Traction is a method of immobilization, which may be used to reduce mobility and to immobilize the fractured part, to align an injured extremity, and to allow the extremity to be restored to its normal length.
Purposes
- To realign bone fragments
- To provide rest for an extremity
- To help prevent or improve contracture deformity
- To correct a deformity
- To treat a dislocation
- To allow preoperative or postoperative positioning and alignment
- To provide immobilization of specific areas of the body of the body
- To reduce muscle spasms (rare in small children)
Equipment Needed
Skin cleansing supplies:
- A basin
- Jugs with hot and cold water separately
- Soap in a soap dish
- Sponge clothes
- Bath towel
- Tale powder
- Skeletal pin site cleansing supplies:
- Sterile gauze pieces in a bowl
- Sterile surgical pad
- Antiseptic solution and ointment for topical application
- Kidney tray
- Pair of sterile gloves
- Plaster
- Scissor
- Sterile sponge holder
- Pillows
- Pressure-reducing mattresses (e.g., water mattress)
- Foot board
- Vital signs tray
Preparation
- Assess for the following:
- Type of fracture/surgery that the child sustained.
- Physical condition and integrity of skeletal system.
- Purpose and type of traction being used.
- Age and weight of child, traction weight ordered by orthopedician.
- Presence of possible latex allergies.
- Check vital signs to identify signs of infection such as fever.
- Perform range of motion exercises to all extremities, unless contraindicated every shift.
- Explain child and family members about the care.
- Encourage parents to stay with child during traction care.
- Have the child to assist in the examination according to his/her developmental level.
Procedure
- Elevate head end to the angle ordered.
- Apply trapeze for convenience in moving in bed (if not contraindicated).
- Ensure the traction apparatus is properly secured to the bed. assess the traction setup, including the amount of weight ordered.
- Full inspection of traction apparatus: verify the alignment of traction cards, integrity of tape, and tightness of knots securing of tapes should not interfere with the line of traction.
- Ensure that weights are hanging free from bed and floor while that the correct amountof weights are used.
Reposition weights as needed at a reasonable level from the floor, a considerable distance from the pulley, hanging free of bed, and always away from the child.
- Perform neuromuscular assessment.
- Perform skin assessment and provide skin care:
- Provide pressure reducing mattress
- Make total body skin checks for redness or breakdown, especially over areas that receive greatest pressure.
- Wash and dry skin at least daily.
- Stimulate circulation with gentle massage only over healthy skin.
- Avoid skin friction with bed linens or traction device.
- Keep skin dry and free from moisture such as sweat or urine.
- Change position at least every 2 hours to relieve pressure.
- Assist child to perform passive and active range of motion of all extremities at least every shift.
- Complete intervention to prevent complications of immobility and promote healing:
- Check pulse in affected areas.
- Assess circular dressings for an excessive tightness.
- Assess restrictive devices such as splints or braces.
- Be sure that they are not too loose or too tight.
- Remove periodically and check for pressure areas.
- Encourage deep breathing, coughing, and use of incentive spirometry.
- Note any neurovascular changes such as the following: color in skin and nail beds, capillary refill, alteration in sensation, increased pain, alterations in motor ability, skin temperature, and presence or absence of pulses.
- Notify the doctor of any abnormal findings care of skin traction:
- Replace non adhesive straps or elastic bandage on skin traction when permitted or necessary but make certain that traction on limb is maintained by someone during procedure.
- Assess bandages to ascertain if they are correctly applied (diagonal or spiral), not too tight, which could cause slippage and malalignment of traction
- Care of skeletal traction:
- Check pin sites frequently for signs of bleeding, inflammation, and infection.
- Cleanse and dress pin sites as per protocol.
- Apply antiseptic or antibiotic daily as per protocol
- Cover ends of pin with protective padding to prevent child’s being scratched by pin.
- Not pull of traction on pin: pull should be even
- Check pin screws to be certain that the screws are tight in metal clamp that attaches traction apparatus to pin.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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