NURSING CARE OF

PIN SITES
Roslyn Eva RN
Graduate Certificate of Orthopaedics.
PIN SITE CARE
 There are many
different ideas about
the care of pin sites.
 They vary from no
care at all.
 To twice daily
cleansing with a range
of options in between.
PIN SITE CARE
 In the end it comes
down to the Surgeon
or Doctor’s
preference.
 In this talk I will
present a range of
options that are in
current use in
Australia.
PIN SITE CARE

 Pinsites are the area

of skin surrounding a
protruding piece of
metal, which is
holding bones in
place while they heal.
PIN SITE CARE
 The metal pin creates a
pathway from the skin on
the outside through to
bone.

 This provides a direct

entry for bacteria so ANY
care is better than NO
care.
PIN SITE CARE
Frequency
Daily or twice daily dressings
 Used for the first 72 – 96 hours following insertion of
the external fixators.
 For duration of hospital stay.

Weekly dressings
 Used for maintenance of clean pin sites with no signs of
inflammation or infection.
PIN SITE CARE
Solutions
Any one of the following may be used for cleaning of pin
sites:-

 Hydrogen peroxide
 Normal Saline

 Sterile water

 Chlorhexidine 2mg/ml

 Betadine solution

 Alcohol swabs
PIN SITE CARE
Set up:-
 Sterile Dressing pack

 Alcohol swabs

 Sterile scissors

 Nu-gauze or ribbon gauze

 Betadine or Alcoholic
Chlorhexidine
 5cm bandage.

 Gloves
PIN SITE CARE
Cleansing
 Use a sterile technique.
 Use a fresh cotton ball or
alcohol swab for each pin
site.
 Remove any crusts or
discharge.
 Using the sterile forceps
push the skin growth down
around the pin to prevent
hypertrophy.
PIN SITE CARE
Primary dressing – this is the layer in direct contact with
the pins and the skin.

 It is often dressed with a ribbon gauze which may be

soaked in Betadine or Chlorhexadine.

 This is applied in a figure 8 or as appropriate to the

position of the pins.
PIN SITE CARE
 Another option is a sheet
of Nu-gauze key hole cut
to fit the pattern of pins.

 This is soaked in
Alcoholic Chlorhexidine
(0.5%in 70% alcohol).
PIN SITE CARE
Secondary Dressing – This
is the layer that covers the
primary dressing and
helps to hold it in place.
 This is often a wider
ribbon gauze, or narrow
crepe bandage.
 Covers the area and the
fixators.
PIN SITE CARE
 Secure to skin by taping
in place.

 The purpose of bandaging

is to maintain a firm
tension against the skin to
prevent hypertrophy and
movement of the skin
around the pin sites.
PIN SITE CARE
Complications
 Infection – localised and
deep.
 Loosening of the pins –
reduced effectiveness in
securing the healing
bones.
 Hypertrophy of the
surrounding skin.
PIN SITE CARE
Infections
 Prophylactic IV Antibiotics are often given at the time of
surgery to prevent an infection.

 In the event of a localised skin infection an appropriate

regime of oral antibiotics may be given.

 Where there is a risk of Osteomyelitis a regime of IV

Antibiotics will be given.
 If severe the pins may need to be removed.
PIN SITE CARE
The National Association of Orthopaedic Nurses
Guidelines for Pin Site Care has four recommendations.
1. Pin sites located in areas with considerable soft tissue
(i.e. Thigh) should be considered at greater risk of
infection.

2. After the first 72 hours pin site care can be attended to

on a daily or weekly basis for sites with mechanically
stable bone pin interfaces.
PIN SITE CARE

3. Chlorhexidine 2mg/ml may be the most effective

cleaning solution for pin site care.

4. Patients and families should be taught pin site care prior

to discharge from hospital using clean (rather than
sterile) procedures.
PIN SITE CARE

Any Questions?
REFERENCES
 Maher,A.B., Salmon,S.W., Pellino,T.A. (2002) Orthopaedic
Nursing.(3rd Edition) Philadelphia, Saunders.
 Tortora.G.J., Derrickson.b.,(2006)Principles of Anatomy and
Physiology. (11th Edition) Hoboken, John Wiley & Sons, Inc.
 Cochrane Library- Pin site care for preventing infections associated
with external bone fixators and pins.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD00455
1/frame.html

 Royal Children’s Hospital, Melbourne. limb.recon@rch.org.au