Sr.

no Content

01 Definition of traction

02 Principles of traction

03 Types of traction

04 Management of traction
Objectives
 After the completion of this presentation, the learners
will be able to know about the:
 Traction
 Principles of effective traction
 Types of traction
 Nursing management of traction
Traction:
 “Traction uses a pulling force to promote and
maintain alignment to an injured part of the body.
The goals of traction include decreasing muscle
spasms and pain, realignment of bone fractures,
and correcting or preventing deformities”


Traction is used primarily as a short-term

intervention until other modalities, such as external
or internal fixation, are possible. These modalities
reduce the risk of disuse syndrome and minimize
hospital lengths of stay, often allowing the patient
to be cared for in the home
Principals of effective traction :
 When caring for the patient in traction, the nurse should follow
these additional principles:
 Traction must be continuous to be effective in reducing and
immobilizing fractures.
 Skeletal traction is never interrupted.
 Weights are not removed unless intermittent traction is
prescribed.
 Any factor that might reduce the effective pull or alter its
resultant line of pull must be eliminated.
 The patient must be in good body alignment in the center of the
bed when traction is applied. Ropes must be unobstructed.
 Weights must hang freely and not rest on the bed or floor. Knots
in the rope or the footplate must not touch the pulley or the foot.
Types of traction:
 There are several types of traction.
 Straight or running traction applies the pulling force
in a straight line with the body part resting on the bed.
 The counter traction is provided by the patient’s body
and movement can alter the traction provided.
 Buck’s extension traction is an example of straight
traction.
 Balanced suspension traction supports the affected
extremity off the bed and allows for some patient
movement without disruption of the line of pull. With
this traction, the counter traction is produced by devices
such as slings or sprints.
Skin Traction
 Skin traction is used less frequently than in years past;
the AAOS (2014) recently reported that there was no
reduction in pain or complications associated with its use
compared with other standard interventions. Nonetheless,
skin traction may be prescribed for;
 use to stabilize a fractured leg,
 control muscle spasms,
 immobilize an area before surgery. The pulling force is
applied by weights that are attached to the client with
Velcro, tape, straps, boots, or cuffs. The amount of
weight applied must not exceed the tolerance of the skin.
No more than 2 to 3.5 kg (4.5 to 8 lb) of traction can be
used on an extremity
 Cont’d….
 Pelvic traction is usually limited to 4.5 to 9 kg (10 to 20
lb.), depending on the weight of the patient.
 Types of skin traction used for adults include:
 Buck’s extension traction (applied to the lower leg)
 chin halter strap (occasionally used to treat chronic
neck pain)
 pelvic belt sometime use to manage back pain.
 Buck’s extension traction (unilateral or bilateral) is
skin traction to the lower leg. The pull is exerted in one
plane when partial or temporary immobilization is
desired
.It is used as a temporary measure to overcome muscle
spasms and promote immobilization of hip fractures in
adult patients waiting for more definitive treatment such
as surgery.
Nursing interventions

 Monitoring and Managing Potential Complications:

Skin Breakdown: During the initial assessment, the
nurse identifies sensitive, fragile skin (common in older
adults). The nurse also inspects the skin area that is in
contact with tape, foam, or shearing forces, at least every 8
hours, for signs of irritation or inflammation.
 The nurse performs the following procedures to
monitor and prevent skin breakdown:
 Removes the foam boots to inspect the skin, the
ankle, and the Achilles tendon three times a day.
 A second person is needed to support the extremity
during the inspection and skin care.
 Palpates the area of the traction tapes daily to detect
underlying tenderness. Provides frequent
repositioning to alleviate pressure and discomfort,
because the patient who must remain in a supine
position is at increased risk for development of a
pressure ulcer.
 Cont’d…

 Pressure at this point can cause foot drop.

 The nurse regularly questions the patient about sensation and asks
the patient to move the toes and foot.
 The nurse should immediately investigate any complaint of a
burning sensation under the traction bandage or boot
Ensure effective skin traction:
 To ensure effective skin traction, it is important to
avoid wrinkling and slipping of the traction
bandage and to maintain countertraction.
 Proper positioning must be maintained to keep the
leg in a neutral position.
 To prevent bony fragments from moving against
one another, the patient should not turn from side to
side; however, the patient may shift position
Nerve damage

Skin traction can place pressure on peripheral nerves. Care must be

taken to avoid pressure on nerves at the point at which passes
around the head of fibula just below the knee , when traction is
applied to lower extremity.
The Nurse should frequently question the patient about any burning
sensation under the traction bandage or boot ,ask the patient to move
the toes and foot.
Circulatory Impairment
 After skin traction is applied, the nurse assesses
circulation of the foot within 15 to 30 minutes and then
every 1 to 2 hours. Circulatory assessment consists of:
 Peripheral pulses,
 color, capillary refill
 temperature of the fingers or toes.
Manifestations of deep vein thrombosis (DVT),
which include unilateral calf tenderness, warmth, redness,
and swelling. The nurse also encourages the patient to
perform active foot exercises.
Skeletal traction
 Skeletal traction is often used when continuous traction
is desired to immobilize, position, and align a fracture of
the femur, tibia, and cervical spine.
 Itis used when traction is to be maintained for a
significant amount of time, when skin traction is not
possible, and when greater weight (11 to 18 kg [25 to 40
lb.]) is needed to achieve the therapeutic effect.
 Skeletal traction involves passing a metal pin or wire
(e.g., Steinmann pin, Kirschner wire) through the bone
(e.g., proximal tibia or distal femur) under local
anesthesia, avoiding nerves, blood vessels, muscles,
tendons, and joints.
Cont’d…

 Traction is then applied using ropes and weights

attached to the end of the pin. Alternatively, skeletal
traction may involve the application of tongs to the head
that are fixed to the skull to immobilize cervical
vertebrae.
Nursing Management
 Assessing Anxiety The nurse must consider the psychological
and physiologic impact of the musculoskeletal problem, traction
device, and immobility. Traction restricts mobility and
independence.
 Confusion,
 disorientation,
 behavioral problems may develop in patients who are confined
in a limited space for an extended time. Therefore, the nurse must
assess and monitor the patient’s anxiety level and psychological
responses to traction. The nurse helps the patient eat, bathe, dress,
and toilet.
Convenient arrangement of items such as the telephone, tissues,
water, and assistive devices (e.g., reachers, over bed trapeze) may
facilitate self-care.
Monitoring and Managing Potential
Complications
 Immobility-related complications may include
 pressure ulcers
 atelectasis,
 pneumonia,
 constipation,
 loss of appetite,
 urinary stasis,
 urinary tract infections,
 VTE formation
Atelectasis and Pneumonia

 The nurse auscultates the patient’s lungs every 4 to 8

hours to assess respiratory status and educates the
patient about performing deep breathing and coughing
exercises to aid in fully expanding the lungs and
clearing pulmonary secretions.
Constipation and Anorexia

 Reduced gastrointestinal motility results in constipation

and anorexia. A diet high in fiber and fluids may help
stimulate gastric motility.
 If constipation develops, therapeutic measures may
include stool softeners, laxatives, suppositories, and
enemas.
 To improve the patient’s appetite, the patient’s food
preferences are included, as appropriate, within the
therapeutic diet.
Urinary Stasis and Infection
 Urinary Stasis and Infection Incomplete emptying of the
bladder related to positioning in bed can result in
urinary stasis and infection. In addition, the patient may
find the use of a bedpan uncomfortable and may limit
fluids to minimize the frequency of urination. The nurse
monitors the fluid intake and the character of the urine.
Adequate hydration is very important.
Venous Thromboembolism:

 Venous stasis that predisposes the patient to VTE occurs

with immobility. The nurse educates the patient about
how to perform ankle and foot exercises within the
limits of the traction therapy every 1 to 2 hours when
awake to prevent DVT. Involving family members in
performing these exercises is the best way to prevent
such complications.
References :
 Bruner and Siddhartha's Medical Surgical Nursing ,
14th edition page#3033-337
 www.science.direct.com
 www.mayoclinic.edu.
 www.slideshare.med.