TRACTION for nursing students

A fundamental topic for nursing students

1. TRACTION SYED JUNAID NASEER B.Sc. Nursing 2022 [email protected]

2. outline INTRODUCTION DEFINITION PRINCIPLES PURPOSES TYPES OF TRACTION COMMONLY USED TRACTIONS COMPLICATIONS NURSING MANAGEMENT OF PATIENT WITH TRACTION

3. introduction Traction is a technique for realigning a broken bone or dislocated part of the body. It uses weights, pulleys, and ropes to gently put pressure on and pull a bone or injured body part back into the right position. The use of traction dates as far back as 3000 years ( Ancient Egyptians ). Used extensively in civil war for fractured femurs.

4. definition Traction can be defined as the applying a pulling force for medical purpose to reduce fractures, maintain bone alignment ,relieve pain , or to prevent spinal injury.

5. principles The traction applied must produce a pulling effect on the body in the longitudinal direction. There should be a counter traction to achieve effective traction. A precise amount of weight must be applied. Weights applied must be hanging freely

6. purposes / uses To stabilize and realign a broken bone or dislocated part of the body (e.g., shoulder ). Helps a fractured bone to get back into a normal position. Temporarily relieves pain before surgery Eliminates muscle spasms and constricted joints, muscles and tendons. Relieves pressure on nerves,(especially spinal nerves). Treats bone deformities.

7. TYPEs OF TRACTION Based on mechanism:- Fixed traction Sliding traction Based on method of application:- Skin traction Skeletal traction

8. Based on mechanism:- 1.Fixed traction :- In this type of traction a pull is generated between two fixed points .Or counter traction is provided by a part of the body itself. 2. Sliding traction :- the pull is exerted by a pull between hanging weights and the patient's own body weight . The fundamental principle of this type of traction is to string the patient up by the injured limb and leave them hanging until the bone has joined. Gallows traction for a child under the age of 3 with fractured femur is a good example of this. Children tolerate the position surprisingly well for the 2–3 weeks necessary for the fracture to unite at this age   The weight of the child should be enough to hold the limb out to length. A hand can be slipped between the buttocks and sheet.

9. Based on the method of application:- Skin traction: -   Skin traction is applied by strapping the patient’s affected lower limb and attaching weights. Skeletal traction :- Skeletal traction involves placing a pin, wire, or screw in the fractured bone. After one of these devices has been inserted, weights are attached to it so the bone can be pulled into the correct position. This type of surgery may be done using a general, spinal, or local anesthesia.

10. Commonly used tractions Bryant's traction. Buck's traction, involving skin traction Dunlop's traction – humeral fractures in children. Russell's traction etc………………..

11. complications Infection. In skeletal traction, a metal pin is inserted into your bone. ... Pressure sores. ... Nerve damage. ... Misalignment of the bone or joint. ... Stiff joints. ... Wire malfunction. ... Deep vein thrombosis (DVT).

12. Nursing management of patient with traction Maintain skin integrity Patient’s legs, heels, elbows and buttocks may develop pressure areas due to remaining in the same position and the pressure of the bandages. Position a rolled-up towel/pillow under the heel to relieve potential pressure. Encourage the patient to reposition themselves or complete pressure area care four hourly.

13. Continue…… Remove the foam stirrup and bandage once per shift, to relieve potential pressure and observe the condition of the patient’s skin. At this time, while the bandages are down you can moisturize the skin. Minimize the sheet's wrinkles and aim to keep dry to reduce potential skin damage. Assess and document the condition of skin throughout care in the progress notes and care plan. Ensure that the pressure injury prevention score and plan is assessed every shift and documented

14. Continue…. Traction care Ensure that the traction weight bag is hanging freely, this bag must NOT rest on the bed or the floor. If the rope becomes frayed replace immediately. The rope must be in the pulley tracks at all times, and should be vertically aligned with the patients’ leg, not on an angle. Ensure the bandages are free from wrinkles which may cause pressure injury.

15. Continue… Observations Check the patient’s neurovascular observations hourly and document in flow sheets. If the bandage is too tight it can cause blood circulation to be slowed. If this is the case the bandage will need to be removed and reapplied maintaining circulation. Monitoring of swelling of the femur should also occur to observe for compartment syndrome. If neurovascular compromise is detected, remove the bandage and reapply bandage. If circulation does not improve notify the orthopedic team.

16. Continue…. Pain assessment and management Regular hourly assessment of pain is essential to ensure that the correct analgesia is administered to manage the patient’s pain. Paracetamol , diazepam and oxycodone should all be charted and administered as necessary. Pre-emptive analgesia ensures that the patient’s pain is sufficiently managed and should be considered prior to pressure area care. Assess and document outcomes of all employed pain management strategies.

17. Continue.. Activity The patient can sit up in bed and participate in quiet activities such as craft, board games and watching TV. Child Life Therapy will be beneficial for patients in traction long term. Non-pharmacological distraction and activity will improve patient comfort. The patient can move in bed as tolerated for hygiene to be completed. Patients who are in traction for several weeks should have a referral to the education department/kinder.