Report in surgery ward
Unibersidad de Manila College of Nursing Group 3 ; Nr-31 Marie jodel Montalvo and Gemilyn Kalaw 12/1/2010
drainage. There should be no knots along the rope Pin site care for skeletal traction: a. The weight of the body serves as the counter traction apply traction continuously Allow the weights to hang freely. Turn the client as indicated Avoid friction. skeletal traction. Various types of traction may also be treatment options before and after surgical reduction of injuries such as cervical fractures and for chronic condition such as low back pain. the application of weights. pain. swelling. b. Traction is the application of a pulling force to an injured body part or extremity while counter traction pulls in the opposite direction. Cleanse and apply antibiotic ointment as prescribed. however. Principles in Care of the client with traction the line of pull should be in line with the deformity There should be an adequate counter traction. Weights should not touch the floor. currently has limited application in the preoperative management of a client with a fractured hip for example. Do neurovascular check Prevent complication of immobility
.g. Lower extremity traction such as Buck or Russel traction. redness. The pulling force can be achieved through the use of the hands (manual traction) or more commonly. warmth. Notify physician if these findings are noted. continues to be an option for multiple trauma clients who are not immediate candidates for open reduction and internal fixation of orthopedic injuries.Traction
Traction has been used to treat fractures since prehistoric times and its principles were well known to Hippocrates. Observed site for signs and symptoms of infection e.
After the insertion. Long term hospitalization is not always indicated if the client in traction can qualify for home care nursing services or depending on the type of traction receive additional treatment as an out patient. although 7 to 10 pounds are commonly used. exerting direct pull on the affected part or balanced. Weights may reach 15 pounds. Major disadvantages include the potential need for prolonged bed rest and the resulting effects of extended immobility. Skeletal traction can be tolerated for longer periods than can skin traction. a direct force can be applied after the physician aseptically inserts stainless steel pins through the bone itself. Suspension may also be running or straight. In addition to the mode of application. exerting a pull on the affected part and also supporting extremity in a splint. The ends of the pin or wire are covered with cork or tape to prevent injury to the patient or caregivers. traction can be categorized as static (continuous) or dynamic (intermittent). The weights are attached to the pin or wire bow by a rope and pulley system that exerts the appropriate amount and direction of pull for effective traction. The most common sites for pin insertions are the distal femur. using surgical asepsis. The insertion site is prepared with a and periosteum. The surgeon makes a small skin incision and drills the sterile pin or wire through the bone. The surgeon applies skeletal traction. The weight applied initially must overcome the shortening spasms of the
. with skeletal traction. the pin or wire is attached to the traction bow or caliper. The patient feels pressure during this procedure and possibly some pain when the periosteum is penetrated.Skeletal traction
Skeletal traction uses pins to apply force to the bone. the proximal tibia and the proximal ulna.
The Thomas splint with a pearson attachment is frequently used with skeletal traction for fractures of the femur because upward traction is required an overbed frame is used. or splints are then used to immobilize and support the healing bone. The pin is cut close to the skin and removed by the physician. As the muscles relax. It can be the skin or skeletal type. Internal fixation.the extremity is gently supported while the weights are removed. The patient is in the supine position. even when the patient moves the upper body. HERE ARE THE SITES OF SKELETAL TRACTION: – – – – – – – Olecranon Metacarpal Upper end femur Lower end of femur Upper end of tibia Lower end of tibia calcaneus
HERE ARE THE COMPLICATIONS: – – – – – – – Infection Cut out Application of splint difficult Distraction at fracture site Ligament damage Physeal damage Depressed scars TYPES OF SKELETAL TRACTION Balanced Suspension Traction Balanced suspension traction is used to stabilize fractures of the femur.affected muscles. the affected leg is suspended by ropes. allows for some patient movement and facilitates patients independence and nursing care while maintaining effective traction. Often a skeletal traction is a balance traction which supports the affected extremity. a pin or wire is surgically placed through the distal end of the femur. As the name suggests. pulleys. tape and wrapping or a traction boot of the kind described under Buck’s traction is used. If it is skeletal. with the head of the bed elevated fro comfort. If it is skin traction. the traction weight is reduced to prevent fracture dislocation and to promote healing.
. casts. and weights in such a way that traction remains constant. When skeletal traction is discontinued.
may then be applied. and weights. Because patients remain in this type of traction for an extended period. such as povidone-iodine ointment. You should. Dressings are usually not required. infection at the tong sites. Although Crutchfield tongs were used almost exclusively in the past. If a hospital bed is used. pain. however. Parallel rods lead from the pin sites on the distal and of the attachment for the rope. provide good nutrition and suggest recreational or occupational activities. The patient is supine and is usually on a special frame instead of the regular hospital bed. Special padding may have to be used. the foot should always be at a right angle on the footrest to prevent footdrop. The Thomas splint consists of a ring. Again. The pin sites are cleansed carefully with soap and water and rinsed thoroughly. Indications include redness. If pins are used for fixation. The tongs are surgically inserted into the bony cranium. Halo Traction
. aseptic technique must be used around pin sites until they have healed. From then on. two or more people are required to assist the patient with any turning movements. and a connector half-halo bar is attached to a hook from which traction can be applied. or fever. These weights hang freely at the foot off the bed. observe the precautions taken for the patient in other types of skeletal traction. that circles and supports the thigh. pulleys. The patient is prepared for either type with a local anesthetic to the scalp. The ring of the Thomas splint can excoriate the skin of the groin. and restlessness and boredom are common. drainage. Skull Tongs Traction Skull tongs are used to immobilize the cervical spine in the treatment of unstable fractures or dislocation of the cervical spine. clean technique can be used.Two important components of balanced suspension traction are the Thomas splint and the Pearson attachment. Traction to the femur is applied through a series of ropes. The head of the bed may be elevated to provide counter traction. Two parallel rods are attached to the splint and extend beyond the foot. It is useful to teach the patient range-of-motion exercises. often lined with foam. Some think these are less likely to pull out than the Crutchfield tongs. constantly assess for infection at the pin sites. The skin should be inspected frequently to identify problems early. Review your facility’s policy on pin care. An antiseptic. unless this varies from policy. Difficulties with the performance of activities of daily living. A Pearson attachment consists of a canvas sling that supports the calf. heat. Gardner-Wells skull tongs are in wide use.
Maintaining positioning The nurse must maintain the alignment of the patient’s body in traction as prescribed to promote an effective line of pull. This digging of the heel into the mattress may injure the tissue therefore the nurse should protect the elbows. The trapeze helps the patient move about in bed and move on and off the bedpan. foot supports. a trapeze can be suspended over head within easy reach of the patient. The patients foot may be supported in a neutral position by orthopedic devices. and the knot in the rope are tied securely.
Preventing skin breakdown The patient’s elbow frequently become sore and nerve injury may occur if the patient reposition by pushing on the elbows. and outward rotation (eversion). Vertical frame pieces extend from a halo section to a frame brace that rests on the patient’s shoulders. that the weights hangs freely.
Specific pressure points are assessed for redness and skin breakdown.Halo traction provides stabilization and support for fractured cervical vertebrae.
NURSING INTERVENTION • Maintaining effective traction The nurse should check the traction apparatus to see that the ropes are in the wheel grooves of the pulleys to see that the ropes are not frayed. E. A half circle of metal frame connects the pins around the front of the head. inward position (inversion). The nurse positions the patients foot to avoid foot drop (plantar flexion). To encourage movement without using elbow or heel. The halo traction allows the patient to be out of bed and mobile while stabilizing the cervical vertebrae could injure the spinal cord. heel and impact for pressure ulcers. The nurse should also evaluate the patients position because slipping down in bed results in ineffective traction. The patient frequently push on the heel of the unaffected leg when they raise themselves. If the patient is not permitted to turn on one side.g. The surgeon inserts pins into the skull. or the other the nurse needs to do a special effort to provide back care and to keep the bed dry
Pin site care is individually prescribed and performed initially one or two times a day. For the first 48 hours after the insertion. DVT is a significant risk for the immobilized patient. If the patient cant do this. Hydrogen peroxide and betadine solutions have been used but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.
Monitoring neurovascular status Assessing the neurovascular status of the immobilized extremity at least every hour initially and that every 4 hours. This goal is to avoid infection and development of osteomylitis.and free of crumbs and wrinkles. The patient to do active flexion extension ankle exercises and isometric contraction of the calf muscle. compression devices. 10 times an hour while awake to decrease venous stasis. Crushing may occur at the pin site and should remain undisturbed unless there are contaminants signs of infection. The patient can assist by holding the overhead trapeze and rising the hips off the bed. A pressure relieving air filled or high density foam mattress overlay may reduce the risk of pressure ulcer. The frequency of the pin care needs to be increased if mechanical looseness of pins or early signs of infection are present. Chlorhexidine solution is the most recommended and common effective cleansing solution however saline and water are just alternate choices. the site is covered with a sterile absorbent nonstick dressing and a rolled gauze or ace type bandage. The nurse instruct the patient to report any changes in sensation or movement immediately so that they can be promptly evaluated. the nurse can push down on the mattress with one hand to relieve pressure on the back and bony prominences and to provide for some shifting of weight. After this time. In addition elastic stockings. Crust provide a normal protective barrier and their removal may disturb healing tissue and make it more vulnerable to infection. They are permitted to
. The patient should be taught to perform pin site care prior to discharge from the hospital and should be provided with written follow up instruction that includes the signs and symptoms of infection. a loose cover dressing or no dressing is recommended. and anticoagulant therapy may be prescribed to help prevent thrombus formation.
Providing pin site care The wound at the pin insertion site requires attention.
• Promoting exercise In patient exercise.
. Isometric exercise of the immobilized extremity is important for maintaining strength in major ambulatory muscles.take showers 5 to 10 days of pin insertion and is encouraged to leave the pins open to the water flow the sites are dried with a clean towel and left open to air. assist the patient in maintaining muscle strength and tone and in promoting circulation. and range of motion and weight resistance exercises for non involved joints. Active exercises include pulling up on the trapeze. flexing and extending the feet.