Adm Traction.pdf

PROTOCOL FOR SKIN TRACTION

Submitted to:Mrs Reena Vincent Professor JMCON Thrissur

Submitted by:Mrs Bitha P B II Year Msc Nursing JMCON Thrissur

INTRODUCTION In the modern day, the development of aseptic techniques, antibiotics and surgical techniques have all combined so that surgical treatment is now the preferred method of treatment. However, traction is still used in some cases .In the medical field, traction refers to the practice of slowly and gently pulling on a fractured or dislocated body part. It’s often done using ropes, pulleys, and weights. These tools help apply force to the tissues surrounding the damaged area

DEFINITION Traction is force applied by weights or other devices to treat bone or muscle disorders or injuries.

PURPOSE •To relieve pain due to muscle spasm, maintaining the limb in a position of comfort and rest. • To restore and maintain alignment of bone following fracture and dislocation. •To help restore blood flow and nerve function. • To allow treatment and dressing of soft tissues. •To rest injured or inflamed joints, and maintain them in a functional position. • To allow movement of joints during fracture healing. •To gradually correct deformities dueto contraction of soft tissues, caused by disease or injury. • To allow the patient to be moved with ease

TYPES There are two major types of traction: skin and skeletal traction, within which there are a number of treatments. 1. Skin traction Skin traction includes weight traction, which uses lighter weights or counterweights to apply force to fractures or dislocated joints. Weight traction may be employed short-term, (e.g., at the scene of an accident) or on a temporary basis (e.g., when weights are connected to a pulley located above the patient's bed). The weights, typically weighing five to seven pounds, attach to

the skin using tape, straps, or boots. They bring together the fractured bone or dislocated joint so that it may heal correctly.  In obstetrics, weights pull along the pelvic axis of a pregnant woman to facilitate delivery.  In elastic traction, an elastic device exerts force on an injured limb.  Skin traction also refers to specialized practices, such as Dunlop's traction, used on children when a fractured arm must maintain a flexed position to avoid circulatory and neurological problems.  Buck's skin traction stabilizes the knee, and reduces muscle spasm for knee injuries not involving fractures.  In addition, splints, surgical collars, and corsets also may be used.

2. Skeletal traction Skeletal traction requires an invasive procedure in which pins, screws, or wires are surgically installed for use in longer term traction requiring heavier weights. This is the case when the force exerted is more than skin traction can bear, or when skin traction is not appropriate for the body part needing treatment. Weights used in skeletal traction generally range from 25–40 lbs (11–18 kg). It is important to place the pins correctly because they may stay in place for several months, and are the hardware to which weights and pulleys are attached. The pins must be clean to avoid infection. Damage may result if the alignment and weights are not carefully calibrated.  Other forms of skeletal traction are tibia pin traction, for fractures of the pelvis, hip, or femur; and overhead arm traction, used in certain upper arm fractures.  Cervical traction is used when the neck vertebrae are fractured.

ESSENTIAL PRINCIPLES • The grip or hold on the patient’s body must be adequate and secure. • Provision for counter traction must be made. • There must be minimal friction on the cords and pulleys. •The line and magnitude of the pull, once correctly established, must be maintained. •There must be frequent checks of the apparatus and of the patient to ensure that: -the traction set-up is functioning as planned. - the patient is not suffering any injury as a result of the traction treatment.

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The grip or hold on the body is achieved:

- manually -via theskin -via the bone. 

Poorly applied traction can cause considerable discomfort to the patient, and may retard rehabilitation. It is important, therefore, that staff responsible for setting up and maintaining traction are

thoroughly familiar with the principles of traction, so that the mechanics of each type of traction set-up are well understood.

INDICATIONS  Temporary management of neck of femur fracture.  Femoral shaft fracture in children  Un displaced fracture of acetabulum.  After reduction of dislocation of Hip.  To correct minor fixed flexion deformities of hip and knee.

APPLICATION Adhesive skin traction : Prepare the skin by shaving as well as washing & applying tincture benzoin which protects the skin and acts as an additional adhesive. Avoid placing adhesive strapping over bony prominences, if not, cover them with cotton padding and do the strapping. Leave a loop of 5 cm projecting beyond the distal end of limb to allow movement of fingers and foot. Non adhesive skin traction :Useful in thin and atrophic skin. Frequent reapplication may be necessary. Attached traction wt. must not be more than 4.5 kgs.

EQUIPMENT • one adhesive or non-adhesive traction kit • crêpe bandages (if not in the kit) • padding (if not integral to the kit) • tape

• scissors

If you are using counter traction, you will need: • traction cord • weights and carriers • balkan beams • cross bars • two pulleys • spreader plate(if not in traction kit).

PROCEDURE

1. Explain the fitting of the traction to the patient and family 2. Check for allergies (do a patch test if necessary) – hypoallergenic kits are available if the patient has skin sensitivities 3. Ensure patient has received prescribed analgesia. 4. Consider requesting a femoral nerve block from medical staff and/or use of inhalation analgesia (Entonox) if the patient has no contraindications, e.g. head injury or chest injury, and depending on the reason for traction. Skin traction is used post operatively as well as for fraction reduction Ensure bed is assembled for traction, before patient arrives 5. One HCP supports the limb in a neutral position 6. Prepare the skin (for adhesive traction only). The second HCP prepares the skin as per local policy. 7. If hair needs to be removed (adults only) clippers or depilatory creams are preferred methods. 8. If creams are to be used, a patch test may be necessary first 9. Adhesive/non-adhesive extension set can be cut to required length and ends rounded. 10. Before application of traction, perform a neurovascular assessment of the affected limb. 11. Check skin for cuts/abrasions/ rashes/ skin conditions/ fragile broken skin, etc. 12. Apply and maintain manual traction to the limb, keeping the leg in alignment. 13. Maintain check on Dorsalis pedis pulse. 14. Check neurovascular status of limb

15. Apply skin extension, making sure that tape is placed to medial and lateral aspects of the limb. 16. Ensure the skin extension tapes are free from creases and the foam padding is over the malleoli. 17. Leave sufficient room between the patient’s foot and the end of the skin extension. 18. Bandage the skin extension to the patient’s lower leg, using crêpe bandages 19. Avoid tight bandaging over the fibula head. 20. Avoid bandaging over the malleoli and the Achilles’ tendon 21. In children/young people the bandages may go to the top of the leg. 22. Secure the ends with tape. 23. Leave knee area exposed. 24. The position of the extensions both laterally and medially can be used to control rotation of the limb, i.e. by placing the lateral extension superiorly and the medial extension inferiorly, external rotation will be corrected 25. Suspending the limb: 26. Different methods exist to suspend the limb in the extensions. Choice depends on the type of bed and the traction equipment available in the hospital 27. Weight may be applied using a separate length of traction cord as per patient’s notes. 28. Elevate the foot of the bed

AFTER CARE Careers should: • remove and check bandages every 24 hours and whenever • not remove the extensions unless there are clinical indications • examine the skin integrity of the patient, and report any signs of skin damage to a nurse or doctor • check the extensions for wrinkles and adhesion and change only if necessary • check the patient’s limb for any neurovascular change or calf pain, and report this to the nurse or doctor If using counter traction, carers should: • always ensure the weights are connected securely and the traction cord and weights are checked at least daily, but usually as often as the patient is checked

• assess that the weight on the traction given is suitable. If the patient is moving either up or down the bed constantly, then either the weight is wrong or the amount of elevation. Inform the senior nurse and doctor about this and record the information in the patient’s notes • lower the bed for the patient to use a bedpan or urinal (bottle) and then put the counter traction straight back on.  Maintain skin integrity 

Patient’s legs, heels, elbows and buttocks may develop pressure areas due to remaining in the same position and the bandages.

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Position a rolled up towel/pillow under the heel to relieve potential pressure.

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Encourage the patient to reposition themselves or complete pressure area care four hourly.

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Remove the foam stirrup and bandage once per shift, to relieve potential pressure and observe condition patients skin.

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Keep the sheets dry.

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Document the condition of skin throughout care in the progress notes and care plan

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Ensure that the pressure injury prevention score and plan is assessed and documented.

 Traction care 

Ensure that the traction weight bag is hanging freely, the bag must not rest on the bed or the floor

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If the rope becomes frayed replace them

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The rope must be in the pulley tracks

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Ensure the bandages are free from wrinkles

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Tilt the bed to maintain counter traction

 Observations 

Check the patient’s neurovascular observations hourly and record

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If the bandage is too tight it can cause blood circulation to be slowed.

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Monitoring of swelling of the femur should also occur to monitor for compartment syndrome.

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If neurovascular compromise is detected remove the bandage and reapply bandage not as tight. If circulation does not improve notify the orthopaedic team.

 Pain Assessment and Management 

Assessment of pain is essential to ensure that the correct analgesic is administered for the desired effect

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Paracetamol, Diazepam and Oxycodone should all be charted and administered as necessary.

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Pre-emptive analgesia ensures that the patient’s pain is sufficiently managed and should be considered prior to pressure area care.

 Activity 

The patient is able to sit up in bed and participate in quiet activities such as craft, board games and watching TV

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Non-pharmacological distraction and activity will improve patient comfort.

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The patient is able to move in bed as tolerated for hygiene to be completed

CARE OF TRACTION APPARATUS •The traction system should be thoroughly checked at least once during each shift, and always after any intervention because the system may have in advertently been altered. Checks should always be carried out by a health care professional with the required knowledge and skills. • The traction apparatus should be kept clean and dust free. Only traction cord should be used for traction as it is designed not to stretch. It should be of correct strength and circumference to use the pulleys and other traction equipment. • The cords must be attached securely by standard non-slip knots, for example a clove hitch or two half hitches knot (see Knots). • The ends of the cords should be short (5cm), single length and continuous, not short knots which have been joined together • The line of pull of the traction cords should be correct and checked at least once during each working shift.This ensures the appropriate pulling force is applied for optimal therapeutic effect at all times.

•Pulleys should be free running: the cord must rest comfortably in the pulley track. Only one cord should run through each single pulley track, as this reduces friction and the possibility of the cord fraying. •The amount of weight should be prescribed and documented in the patient’s nursing records/medical notes. The prescribed weights should be maintained at all times. •The weights must hang freely and not be obstructed,otherwise the efficiency of the system cannot be maintained. • Caution should be taken when choosing traction equipment to ensure that it is compatible with the bed being used. • Weights should not be hung directly over the patient unless an extra safety cord is used and checked regularly. • The pointed ends of pins or wires used in the traction system (in skeletal traction) should be covered to prevent potential injury to the patient or health care professional. •The patient should be managed on an appropriate mattress to give full support and comfort, plus allow sufficient traction to be maintained. • Bed attachments should be considered to help the patient to move as their condition allows. • Counter traction must be maintained at all times in any traction system. If counter traction is not present, the patient tends to be pulled in the direction of the traction force

SPECIFIC CARE FOR CHILDREN/YOUNG PEOPLE The care for children/young people is the same as shown in the plan above, but with some specific, further considerations. • Non-adhesive skin traction should always be the first choice. • If the child/young person is to have surgery then adhesive extensions should not go over the proposed surgical site. • The knee should have a pad behind it to keep the knee in 15 degrees of flexion. 

Careers need to take extra care with what they give younger children to eat and drink as there is a risk of choking – extra pillows will help.

• Fluids need to be encouraged as they are at risk of renal calculi. • Effective analgesia is essential so the child/young person is not frightened to use a bed pan/urinal.

COMPLICATIONS 

Skin breakdown/pressure areas

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Neurovascular impairment

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Compartment syndrome

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Joint contractures

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Constipation from immobility and analgesics

CONCLUSION Skin traction is a nonsurgical treatment option that can help heal fractured bones or orthopedic abnormalities. This treatment is often used for children, and almost always used to help treat leg injuries or abnormal leg development. Traction pulls the skin that lies on or near the affected bone, manipulating soft tissue and pulling the bone into a fixed, rigid position. This forces the bone to stay in the corrective spot. Skin traction should only be applied by a team of medical professionals, following a formal diagnosis and skin traction prescription.

REFERENCES 1. Clement I. basic concepts of nursing procedure. Second edition. New Delhi;Jaypee publications. 2.

Perry A G, Potter P A. clinical nursing skills & techniques. 6th edition. 2006. Elsevier mosby. USA

3. Proehl J A.emergency nursing procedure.Third edition.Missouri; Elsevier publications. 2004 4. Nancy sr. (2008)Principles & practice of nursing. 6 th edition 5. Jacob Annamma, R Rekha , Jadhav Sonali Tarachand.(2011) Clinical nursing procedures: the art of nursing practice 6. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/skin_traction 7. file:///C:/Users/hp/Downloads/PUB-004721%20(1).pdf 8.

https://www.surgeryencyclopedia.com/St-Wr/Traction.html#ixzz5aZdx25je