Nursing care of patient on traction

Limistéar Lár Tíre GL No: R.O.U.012.

Midland Area Revision No: 0
Page:1
Department
Orthopaedic No of Pages: 9

Guideline Date: January 04

Guideline Title: Nursing care of a patient on Traction.

Written by: Title:
Nursing staff of the Regional Orthopaedic Unit.

Approved by: Title:
Ms. Fiona McMahon. D.N.M.

1.0 Purpose
1.1 To provide guidance to nursing staff and nursing students (under
supervision of a registered nurse) on the care of a patient on Traction.

2.0 Scope
2.1 This guideline applies to the registered nurse and the nursing student
(under the supervision of a registered nurse) within the Midland
Regional Hospital Tullamore.

3.0 Definition.
3.1 Traction is the application of a pulling force to a part of the body with
countertraction a pull in the opposite direction. More specifically,
orthopaedic traction occurs when “ A pulling force is exerted on a part
or parts of the body”(Davis, 1996).

3.2 Traction has several purposes:
3.2.1 To reduce a fracture and realign bone fragments by overcoming
muscle spasms.
3.2.2 To maintain skeletal length and alignment.
3.2.3 To reduce and treat dislocations.
Document Routing
Draft Released Approved Distribution
Date: October 03 Date: November Date: January 04 Date: March,
03 2005
Sign: F. McMahon. Sign: F.
Sign: F. McMahon. Sign: W.
McMahon. Harding
QA Template 002 Rev 2 January 2005
This is a controlled document and may be subject to change at any time.

Limistéar Lár Tíre GL No: R.O.U. 012.

Page: 2
Department
Orthopaedic No. Of Pages:9



3.2.4 To immobilise and to prevent further tissue damage.
3.2.5 To prevent the development of contractures when there is a pathologic
condition that causes the muscles to contract.
3.2.6 To relieve muscle spasms that occur as a reaction to musculoskeletal
trauma in the absence of a fracture such as cervical sprain or low back
pain.
3.2.7 To lesson deformities, such as with arthritis.
3.2.8 To rest a diseased joint.
3.3 Classification of Traction.
3.3.1 Skin Traction: is attached directly to the patient’s skin to immobilise
a body part continuously or intermittently over a short or extended
period. The direct application of a pulling force to the patients skin and
soft tissues may be accomplished by using adhesive or nonadhesive
traction tape or other skin traction devices such as a cast, a boot, a
belt or a halter. (Schoen 2000)

3.3.2 Skeletal Traction: is attached directly to the patients skeletal
system to immobilise a body part. The direct application of the pulling
force may be accomplished by attaching pins, screws, wires or tongs.
(Schoen 2000)

3.3.3 Manual Traction: is traction that is accomplished by a persons hands
exerting a pulling force. It is utilised to reduce fractures and
dislocations and to apply a steady pull while mechanical traction is
released for adjustment or while a cast is being applied. (Schoen
2000)

3.3.4 Fixed Traction: The pull is exerted against a fixed point; for
example, the tapes are tied to the crosspiece of a Thomas splint and
pull the leg down. (Apley 1993)

3.3.5 Balanced Traction: The pull is exerted against an opposing force
provided by the weight of the body when the foot of the bed is raised.
(Apley 1993)

QA Template 002 Rev 2 January 2005
This is a controlled document and may be subject to change at any time.


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Department



4.0 Responsibility
4.1 It is the responsibility of the Divisional Nurse Manager and
Nursing Administration to ensure this guideline is in place on the
appropriate wards and that relevant staff are informed of their
responsibilities in relation to this document.
4.2 It is the responsibility of the C.N.M.11. on any ward with an
Orthopaedic patient to ensure that staff providing care to that
patient are aware of the requirements of this guideline.
4.3 It is the responsibility of all Nursing Staff providing care to an
Orthopaedic patient to ensure that their practise is in line with
this guideline document.

5.0 Guideline
Action. Rationale.
Knowledge Deficit.
5.1 Explain the purpose of traction • Providing information helps
related to injury and healing alleviate anxiety and enables the
process. Explain the traction patient to retain further
apparatus. For skeletal traction information and instructions.
explain pin insertion and removal
procedures and care of pin-sites.
Maintaining activities of daily living
while in traction.

Pain Management. • To monitor the effectiveness of
5.2 Assess the patient’s level of the prescribed analgesia
pain and administer analgesia
as prescribed.
• Patient’s treated in traction have
pain due to soft tissue and bone
5.3 Explain that traction trauma.
decreases muscle spasms and
will gradually help lessen pain.

• Diversionary activities (books,


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Department



5.4 Eliminate additional sources games, television etc), heat or
of pain by providing comfort cold treatments and position
measures. changes.

• Incorrect positioning and
5.5 Assess for correct positioning malalignment can be sources of
of traction and alignment of pain.
affected extremity.

Risk for Impaired Skin Integrity • Frequent repositioning is
5.6 The patient’s Waterlow Score required to alleviate pressure
is assessed. Assess skin over pain and discomfort. A thorough
bony prominences (sacrum, skin assessment should be
trochanters, scapulae, elbows, carried out each time the
heels, inner and outer patient is repositioned.
malleolus, inner and outer
knees and back of head). Areas
where skin is stretched tautly
over bony prominences are at a
greater risk for breakdown
because the possibility of
ischeamia to skin is high due to
compression of skin capillaries
between a hard surface
(mattress, chair,) and the bone. • These measures help to
minimise the risk of
5.7 The decision to nurse the complications of skin
patient on a pressure-relieving breakdown.
mattress depends on the
nurse’s clinical judgement.

• Pressure areas and skin irritation
5.8 Maintain correct padding for can develop under or at the edge
affected extremity in traction, of traction device.
keep bed-linen wrinkle free and
dry. • The urea in urine turns into


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ammonia within minutes, and is
5.9 Assess for faecal or urinary caustic to the skin. Faeces may
incontinence, clean and dry skin contain enzymes that cause skin
daily. breakdown.

• To promote independence.
Impaired Physical Mobility.
5.10 Instruct in the use of
assistance devices i.e. Monkey • Exercises should be active to
pole. prevent muscle atrophy and joint
stiffness, which occur quickly in
5.11 Teach strengthening exercises the situation of reduced mobility.
to affected limb and other limbs
as appropriate. • To promote independence.

5.12 Encourage activities of self-
care and the use of the trapeze
if the patient’s arms will allow.
• The traction system should be
checked thoroughly at least daily
High risk of injury. and always after interventions
Traction Device: such as physiotherapy and x-ray.
5.13 Keep weights hanging freely,
tighten all traction equipment
and secure all knots. • To maintain a safe environment.

5.14 Cords should be checked daily
for fraying, particularly where
they pass over pulleys. • To protect the patient from
accidental injuries.

5.15 Pointed ends of pins or wires • For comfort, and to ensure free
should be covered with cork or running of traction cords.
adhesive tape.

5.16 Bed aids such as cradles


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Department



should be used to keep • Promotes early detection and
bedclothes away from the prompt treatment.
patient as necessary.

Pin-sites: • To prevent infection.
5.17 Continuously assess the pin-
sites for migration, assess the skin
around the pin for tears and assess
for pain at the pin-sites. • Careful monitoring enables early
detection. The traction
5.18 Maintain asepsis during pin- equipment may through
site dressing. See guidelines on increased pressure on nerves
pin-site care/dressing. and blood vessels cause
temporary or permanent
5.19 Monitor the patient for signs damage.
and symptoms of neurovascular
compromise, comparing findings
to the unaffected limb.
ü Surgical trauma causes swelling
and oedema, which can
compromise circulation and
compress nerves.
a) Check for diminished or absent
pedal pulses. (See appendix 1) ü Prolonged capillary refill time
points to diminished capillary
perfusion.
b) Check for capillary refill time >3
seconds.
ü These signs may indicate
compromised circulation.
c) Observe for pallor, blanching,
cyanosis and coolness of ü These symptoms may result
extremity. from nerve compression.

d) Check for complaints of ü Tissue and nerve ischaemia
abnormal sensations, e.g. produces a deep, throbbing
tingling and numbness. unrelenting pain.

e) Observe for increased pain not


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controlled by medication. • Compartment syndrome results
from severe tissue swelling that
decreases blood flow, causes
5.20 Assess the affected extremity ischaemia and may cause
for signs and symptoms of altered permanent motor/sensory
perfusion of compartment damage.
syndrome. (See guideline on
Compartment Syndrome.)

Risk for Deep venous
thrombosis/Pulmonary • Elastic stockings have been
embolus. shown to reduce the risk of
D.V.T. by about 25%
5.21 Ensure anti-embolic stockings (Todd&Sitzman 1998).
are fitted on both limbs. Compression stockings must be
used correctly, otherwise they
5.22 Continuously assess the may become a cause rather than
patient for signs and symptoms a deterrent of D.V.T. (Evans,
of: 1991).
Deep Venous Thrombosis
Positive Homan’s Sign (See
appendix 2)
Swelling of leg, • Early detection and treatment.
Tenderness in calf.
Pulmonary Embolus.
Dyspneoa,
Chest pain,
Tachycardia,
Haemoptysis,
Cyanosis,
Anxiety,
Pyrexia of unknown origin.

5.23 Give anti-coagulant
i.e.Innohep/Clexane s/c Daily at
6pm.


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• To prevent complications of deep
venous thrombosis or pulmonary
embolus.
Risk for Infection.

5.24 Assess pin-sites daily for signs
of infection, assess skin tension at
pin-sites.

5.25 Maintain asepsis for dressing • To promote early detection and
changes, catheter care and treatment if necessary.
handling, and peripheral
intravenous access • To prevent infection.
management.

5.26 Observe the colour of
respiratory secretions.
• Yellow or yellow green sputum is
5.27 Observe the appearance of indicative of respiratory
urine. infection.

• Cloudy or foul smelling urine is
Risk for Constipation. indicative of urinary tract
5.28 Assess usual pattern of infection.
elimination. Evaluate usual
dietary habits and compare with
hospital regime. • Changes in mealtimes, types of
food and anxiety related to
hospitalisation can lead to
5.29 Evaluate current medication constipation.
usage, which may contribute to
constipation e.g.narcotics,
antacids, antidepressants, iron • To prevent constipation.
and calcium supplements.

5.30 Encourage and provide a daily


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fluid intake of 2-3 litres per day
(if not medically contra- • To promote healing and well
indicated). Encourage a high being.
fibre diet e.g. fruit, vegetables,
bran etc.

6.0 References
6.1 Apley, A.G., Solomon, L. (1993) Apley’s System of Orthopaedics and
Fractures. 7th Edition.Butterworth Heinemann.

6.2 Black, Matassarin, Jacobs (1993). An Introduction to Orthopaedic
Nursing 2nd Edition. Naon Productions.

6.3 Davis, P.S. (1996) Nursing the Orthopaedic Patient. Churchill
Livingstone.

6.4 Evans A. (1991) Sensible Stockings. Nursing Times 87 (51) 40-41.

6.5 Todd B.,Sitzman M.D. (1998) Prevention of Perioperative Deep Vein
Thrombosis and Pulmonary Embolism.

6.6 Schoen D.C. (2000). Adult Orthopaedic Nursing.1st Publication
Philadelphia Lippincott.

7.0 Appendices
7.1 Pedal Pulse: The posterior Tibialis pulse is located behind and
just above the medial malleolus of the ankle. The dorsalis pedis
pulse is located on the mid-dorsum of the foot above the second
third digit.
(Black, Matassarin, Jacobs 1993).

7.2 Homans sign: Forced dorsiflexion of the foot causing discomfort
in the upper calf. (An Introduction to Orthopaedic Nursing 2nd
Edition) Naon Productions.

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