TRACTION

1. TRACTION – The act of pulling and drawing associated with counter traction. It is used for
straightening broken bones or relieving pressure on the spine and skeletal system.

- Traction controls movements of an injured part of the body – aids in healing.

Purposes:

 To regain normal length and alignment of involved bone.

 To reduce and immobilize a fractured bone.

 To lessen or eliminate pain and muscle spasms.

 To relieve pressure on nerves, especially spinal.

 To prevent or reduce skeletal deformities or muscle contractures.

2. PRINCIPLES

a.countertraction must be used to achieve effective traction – this is the force acting in opposite
direction
b.usually the person’s 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.Fixed Traction - Traction is applied to the leg against a fixed point of counter pressure.

Example: Hare Traction used by paramedics during rescues

b.Sliding Traction - When the weight of all or part of the body, acting under the influence of gravity, is
utilized to provide counter-traction.

Example: Crutchfield Tong while the bed is tilted by shock blocks

4.METHODS OF TRACTION

a. Skin traction – Adhesive/ Non-adhesive

b. Skeletal traction

5.SKIN TRACTION

a.adhesive straps are applied to the skin while the pull is offered by a weight

>Adhesive skin traction:

–Maximum weight 15 lb or 6.7 kg

>Non-adhesive skin traction

–Maximum weight should not exceed 10 lb or

4.5 kg

–thin and atrophic skin,

–skin sensitive to adhesive strapping

b. Complications

1. Skin Breakdown

a.from irritation by contact of skin w/tape or foam & shearing forces

b. Elderly @ ↑ 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 – A second nurse is needed to support

the extremity during inspection and skin care

f.palpate area under traction tape for skin tenderness

2.Pressure sores over bony prominence

3. circulatory impairment

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

6. SKELETAL TRACTION

a.pin or wire

b.more frequently used in lower limb fractures

c.should be reserved for those cases in which skin traction is contraindicated or insufficient
d.SITES:

–Olecranon
–Metacarpal
–Upper end femur
–Lower end of femur
–Upper end of tibia
–Lower end of tibia
–calcaneus

e.COMPLICATIONS:

•Infection
•Cut out
•Application of splint difficult
•Distraction at fracture site
•Ligament damage
•Physeal damage
•Depressed scars

f. Nursing Interventions

1.maintain effective traction

a.check to see if ropes are in wheel grooves
b.no fraying of ropes
cweights hang freely
d.knots in rope are secure
e.evaluate position of patient – slipping down in the bed results in ineffective traction
f.never remove weights from skeletal traction – 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 and heels– he may reposition himself

b.encourage trapeze bar for moving

c.assess pressure points- Lower extremity traction apparatus, you need to check ischial tuberosity,
popliteal space, Achilles tendon, heel , back of head
d.keep bed dry, free of crumbs and wrinkles

4.Provide pin site care

a.Goal – to avoid infection and development of osteomyelitis (infection of the bone)
b.pin care 3/day, q 8 hours
c.should be no crusts
5. promote exercise

7. THE PATIENT IN TRACTION

a. Assessment

1.consider the psychological & physiologic impact of the problem, traction device, and immobility
2.restricts mobility, independence
3.equipment looks threatening, frightening
4.monitor anxiety level

a.frequent visits by the nurse can reduce feelings of isolation and confinement
b.encourage family and friends to visit frequently
c.encourage diversional activities

5.compare affected extremity to unaffected extremity

b. Complications
1. Pressure Ulcers
2. Pneumonia

a.auscultate q 4-8 hours

b.deep breathing, coughing q 2 hrs

3. Constipation, Anorexia

4.Urinary Stasis, Infection

5. Venous Stasis, DV