Care of patient with Traction.pptxforbsn

useful for nursing

1. Traction Mr Yogendra Mehta Lecturer HOD(AHD), BRNC

2. Introduction Traction is defined as an act of drawing or exerting a pulling force applied to limbs, bones, or other tissues along the longitudinal axis of the structure to pull the tissues apart, often for realignment. When limb becomes painful as a result of inflammation or fracture the controlling muscles go into spasm and can produce deformity which impairs the future function of limb. Traction when applied to the injured limb can over come the effect of original deforming forces.

3. Introduction... The actual resultant pulling force is somewhere between the two lines of pull. The effects of traction are evaluated by X-ray studies and adjustments are made as necessary. Traction is normally used as a short term intervention until other modalities such as external and internal fixators are possible.

4. Purposes Reduce a fracture Reduce dislocation of a joint Relieve pain Rest the limb in functional position Aid in healing of bone. To relieve pressure on nerves. To regain normal length and alignment of the bone Overcome muscle spasm and deforming forces. Correction of soft tissue contractures by pulling them gradually. To reduce and immobilize a fractured bone.

5. Principles Whenever traction is applied, counter-traction must be used to achieve effective traction. Counter-traction is the force acting in the opposite direction. Usually the patient body weight and bed position adjustment supply the needed counter-traction. The traction must be continuous to be effective in reducing and immobilizing fractures. Skeletal traction is never interrupted.

6. Principles... Weighs 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 the traction is applied. Ropes must be unobstructed. Weights must hang freely and must not rest on the bed or floor. Knots on the rope or the footplate must not touch the pulley or the foot of the bed.

7. NURSING ASSESSMENT RELATIVE TO PRINCIPLES COUNTER TRACTION-Is a force that counteracts the pull of traction. Keep the bed flat. Foot& bed should be elevated. Change the position of the patient . Assist the patient in lifting himself.

8. CONTD… FRICTION Check the - Weight applied. Knots Footplates &splints. Bed- linen.

9. KNOTS & WEIGHTS

10. CONTD… LINE OF PULL Patient position should be checked to see that his body is resting in line or not. Care should be taken when changing the position. CONTIOUSNESS Tapes should not be slipping . Check continousness of the traction frequently. POSITIONING Provide good body alignment . Provide support . Elevate head end of the bed.

11. NURSING RESPONSIBILITIES PRIOR TO APPLICATION OF TRACTION - ASSESSMENT PHYSICAL ASSESSMENT- History taking. Inspection of skin area. Assess the neurovascular status. Identify any pain.

12. CONTD.. PSYCHOLOGICAL ASSESSMENT- Explain about the procedure ,it’s purposes. Reassure the patient . Be with the patient during the procedure.

13. CONTD… ASSISTING WITH TRACTION APPLICATION - All equipments should be kept ready. Maintain aseptic technique . Reassure the patient . Be sure to hang the weight in a slow manner. ASSISTING WITH TRACTION APPLICATION - All equipments should be kept ready. Maintain aseptic technique . Reassure the patient . Be sure to hang the weight in a slow manner.

14. Essential Materials Needed Firm mattress or a bed board. Facility to elevate the head end and foot end of the bed. An overhead frame, trapeze, monkey ropes and side rails to shift the position of the patient. Bars, pulleys, ropes, wt. hangers, skeletal traction apparatus and plaster cast materials. Traction must always be opposed by counter traction. Constant care and vigilance to avoid all the hazards of prolonged bed rest

15. Bohlers striuup with steinmann pin Bohlers Stiruup with steinman pin Applied as skeletal traction

16. Bohler Braun frame

17. TYPES OF TRACTION There are mainly of two types: Skin traction Adhesive Skin Traction Non Adhesive Skin Traction Skeletal traction

18. SKIN TRACTION Skin traction is traction applied to the skin. Skin traction can be achieved by using a weight to pull on a traction tape or on a foam boot attached to the skin. The amount of weight applied must not exceed the tolerance of the skin. No more than 2-3.5 kg(4.5-8 lb) of traction can be used on an extremity. Pelvic traction is usually 4.5-9 kg (10-20 lbs) depending on the weight of the patient. Maximum weight: Recommended is 6.7kg (depending on size and age of patient ) (1/10 th the body weight).

19. Mechanism: SKIN TRACTION Traction force is applied over a large area. Load is spread and is more comfortable and efficient. Force applied is transmitted from skin to the bones, via the superficial fascia, deep fascia and intermuscular septa. For better efficiency, the traction force is applied only to the limb distal to the fracture.

20. Methods of applying Skin Traction Adhesive Skin Traction Non Adhesive Skin Traction

21. 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. Use adhesive strapping which can be stretched only transversely. Avoid placing adhesive strapping over bony prominences. Leave a loop of 2 inches ( 5cm) projecting beyond the distal end of limb to allow the movement of finger / foot.

22. Adhesive Skin Traction Always leave a free skin between the straps Must not be too tight or too loose Leave the heels free Can be safely used for 4- 6 weeks

23. Non Adhesive Skin Traction This consists of lengths of soft, ventilated latex foam rubber, laminated into a strong cloth backing. These are useful in thin and atrophic skin or when there is sensitivity to adhesive strapping. It is applied in similar fashion as adhesive skin traction As the grip is less secure, frequent reapplication may be necessary Attached traction weight should not be more than 4.5kg (10 lbs )

24. Types of Skin Traction BUCK’S TRACTION CERVICAL HEAD HALTER PELVIC BELT

25. Indications Temporary management of femoral neck fractures and intertrochanteric fractures. Management of femoral shaft fractures in older and hefty children. Undisplaced fracture of acetabulum. After reduction of a dislocation of the hip. Prevent minor fixed flexion deformities of the hip or knee. Management of low back ache. Post Gullitone amputation to approximate the tissues. Note: All of the tissues from the skin to bone are cut at the level of the ankle without creating flaps of soft tissues.

26. Contraindications Abrasion & Laceration of skin. Dermatitis. Any fragile condition of skin. Impairment of circulation- varicose ulcers, Impending gangrene. Marked shortening of bony fragments where more traction weight has to be applied.

27. Complications Allergic reaction to adhesive. Excoriation of skin from slipping of adhesive strapping. Pressure sores around malleoli & tendoachilles . Common peroneal nerve palsy .

28. COMMON SKIN TRACTION BUCK’S TRACTION HAMILTON RUSSEL TRACTION GALLOW’S OR BRAYANT’S TRACTION PELVIC TRACTION DUNLOP TRACTION

29. Bucks Traction Femoral neck fracture Inter Trochanteric fracture After reduction of a hip dislocation To correct minor flexed deformities of the hip or knee Management of low back pain. Not more than 4.5 kgs .

30. Russel’s Traction Used in femur trochanteric Fracture. Bucks with sling.

31. Bryants / GALLOWS traction Fracture shaft of femur in <2yrs age. Skin traction is applied to both legs child is suspended from a beam Raise mattress for counter traction Rarely used currently.

32. Perkins Traction Treatment of tibia and femur from the sub trochanter region distally. Denham pin is inserted through upper end of tibia for fracture of femur, the mid tibia for fracture of condyles of tibia.

33. Agnus Hunt T raction Agnus hunt traction is used for correction of mild flexion deformity of hip joint in poliomyelitis.

34. Dunlop’s Traction Used for supracondylar and transcondylar fractures in children. Forearm skin traction with weight on upper arm. Elbow flexed at 45 degrees.

35. NURSING MANAGEMENT GOAL- To prevent skin or neuro vascular problems. To prevent from potential complications. ENSURING EFFECTIVE TRACTION Avoid wrinkling & slipping of the traction bandage. Provide proper positioning. Bandages & tapes & other “soft goods’’are applied in a correct way.

36. CONTD… MONITORING & MANAGING POTENTIAL COMPLICATIONS SKIN BREAK DOWN - Monitor the reaction of the skin. Assist patient in personal hygiene procedures. Palpate the area of traction tapes daily. Inspect the skin, ankle, achilles tendon three times a day. Provide back care every two hourly . Inspect skin specially pressure points. Provide comfort devices . Change the position of the patient frequently.

37. CONTD… NERVE – PRESSURE Avoid pressure on peroneal nerve. Check sensation & movement . Immediately investigate any complaint of the patient. Report altered sensation or motor function. CIRCULATORY IMPAIRMENT Assess the circulation of foot or hand. Check for- Peripheral pulses Color & capillary refill & temperature. Indicators of deep vein thrombosis. Encourages the patient to perform active foot exercises.

38. SKELETAL TRACTION It may be used as a means of reducing or maintaining the reduction of a fracture. It should be reserved for those cases in which skin traction is contraindicated.

39. Contd …. Steel pins of varying lengths 4 – 6 mm in diameter. Bohler stirrup is attached to steinmann pin which allows the direction of the traction to be changed without turning the pin in the bone.

40. Contd ….. Denham Pin Identical to stienmann pin except for a short threaded length in the center . This threaded portion engages the bony cortex and reduce the risk of the pin sliding.

41. Contd …… Kirschner wire They are easy to insert and minimize the chance of soft tissue damage and infections, It easily cuts out of the bone if a heavy traction weight is applied, Most commonly used in upper limb eg . Olecranon traction

42. Application Use GA or LA. Paint the skin with iodine and spirit. Mount the pin/wire on the hand drill. Identify the site of insertion and make a stab wound. The pin should pass only through skin, SC tissue and bone avoiding muscles and tendons.

43. Crutchfield Traction To hyper extend the head and neck of patients with fractured cervical vertebrae for the purpose of immobilizing and aligning the vertebrae.

44. Recommended traction weights Level Minimum weight Maximum weight C1 2.3 kg 4.5 kg C2 2.7 kg 4.5 to 5.4 kg C3 3.6 kg 4.5 to 6.7 kg C4 4.5 kg 6.7 to 9.0 kg C5 5.4 kg 9.0 to 11.3 kg C6 6.7 kg 9.0 to 13.5 kg C7 8.2 kg 11.3 to 15.8 kg

45. Complications

46. C ommon nursing problems encountered Impaired Physical Mobility Risk for Impaired Skin Integrity Risk for Infection Ineffective Tissue Perfusion

47. Nursing management

48. Minimizing the Effects of Immobility Encourage active exercise of uninvolved muscles and joints. Encourage deep breathing and coughing. Auscultate lung fields twice per day. Encourage fluid intake of 2,000 to 2,500 ml daily . Provide balanced high- fiber diet rich in protein. Prevent pressure on the calf, to prevent thrombophlebitis. Check traction apparatus at repeated intervals.

49. Maintain Skin Integrity Examine bony prominences frequently for evidence of pressure or friction irritation. Observe for skin irritation around the traction bandage. Observe for pressure at traction skin contact points. Report complaint of burning sensation under traction. Relieve pressure without disrupting traction effectiveness.

50. Avoid Infection at Pin Site Watch for signs of infection, especially around the pin tract. Monitor vital signs for fever or tachycardia. If directed, clean the pin tract with sterile applicators and apply the prescribed solution/ ointment

51. Promoting Tissue Perfusion Assess motor and sensory function of specific nerves that might be compromised . Determine adequacy of circulation ( eg , colour, temperature, motion, capillary refill of peripheral fingers or toes ). Report promptly if change in neurovascular status is identified.

52. MNEMONICS CARE OF CLIENT IN TRACTION T Temperature R Ropes hang freely A Alignment C Circulation check (5 P’s) T Types and location of fracture I Increase fluid intake O Overhead Trapeze N No weights on bed or floor Extremity infection

53. Circulation assessment 5p’s P AIN P ULSE P ALLOR P ARESTHESIA P ARALYSIS ouch Can u move this

54. THANKS