Traction

TRACTION 1. TRACTION a. the application of a pulling force to a part of the body b. used to minimize muscle spasms c. to reduce, align, and immobilize fractures d. to reduce deformity e. to increase space between opposing surfaces – for someone w/lower back pain f. prevent soft tissue damage – a broken bone or slipped disc impinging upon soft tissue &/or nerves g. can be applied in more than 1 direction – when this is done, one of the lines counteracts the other h. the effects of traction are evaluated w/x-rays i. used for short-term intervention 2. PRINCIPLES a. countertraction must be used to achieve effective traction – this is the force acting in opposite direction b. usually the person’s body weight and bed position adjustments supply the needed countertraction c. traction must be continuous to be effective d. SKELETAL traction is never interrupted e. weights are not removed unless intermittent traction is ordered f. Factors affecting the pull 1. patient must be in good body alignment in the CENTER of the bed when traction is applied 2. ropes must be unobstructed 3. weights must hang free and not rest on bed or floor 4. knots in rope or the footplate must not touch the pulley or foot of bed 3. TYPES OF TRACTION a. Straight or Running traction – applies the pulling force in a straight line w/body part resting on bed (Buck’s Traction) b. Balanced Suspension traction – supports the affected extremity off the bed, and allows for some patient movement without disruption of the line of pull 4. METHODS OF TRACTION a. Skin traction b. Skeletal traction 5. SKIN TRACTION a. used to control muscle spasms and to immobilize an area before surgery b. a weight is used to pull on traction tape or a foam boot attached to the skin c. amount of weight applied must not exceed tolerance of skin (duh!) 1. 4.5 - 7 lbs – extremity (book says 4.5-8) 2. 10-20 lbs – pelvic traction – depends on pt’s weight d. Examples 1. Cervical head halter a. used to treat neck, shoulders, upper arm, fingers pain & numbness b. C 4,5,6 – most common area of cervix c. Look for pressure points d. teach patient about pressure points 2. Pelvic Belt a. to treat back pain b. intermittent pelvic sling which releases back, hip, and leg pain 3. Buck’s Traction – lower leg a. used BEFORE surgical fixation b. inspect skin for abrasions and circulatory problems before applying boot c. clean and dry d. To Apply – one nurse elevates and supports the extremity under the patient’s heel and knee while another nurse places the foam boot under the leg, with the heel down into the boot. Velcro straps around the leg. e. Traction tape overwrapped w/elastic bandage in a spiral fashion may be used instead of boot f. avoid excessive pressure over malleolus, fibula – prevents ulcers, nerve damage g. pass the rope affixed to the spreader or footplate over pulley fastened to the end of the bed – attach weight – usually 3-5 lbs h. NO HOB ↑ - flat – no big pillows under leg either e. This is an intermittent traction – can take off to inspect and clean skin

f. Complications 1. skin breakdown a. from irritation by contact of skin w/tape or foam & shearing forces b. Elderly @ ↑ Risk c. identify sensitive, fragile skin during the initial assessment d. closely monitor for reaction e. remove boots to inspect skin, ankle, Achilles tendon 3/day – A second nurse is needed to support the extremity during inspection and skin care f. palpate area under traction tape for skin tenderness g. provide back care q 2 hrs – prevents pressure ulcers 2. nerve pressure a. from pressure on peripheral nerves b. Footdrop if pressure is applied to peroneal nerve at point at which it passes around the neck of the fibula, just below the knee c. question patient about sensation d. have patient move toes, foot e. Dorsiflexing the foot – functioning peroneal nerve f. Weakness of dorsiflex, or foot movement and inversion of foot – pressure on nerve g. Plantar flextion – functioning tibial nerve h. investigate c/o burning sensation under bandages or boot i. Call DR!! 3. circulatory impairment a. S&S - cold skin temp, ↓ pulses, slow cap refill, bluish skin b. assess circulation of foot or hand within 15-30 min after skin traction is applied c. then assess q 1-2 hrs d. active foot exercises q hour while awake 4. DVT – calf tenderness, swelling, + Homan’s g. Interventions 1. avoid wrinkling and slipping of the traction bandage 2. maintaincountertraction 3. proper positioning – leg in neutral position 4. no turning from side to side – can shift position slightly w/assistance 6. SKELETAL TRACTION a. applied directly to the bone w/a metal pin or wire (Steinmann pin, Kirschner wire) b. the pin is inserted into bone distal to fracture – avoiding nerves, BV, muscles, tendons, joints c. Femur, Tibia, Cervical Spine fractures d. Tongs applied to head – Gardner-Wells or Vinke tongs – for cervical spine fractures e. 15-25 lbs – weights applied initially must overcome the shortening spasms – once muscles relax, the traction weight is reduced f. usually Balanced traction g. Thomas splint w/Pearson attachment – fractures of femur – overbed frame is used h. Russell’s – fracture of tibia i. Dunlop’s – fracture of humerus, forearm, elbow j. Halo vest – cervical neck problem – neck stays in alignment – can be mobile k. Nursing Interventions 1. maintain effective traction a. check to see if ropes are in wheel grooves b. no fraying of ropes c weights hang freely d. knots in rope are secure e. evaluate position of patient – slipping down in the bed results in ineffective traction f. Never remove weights from skeletal traction – unless a life-threatening situation occurs 2. maintain position a. maintain alignment of body b. position foot to avoid Footdrop c. foot can be supported w/ortho devices 3. prevent skin breakdown a. check elbows – he may reposition himself w/elbows b. check heels c. encourage trapeze bar for moving d. assess pressure points - Lower extremity traction apparatus, you need to check ischial tuberosity,

popliteal space, Achilles tendon, heel , back of head e. provide back care f. keep bed dry, free of crumbs and wrinkles g. if pt can’t turn from side to side, nurse can push down on the mattress w/one hand to relieve pressure on the back and bony prominences h. Bed linen change – pt raises torso while nurses on both sides of bed roll down and replace the upper mattress sheet - then the patient raises buttocks off mattress, the nurses slide the sheets under the buttocks – then puts the lower section of sheets on i. Triple log roll - turn as a unit – 3 people 4. monitor neurovascular status a. initially q hour, then q 4 hours b. encourage exercises c. active flexion and extension of ankles d. isometric contraction of calf muscles 10 times an hour – decreases stasis 5. Provide pin site care a. Goal – to avoid infection and development of osteomyelitis (infection of the bone) b. pin care 3/day, q 8 hours c. should be no crusts 6. promote exercise 7. THE PATIENT IN TRACTION a. Assessment 1. consider the psychological & physiologic impact of the msk problem, traction device, and immobility 2. restricts mobility, independence 3. equipment looks threatening, frightening 4. monitor anxiety level a. frequent visits by the nurse can reduce feelings of isolation and confinement b. encourage family and friends to visit frequently c. encourage diversional activities 5. compare affected extremity to unaffected extremity b. Complications 1. Pressure Ulcers 2. Pneumonia a. auscultate q 4-8 hours b. deep breathing, coughing q 2 hrs c. IS 3. Constipation, Anorexia 4. Urinary Stasis, Infection 5. Venous Stasis, DVT **If using Countertraction – raise FOB