Traction

Traction is the application of a pulling force to a part of the body.
It is used primarily as a short term interventions.
Traction produces physical &
emotional frustration.

1. CARE OF THE
PATIENT WITH TRACTION
Prepare by :
Arpana Bhusal
BNS

2. INTRODUCTION
Tractionistheapplicationofapulling
forcetoapartofthebody.
Itisusedprimarilyasashortterm
interventions.
Tractionproducesphysical&
emotionalfrustration.

3. DEFINITION
Traction means that a pulling force is
applied to a part of the body or an
extremity while a countertraction pulls in
the opposite direction.

4. PURPOSES
Provide alignment.
Reduce muscle spasms.
Prevent deformities.
Provide immobilization.
Increase space between opposing
surfaces.

5. PRINCIPLES
Have an opposite pull or traction.
Free from friction.
Continous.
Good body alignment.
Line of pull.

6. 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.

7. CONTD…
FRICTION
Check the -
Weight applied.
Knots
Footplates &splints.
Bed-linen.

8. KNOTS & WEIGHTS

9. 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.

10. CONTD..
CONTIOUSNESS
Tapes should not be slipping .
Check contiousness of the traction
frequently.

11. CONTD..
POSITIONING
Provide good body alignment .
Provide support .
Elevate head end of the bed.

12. NURSING
RESPONSIBILITIES
PRIOR TO APPLICATION OF TRACTION -
ASSESSMENT
oPHYSICAL ASSESSMENT -
History taking.
Inspection of skin area.
Assess the neurovascular status.
Identify any pain.

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

14. 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.

15. CLASSIFICATION
STRAIGHT TRACTION
SUSPENSION TRACTION

16. STRAIGHT TRACTION
CALLED AS RUNNING TRACTION.
POSITIONS USED-
FLAT
TILTED AWAY
ELEVATING HEAD OR KNEE.

17. SUSPENSION TRACTION
CALLED AS BALANCED TRACTION
DEVICES USED-
SLINGS
HAMMOCKS
SPLINTS

18. BALANCED TRACTION

19. SPLINTS & SLINGS

20. CLASSIFICATION CONTD…
SKIN TRACTION
SKELETAL TRACTION
MANUAL TRACTION

21. SKIN TRACTION
It is the application of a pulling force to
the skin & soft tissues.
MATERIALS USED-
Wrapping bandages
Tapes
Slings
Halters

22. Contd…
Uses-
Applied to skin & soft tissues.
Used to control muscle spasms.
Weight applied-
2 –3.5 kg.
For pelvic traction-
Depends on body weight
Usually 4.5-9 kg.

23. TYPES OF SKIN TRACTION
BUCK’S TRACTION
CERVICAL HEAD HALTER
PELVIC BELT

24. BUCK’S EXTENSION
TRACTION

25. PELVIC BELT

26. CONTD..
ADVANTAGES
Prevent source of infection.
No device is introduced into skeleton.
DIS-ADVANTAGE
Causes skin irritation.
Pressure problems.

27. CONTD..
CONTRA-INDICATIONS
Patient who have
Dermatitis
Diabetes
Varicose ulcers
Skin & soft tissue injury.
COMPLICATIONS
Skin break down
Nerve pressure
Circulatory impairment

28. NURSING MANAGEMENT
GOAL-
To prevent skin or neuro vascular
problems.
To prevent from potential complications.

29. CONTD..
ENSURING EFFECTIVE TRACTION
Avoid wrinkling & slipping of the traction
bandage.
Provide proper positioning.
Bandages & tapes & other “soft
goods’’are applied in a correct way.

30. 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.

31. CONTD..
Provide back care every two hourly .
Inspect skin specially pressure points.
Provide comfort devices .
Change the position of the patient
frequently.

32. PREVENT FROM
PRESSURE ULCERS

33. CONTD..
NERVE –PRESSURE
Avoid pressure on peroneal nerve.
Check sensation & movement .
Immediately investigate any complaint
of the patient.
Report altered sensation or motor
function.

34. CONTD…
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.

35. SKELETAL TRACTION
It is applied directly to the bone by use
of a metal pin or wire that is inserted
through the bone distal to the fracture .
USES
Fractures of femur, cervical spine.
Displaced fractures of pelvis & proximal
end of tibia, calcaneus, proximal ulna.

36. SKELETAL TRACTION

37. CONTD..
DEVICES USED-
Steinmann pin
Kirschner wire
Crutchfield tong.
INSERTION OF DEVICE-
Preparation of skin.
Use aseptic technique.
Prevent from complcations.
Prepare the articles required .

38. SKELETAL TRACTION

39. NURSING MANAGEMENT
GOALS-
To prevent from infection.
To improve the general condition of the
patient.
To prevent from injury.
oINTERVENTIONS-
oMAINTAINING EFFECTIVE TRACTION
Check position, ropes , apparatus.

40. CONTD..
MAINTAINING POSITIONING
Maintain alignment of patient’s body.
Support the patient’s foot in a neutral
position.
Avoid footdrop,inward
movement,outward rotation.

41. CONTD…
PREVENTING SKIN BREAKDOWN
Protect elbows & heels from injury.
Inspect for preessure ulcers.
Encourage movement of body part.
Provide back care frequently.
Special precaution should be taken while
doing procedure.
Provide special comfortable devices.

42. CONTD…
MONITORING NEUROVASCULAR
STATUS
Check neurovascular status every hour.
Encourage to do exercise.
Check for DVT.
Anticoagulant therapy
Provide elastic stockings,compression
devices.

43. CONTD…
PROVIDING PIN SITE CARE
Use aseptic technique while dressing.
Check for complications.
Avoid infection& development of
osteomyelitis.
Check the insertion site.

44. CONTD…
PROMOTING EXERCISE
Encourage movement of unaffected
part.
Explain range of motion exercises.
Provide conducive environment to the
patient.
Teach isometric exercises to the
patient.

45. MANUAL TRACTION
It is used to tying to mobilize soft
tissues& to treat hypomobility.
It is applied with hands.
It is a temporarily measure used in
neck-injury .
It is also used to apply the necessary
pull to an extremity when cast is
applied.

46. COMPLICATIONS
PRESSURE ULCERS
HYPOSTATIC PNEUMONIA
THROMBOPHLEBITIS
OSTEOPOROSIS
ANOREXIA
URINARY STASIS & INFECTION
DEEP VEIN THROMBOSIS

48. NURSING MANAGEMENT
ASSESSMENT
PHYSICAL ASSESSMENT
Assess & monitor the movement .
Assess neurovascular status.
Assess skin integrity.
Assess for potential complications.

49. CONTD..
PSYCHOLOGICAL ASSESSMENT
Assess level of anxiety & response to
traction.
Explain about the procedure.
Assess the economic status .
Assess the coping mechanisms used by
the patient.

50. NURSING MANAGEMENT
NURSING DIAGNOSIS
Acute pain r/t musculo skeletal disorder
as evidenced by facial expression of the
patient.
GOAL-
To relief from pain.
To make the patient comfortable.

51. CONTD…
INTERVENTIONS-
Assess the intensity,frequency of pain.
Maintain immobilization of affected part.
Provide medication as prescribed by
physician.
Elevate & support the injured extremity.

52. CONTD….
Encourage patient to discuss problems.
Provide recreational activities.
Explain procedures before performing.
Avoid use of plastic sheets,pillows.
Investigate any reports of pain.

53. CONTD..
NURSING DIAGNOSIS
Impaired physical mobility r/t application
of traction as evidenced by decreased
muscle strength,limited ROM.
GOAL-
To maintain mobility at highest level.
To increase function of affected part.
To maintain position of body part.

54. CONTD…
INTERVENTIONS-
Assess degree of immobility .&
Note patient’s perception of immobility.
Encourage participation in diversional
activities.
Instruct patient in active & passive
exercise.
Assist the patient in self-care activities.

55. CONTD…
Assist with mobility by means of
assistive devices.
Reposition periodically & encourage
deep breathing & coughing exercises.
Provide comfortable bed & conducive
environment.

56. CONTD…
NURSING DIAGNOSIS
Risk for impaired skin integrity R/ T
insertion of traction pins,wires, screws
as evidenced by reports of itching,
disruption of skin surface
GOALS-
To improve the skin integrity.
To prevent the itching.
To prevent from pressure ulcers..

57. CONTD..
INTERVENTIONS-
Examine the skin for rashes,
discoloration,itching.
Cleanse the skin with warm ,soapy water.
Maintain the personal hygiene of the patient.
Apply emollients regularly.
Change the position of the patient frequently.
Provide moist free bed& air mattress..

58. CONTD..
Palpate taped tissues daily& document
if any tenderness or pain.
Remove skin traction every 24 hr
inspect & give skin care.
Place protective padding under leg &
over bony prominences.

59. CONTD…
NURSING DIAGNOSIS-
Self-care deficits r/t application of
traction, fracture .
GOALS-
To make the patient as independent as
possible.
To enhance the self-esteem of the
patient.

60. CONTD..
INTERVENTIONS-
Assess the general condition of the
patient.
Assist the patient in self-care activities.
Kept all articles near by patient as
required by the patient.
Maintain an environment in which
patient’s independence is maximum.

61. CONTD..
NURSING DIAGNOSIS-
Anxiety r/t health status & traction
devices as evidenced by frustration,
frequent asking of questions
GOALS-
To remove anxiety.
To educate about adaptive techniques.

62. CONTD..
INTERVENTIONS-
Explain each & every procedure before
doing.
Reassure the patient & family members.
Provide diversional therapies to patient.
Provide time to patient to ventilate his
feelings& explore problems.
Provide emotional support to the patient.

63. CONTD..
Encourage the patient to participate in
activities.
Educate the patient to use coping skills
& positive thinking.

64. PATIENT EDUCATION
Explain traction in relation to fracture &
plan of treatment.
Explain amount of movement permitted &
how to achieve it.
Explain correct body positioning.
Explain about traction devices like
splints, weights etc..
Explain about personal hygiene &
pressure ulcers.

65. CONTD…
Explain about complications.
Explain about range of motion &
isometric exercises.
Explain about self-care activities.