulation, capillary refill using blanch technique

 Bedsore complications – assist patient to change position only every 2 hours using overhead
trapeze.

 Prevent hypostatic pneumonia related to prolonged immobility.

 Provide chest physiotherapy. Clapping, deep breathing, increase fluids.

 Constipation due to immobility – Introduce high fiber foods; increase fluids; provide privacy

 UTI- increase fluids; provide bedpan, privacy, perinneal care for women

 Boredom – provide diversional activities; provide reading materials

 Provide psychological and emotional support.

 Provide nurse patient interaction.