Care of Patients in Traction

7/23/2019 Care of Patients in Traction

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CARE OF PATIENTS

IN TRACTION


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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. In straight orrunning traction countertraction is

supplied by the patients body with the

bed in one of the following positions.


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Basic types of tractions

Skin tractionis the application of a pulling force to the skin

from where it is transmitted to the muscles and then to the

bones by the use of:

Adhesie type material

! "xample: #ryant! $unlop

! #ucks "xtension

%on-adhesie type materials like: canas& slings leathers and

straps with buckles and laces

! "xamples: 'ead halter traction! 'ammock suspension traction

! (elic traction

!Anklet traction


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Skeletal traction ) the pulling force is applied

directly to the bone using pins and wires such

as *irshners wire. Steinmans pin& inkes

skull retractor and crutch field tongs. +anual traction ) the pulling force is applied

by the hands of the operator. It is a temporary

measure sometimes employed in handling

neck in,ury when a cerical spine is fractured.It is also used to apply the necessary pull to

an extremity when cast is being applied.


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Purposes of traction. Traction is often used in the treatment of fractured extremities.

To lessen muscle spasm

To reduce fracture

To proide immobiliation

To maintain alignment thus proe

/. Traction is also used to correct& lessen or preent deformities as inthe case of arthritis patient with flexion contraction or a child who

has scoliosis and is placed in traction to help lessen the curature of

the spice before correction surgery is carried out to insert a

'arlington rod.

0. (rior to total hip replacement& surgeons may apply skeletal traction&in an attempt to stretch muscles and obtain more 1working space2

within the ,oints.

3. It lessens muscles spasm in back pain and in resting a diseased ,oint

as in tuberculosis.


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Principles of traction

'ae an opposite pull or countertraction

#e free from any friction

4ollow an established line of pull that is

the line of pull must be in line with the

deformity

#e continuous

#e applied to a patient in a supineposition


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Nursing implication in varioustractions application

(hysicians ary in their methods of applying traction

according to the way they hae been taught& what

they hae practiced and what they hae found to be

effectie and efficient. This contributes to makingdifference in traction application regional as well as

personal. In addition hospitals ary in the types of

e5uipment they use.

All of these means that the nurse must beknowledgeable about principles first of all& before

she can understand the traction routines of the

hospitals and staff physicians. The nurse must

understands the basic care of a patient in traction.


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Observations to be made incaring for Patient in Traction

. (atient is free from the following:

Impaired circulation of the extremities

6espiratory distress

7ondition of the skin with emphasis on

the ischial& sacral& popliteal& achilles

tendon& dorsum of foot& heel.

$eformity like footdrop contracture of,oint.

Signs of infection


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/. #one alignment and position of

extremities which the purpose of traction

is being accomplished.

0. (atients comfort ) traction should neerbe a source of undue discomfort of the

patient. 7are of skin& mouth& hair& nails

and toes& genitalia must be included inthe plan of daily care.


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3. (roisions of exercises

68+ exercise of all unaffected ,oints

Static 5uadriceps exercises

$eep breathing and coughing exercises

4lexion and extension of the toes&

fingers in traction


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9. (roision of supportie therapy

. 7hecks the nutritional status of the

patient

;. "ery complaint of the patients in

traction should be inestigated


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=. (roide care to specific type of traction


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a. #ryant traction

Applied for fractures of the femur& in,uries to the hipamong children below 0 years old.

Specific obseration- care(ositions leel bed two legs suspended ertically& hips

flexed at right angle buttocks not resting against

mattress.

7heck for presence of pimples& blisters and purulent

discharges on tracted legs.

7heck for signs of impaired circulation of toesSkin traction snug and in place

(roper application of diaper

(roide toys for children to play on.


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b. #ucks extension traction Indication: affections of femur and hip

Specific obserations(osition- bed in trendelenburgh with the legs in

traction supported by a #raun splint or pillow.

7heck toes for signs of impaired circulation

7heck for signs of irritation and discharge on tracted

legs

(ressure around malleali and pepliteal region and

heel.

Skin traction snug and in place.


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c. 6ussel-

Indication: affections of femur and hip Specific obserations

(osition leel bed pillows to support the legs with

the hip in /> angle from the bed.

7hecks for signs of impaired circulation of toes

Signs of irritation or discharges on the ischial

tuberosity& popliteal region& melleoli and heel

(atient allowed to sit& turn and moe wall while intraction


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d. $unlop traction:

indication: supracondylar fracture& humerus specific obserations

position ) leel bed& tilted laterally

checks sign of impaired circulation

check radial pulse of fingers

check signs of irritation blisters and purulent

discharges on tracted arms


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e. 'ead 'alter Traction

indication: 7erical spine affections Specific obserations

(osition-semi fowlers

7heck for signs of respiratory distress7heck for signs of irritation on the chin& ,aw& face&

and ear and on the posterior portion of the head

7heck sensation of the extremities

7heck for urinary and bowel disturbances


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f. (elic traction

Indication: affections of the lumbar spine

such as '.%.(& low back syndrome

Specific 8bserations

(osition ) leel bed in slight trendelenburgh7heck for signs of irritation along the lumbo-

sacral region

(elic strap must not be applied directly to the

skin& proide padding material before applying

strap

7heck for free moement of the lower extremity


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g. 'ammock Suspension Traction

Indication: affection of the pelis region affection Specific obserations

(osition- leel bed& buttocks not resting on the mattress

(lace padding material first before applying the

hammock suspension

It is applied including the lumbar spine and mid-thigh

7heck for signs of intraabdominal in,ury& urinary and

bowel disturbance

7heck for irritations on edges of the hammock

suspension


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h.Skeletal traction

Skeletal traction is achieed by insertion of a Steinmann pin&*irshners wire& 7rutchfield tong or similar deices into the bone&

enabling direct longitudinal pull to be applied directly to the bone.

?hen wires or pins are used& the traction force itself is applied to

a traction bow @spreads stirrups or calliper which is attached to

the wire or pin. These attachment can withstand the stress of 9to 3> lbs. of weight for external periods of time and are therefore

effectie means of proiding traction when a strong steady force

is indicated.

Sites most commonly used on the extremities are the distal end

of the femur& the proximal end of the tibia& the calcareus and theproximal ulna. Skeletal traction of the toe or finger is also

employed although rarely. Tongs are used in the skull for traction

and immobiliation of the cerical spine fractures.


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%ursing 7arecheck the efficiency of traction by applying the

principle of tractiongiing diersional therapy

increase caloric diet& increase protein intake

encourage immobiliationencourage fluid intake to preent urinary

complication

personal hygiene

maintain stability of tractionaoid infection

deep breathing and coughing exercise

obsere for circulatory impairments


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Examples of skeletal traction andtheir corresponding indications

. Skeletal traction using *irschners wire

and Steinmans pin

indications ) affections of femur& hip&

tibia& supracondylar humerus it can be used either for a fixed or a

balance traction @discussion will follow


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STEIN!NN PINN "IT# #O$%E&


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/. 7rutchfield tong or Binkes skull calliper

Indications: affections of the upper dorsal and

cerical spine

(osition: semi-4owler position

#ed preparation: bed with fracture board& firm

mattress& ariables sies of pillows for the nape&

for the back& for the legs and foot support and /

sandbags.

#ed with: / ertical bars& cure bar& pulley&

sash cord& and / clamps


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)inke*s skull caliper


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'rutch(eld Traction


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76CT7'4I"D$ T8%E A%$ BI%*"S

S*CDD 7ADI("6 ) 486 7"6BI7AD

A44"7TI8%


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Specific 8bseration8bsere signs of respiratory distress

8bsere alignment of traction

6egular check-up for signs of loosening of thescrews of the tong

?eights must be hanging freely

(recautions:

'ead halter traction must be ready at the bedsideTraction must not be released at anytime

Turning the patient as unit by the 1turning2 team


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0 . 'alo ) femoral

'alo ) pelic tractionindication ) scoliosis& kyphosis


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#alo+pelvic traction


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0. (reparationIdentify the different parts of the orthopaedic bed

Assemble the needed e5uipments:! Thomas splint F (earson Attachment

! Dateral side! Cpper potion

! +edial side @lower portion

! +edial upright

-know the affected extremity

G ?here to stand the demo side- look for the last

pulley and stand on that side

3. +ount the Thomas F (earson on the rest splint:


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9 (6I%7I(D"S I% T'" A((DI7ATI8% 84

SDI%ES T8 "+('ASIH"

%ot too tight not too loose

8ne @ inch distance in between theslings to promote aeration or entilation

(opliteal and heel portion should be free

from any sling Two @/ longer and wider slings for the

thigh portion and three @0 for the leg area


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'ow to apply sling

Start from the medial side to the lateral side&

secure both ends together& fan hold nicely on

the lateral aspect and secure with a pin orclip. 8bsere the principle of not too loose

and aoid hitting the patients extremely a pin.

The thigh rope should be attached on the

medial upright of the Thomas splint andsecure temporarily to the (earson screw

attachment.


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9. Insertion of the apparatus under the affected

extremity Three @0 manpower needed:

To insert whole apparatus under the affected extremity

+anual traction to be released after the completion of

traction weight on the third @0rd pulley

To lift the affected extremity

! -Simultaneous at the count of three

G Instruction to the patient:

- 'old the trapee& flex unaffected leg at the count of

three @0& the three @0 manpower to do their work

simultaneously


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. Application of Traction ?eight

6ope to be attached to the Steinman pin

holder to run along the third @0rd pulley

and attached the prescribed weight 7heck the principle of sling application&

and make the necessary ad,ustments&

also check the alignment.


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;. Apply suspension traction8ne @ end of the thigh rope to be attached to the

lateral aspect of the ischial ring with a slip knot

Attach suspension rope on the mid part of the

thigh rope& to the first @st pulley insert suspension

weight& hang it on the first @st pulley pass it on the

second @/nd pulley under the rest splint club hitch

knot on the Thomas spin tang another club hitch

on the (earson& close it with a knot to secure it.#e sure to maintain the traction rope inside& and

the suspension weight should be outside.


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Swing the patients to and form& side-to-side to check

the efficiency of traction.

a. (atient should be on dorsal recumbent positionb. Dine of pull should be in line with the deformity. (ositioning

the diagonal bar and positioning of a pulley. 4irst @st pulley

should be in line with the thigh& second @/nd pulley should be

in line with the knee or screw. Third @0rd pulley should be in

line with the first @st and second @/nd pulley.c. Should always be continuousJ emphasie the importance of

manual traction.

d. Aoid friction- rope should be running along the grooe of

the pulley& knots should be away from the pulley. ?eight

bags should be hanging freely. 8bsere for wear and tear of

the rope and bags.

e. (roide counter traction- patients body weight will

sere as a counter traction.


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&EO)!$ O, T&!'TION

.Apply rest splint

/.'ang suspension weight on the first @st pulley

0.7omplete remoal of suspension weight-

remoe the knot on the (earson and Thomas3.+anual traction on the Steinman pin holder&

remoe the traction weight on the third @0rd

pulley& secure the traction rope on the rest

splint another on the Thomas and (earsonattachment.

) i T f T ti d


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)arious Types of Traction andtheir 'orresponding Indication

'alo- femoral tractionSkin

Indication seere scoliosis


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'ead 'alter TractionSkin

Cse: seere cerical sprains& cerical

strains& torticollis& mild serical spine


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7ruthfield Tong Traction and 'alo-

tractionSkeletal

7erical fracture& subluxation


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$unlop TractionSkin

Cse: supracondylar 4racture humerus


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(elic tractionSkin @non-adhesie type

Cse: low back pain


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7otrelSkin @combination of head halter F (elic

Traction

Cse: scoliosis


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#ead halter - Pelvic girdle for

Scoliosis


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#ryant TractionSkin @adhesie type

Cse: 4emur 4racture& congenital hp

dislocation in infants less than 0 years old&less than 0 lbs.


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#ucks "xtensionSkin @adhesie type

Cse : In,uries to the hip and femur knee


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6ussell TractionSkin @adhesie Type

Cse: in,uries to the hip and femur knee


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- ower ex rem y rac onSkin or skeletalCse: $isplaced femoral 4racture


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=>-=> lower extremity tractionSkin or skeletal

Cse: $isplaced femoral 4racture


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Ad,unct to traction: #alance suspensionwith Thomas splint and (earsons

attachment

$eice that support the extremity andoercomes the force of graity thus allowing

the patient to moe in bed while in traction

Cse: used in skin or skeletal traction for

femur fractures to allow for exercise& tomaintain eleation& to support a dependent

part and correct alignment.


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Boot leg traction


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Boot leg traction


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Stoe in chest

4or multiple rib fracture

Sto e in chest


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Stove in chest

#!O'. S/SPENSION


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pelvic a0ection


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Gallows traction@oerhead #ryant skin

tractionis useful for children younger than / years

who weigh >-/ kg for 4racture shaft of

femur.

The traction should be enough to ,ust lift the

buttocks of the child off the bed.

7areful examination of the neuroascular

status of the extremity is mandatory in theearly period after application of traction.


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T&!'TIONS !N%


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IN%I'!TIONS 'ead 'alter ) cerical spine affection (elic Eirdle ) Dumbo sacral affection&

'erniated %ucleus (ulposus

8erhead Skeletal ) fracture of humerus #ucks "xtension ) femoral fractures&

hipo in,uries among kids below 0 years

old #oot 7ast ) hip and femoral affection&

post polio& knee contracture

Tractions and indications


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Tractions and indications

'alo (elic ) scoliosis 'alo 4emoral ) seere scoliosis

%inety $egrees ) subtrochonteric

fracture of femur Stoe-in-7hest ) seere chest in,ury

with multiple rib fracture

$unlops Skin Traction ) supracondylarfracture of the humerus

'ammock Suspension- pelic affection


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(arts of an 8rthopedic bed:

4irm mattress

4racture board

#ed eleator or shock

block


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#alkan frame:

3 ertical bars

/ horiontal bars

diagonal bar

straight bar or cross bar


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(ulleys @0

7lamps ) to hold bars in

place

8erhead trapee


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Traction e5uipments:

Thomas splint with (earson attachment

6est splint

7ord sash @0Short-thigh

Dong-traction

Dongest suspension


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Safety pins7lips

4oot restSlings @/ sies

?eights and bags- Suspension

weight is K lighter than the

weight of the traction


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Care of Patients in Traction

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