Nursing care of patient on traction

1. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U.012.
Revision No: 0
Page:1
No of Pages: 9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
Written by:
Nursing staff of the Regional Orthopaedic Unit.
Title:
Approved by:
Ms. Fiona McMahon.
Title:
D.N.M.
Document Routing
Draft Released Approved Distribution
Date: October 03
Sign: F. McMahon.
Date: November
03
Sign: F.
McMahon.
Date: January 04
Sign: F.
McMahon.
Date: March,
2005
Sign: W.
Harding
QA Template 002 Rev 2 January 2005
This is a controlled document and may be subject to change at any time.
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.

2. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U. 012.
Revision No: 0
Page: 2
No. Of Pages:9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
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.

3. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U. 012.
Revision No: 0
Page: 3
No. Of Pages:9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
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.
Knowledge Deficit.
5.1 Explain the purpose of traction
related to injury and healing
process. Explain the traction
apparatus. For skeletal traction
explain pin insertion and removal
procedures and care of pin-sites.
Maintaining activities of daily living
while in traction.
Pain Management.
5.2 Assess the patient’s level of
pain and administer analgesia
as prescribed.
5.3 Explain that traction
decreases muscle spasms and
will gradually help lessen pain.
Rationale.
· Providing information helps
alleviate anxiety and enables the
patient to retain further
information and instructions.
· To monitor the effectiveness of
the prescribed analgesia
· Patient’s treated in traction have
pain due to soft tissue and bone
trauma.
· Diversionary activities (books,

4. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U. 012.
Revision No: 0
Page: 4
No. Of Pages:9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
5.4 Eliminate additional sources
of pain by providing comfort
measures.
5.5 Assess for correct positioning
of traction and alignment of
affected extremity.
Risk for Impaired Skin Integrity
5.6 The patient’s Waterlow Score
is assessed. Assess skin over
bony prominences (sacrum,
trochanters, scapulae, elbows,
heels, inner and outer
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.
5.7 The decision to nurse the
patient on a pressure-relieving
mattress depends on the
nurses clinical judgement.
5.8 Maintain correct padding for
affected extremity in traction,
keep bed-linen wrinkle free and
dry.
games, television etc), heat or
cold treatments and position
changes.
· Incorrect positioning and
malalignment can be sources of
pain.
· Frequent repositioning is
required to alleviate pressure
pain and discomfort. A thorough
skin assessment should be
carried out each time the
patient is repositioned.
· These measures help to
minimise the risk of
complications of skin
breakdown.
· Pressure areas and skin irritation
can develop under or at the edge
of traction device.
· The urea in urine turns into

5. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U. 012.
Revision No: 0
Page: 5
No. Of Pages:9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
5.9 Assess for faecal or urinary
incontinence, clean and dry skin
daily.
Impaired Physical Mobility.
5.10 Instruct in the use of
assistance devices i.e. Monkey
pole.
5.11 Teach strengthening exercises
to affected limb and other limbs
as appropriate.
5.12 Encourage activities of self-
care and the use of the trapeze
if the patient’s arms will allow.
High risk of injury.
Traction Device:
5.13 Keep weights hanging freely,
tighten all traction equipment
and secure all knots.
5.14 Cords should be checked daily
for fraying, particularly where
they pass over pulleys.
5.15 Pointed ends of pins or wires
should be covered with cork or
adhesive tape.
5.16 Bed aids such as cradles
ammonia within minutes, and is
caustic to the skin. Faeces may
contain enzymes that cause skin
breakdown.
· To promote independence.
· Exercises should be active to
prevent muscle atrophy and joint
stiffness, which occur quickly in
the situation of reduced mobility.
· To promote independence.
· The traction system should be
checked thoroughly at least daily
and always after interventions
such as physiotherapy and x-ray.
· To maintain a safe environment.
· To protect the patient from
accidental injuries.
· For comfort, and to ensure free
running of traction cords.

6. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U. 012.
Revision No: 0
Page: 6
No. Of Pages:9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
should be used to keep
bedclothes away from the
patient as necessary.
Pin-sites:
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.
5.18 Maintain asepsis during pin-
site dressing. See guidelines on
pin-site care/dressing.
5.19
Monitor the patient for signs
and symptoms of neurovascular
compromise, comparing findings
to the unaffected limb.
a)
Check for diminished or absent
pedal pulses. (See appendix 1)
b) Check for capillary refill time >3
seconds.
c) Observe for pallor, blanching,
cyanosis and coolness of
extremity.
d) Check for complaints of
abnormal sensations, e.g.
tingling and numbness.
e) Observe for increased pain not
· Promotes early detection and
prompt treatment.
· To prevent infection.
· Careful monitoring enables early
detection. The traction
equipment may through
increased pressure on nerves
and blood vessels cause
temporary or permanent
damage.
ü Surgical trauma causes swelling
and oedema, which can
compromise circulation and
compress nerves.
ü Prolonged capillary refill time
points to diminished capillary
perfusion.
ü These signs may indicate
compromised circulation.
ü These symptoms may result
from nerve compression.
ü Tissue and nerve ischaemia
produces a deep, throbbing
unrelenting pain.

7. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U. 012.
Revision No: 0
Page: 7
No. Of Pages:9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
controlled by medication.
5.20 Assess the affected extremity
for signs and symptoms of altered
perfusion of compartment
syndrome. (See guideline on
Compartment Syndrome.)
Risk for Deep venous
thrombosis/Pulmonary
embolus.
5.21 Ensure anti-embolic stockings
are fitted on both limbs.
5.22 Continuously assess the
patient for signs and symptoms
of:
Deep Venous Thrombosis
Positive Homan’s Sign (See
appendix 2)
Swelling of leg,
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.
· Compartment syndrome results
from severe tissue swelling that
decreases blood flow, causes
ischaemia and may cause
permanent motor/sensory
damage.
· Elastic stockings have been
shown to reduce the risk of
D.V.T. by about 25%
(Todd&Sitzman 1998).
Compression stockings must be
used correctly, otherwise they
may become a cause rather than
a deterrent of D.V.T. (Evans,
1991).
· Early detection and treatment.

8. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U. 012.
Revision No: 0
Page: 8
No. Of Pages:9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
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
changes, catheter care and
handling, and peripheral
intravenous access
management.
5.26 Observe the colour of
respiratory secretions.
5.27 Observe the appearance of
urine.
Risk for Constipation.
5.28 Assess usual pattern of
elimination. Evaluate usual
dietary habits and compare with
hospital regime.
5.29 Evaluate current medication
usage, which may contribute to
constipation e.g.narcotics,
antacids, antidepressants, iron
and calcium supplements.
5.30 Encourage and provide a daily
· To prevent complications of deep
venous thrombosis or pulmonary
embolus.
· To promote early detection and
treatment if necessary.
· To prevent infection.
· Yellow or yellow green sputum is
indicative of respiratory
infection.
· Cloudy or foul smelling urine is
indicative of urinary tract
infection.
· Changes in mealtimes, types of
food and anxiety related to
hospitalisation can lead to
constipation.
· To prevent constipation.

9. Limistéar Lár Tíre
Midland Area
Department
Orthopaedic
Guideline
GL No: R.O.U. 012.
Revision No: 0
Page: 9
No. Of Pages:9
Date: January 04
Guideline Title: Nursing care of a patient on Traction.
fluid intake of 2-3 litres per day
(if not medically contra-
indicated). Encourage a high
fibre diet e.g. fruit, vegetables,
bran etc.
· To promote healing and well
being.
6.0 References
6.1Apley, A.G., Solomon, L. (1993) Apley’s System of Orthopaedics and
Fractures. 7
th
Edition.Butterworth Heinemann.
6.2 Black, Matassarin, Jacobs (1993). An Introduction to Orthopaedic
Nursing 2
nd
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.1
st
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 2
nd
Edition) Naon Productions.