03 Pin site care - E

NURSING CARE OF PIN SITES

Roslyn Eva RNGraduate Certificate of Orthopaedics.

PIN SITE CARE There are many

different ideas about the care of pin sites.

They vary from no care at all.

To twice daily cleansing with a range of options in between.

PIN SITE CARE In the end it

comes down to the Surgeon or Doctor’s preference.

In this talk I will present a range of options that are in current use in Australia.

PIN SITE CARE

Pin sites are the area of skin surrounding a protruding piece of metal, which is holding bones in place while they heal.

PIN SITE CARE The metal pin

creates a pathway from the skin on the outside through to bone.

This provides a direct entry for bacteria so ANY care is better than NO care.

PIN SITE CAREFrequencyDaily or twice daily dressings Used for the first 72 – 96 hours following

insertion of the external fixators. For duration of hospital stay.

Weekly dressings Used for maintenance of clean pin sites with

no signs of inflammation or infection.

PIN SITE CARESolutions Any one of the following may be used for

cleaning of pin sites:-

Hydrogen peroxide Normal Saline Sterile water Chlorhexidine 2mg/ml Betadine solution Alcohol swabs

PIN SITE CARESet up:- Sterile Dressing pack Alcohol swabs Sterile scissors Nu-gauze or ribbon

gauze Betadine or Alcoholic

Chlorhexidine 5cm bandage. Gloves

PIN SITE CARECleansing Use a sterile technique. Use a fresh cotton ball

or alcohol swab for each pin site.

Remove any crusts or discharge.

Using the sterile forceps push the skin growth down around the pin to prevent hypertrophy.

PIN SITE CAREPrimary dressing – this is the layer in direct

contact with the pins and the skin.

It is often dressed with a ribbon gauze which may be soaked in Betadine or Chlorhexadine.

This is applied in a figure 8 or as appropriate to the position of the pins.

PIN SITE CARE Another option is a

sheet of Nu-gauze key hole cut to fit the pattern of pins.

This is soaked in Alcoholic Chlorhexidine (0.5%in 70% alcohol).

PIN SITE CARESecondary Dressing –

This is the layer that covers the primary dressing and helps to hold it in place.

This is often a wider ribbon gauze, or narrow crepe bandage.

Covers the area and the fixators.

PIN SITE CARE Secure to skin by

taping in place.

The purpose of bandaging is to maintain a firm tension against the skin to prevent hypertrophy and movement of the skin around the pin sites.

PIN SITE CAREComplications Infection – localised

and deep. Loosening of the

pins – reduced effectiveness in securing the healing bones.

Hypertrophy of the surrounding skin.

PIN SITE CAREInfections Prophylactic IV Antibiotics are often given at

the time of surgery to prevent an infection.

In the event of a localised skin infection an appropriate regime of oral antibiotics may be given.

Where there is a risk of Osteomyelitis a regime of IV Antibiotics will be given.

If severe the pins may need to be removed.

PIN SITE CAREThe National Association of Orthopaedic Nurses

Guidelines for Pin Site Care has four recommendations.

1. Pin sites located in areas with considerable soft tissue (i.e. Thigh) should be considered at greater risk of infection.

2. After the first 72 hours pin site care can be attended to on a daily or weekly basis for sites with mechanically stable bone pin interfaces.

PIN SITE CARE

3. Chlorhexidine 2mg/ml may be the most effective cleaning solution for pin site care.

4. Patients and families should be taught pin site care prior to discharge from hospital using clean (rather than sterile) procedures.

PIN SITE CARE

Any Questions?

REFERENCES Maher,A.B., Salmon,S.W., Pellino,T.A. (2002)

Orthopaedic Nursing.(3rd Edition) Philadelphia, Saunders.

Tortora.G.J., Derrickson.b.,(2006)Principles of Anatomy and Physiology. (11th Edition) Hoboken, John Wiley & Sons, Inc.

Cochrane Library- Pin site care for preventing infections associated with external bone fixators and pins. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004551/frame.html

Royal Children’s Hospital, Melbourne. [email protected]