Concept about Traction – Introduction to fundamental concepts of Biological Science including the organization and common characteristics of living matters, cell structures and functions, food production by photosynthesis, harvesting energy, mechanism of cells reproduction, genetics, evolutions, and Human Biology. Introduction to general chemistry including basic concepts about matter, atomic structure, chemical bonds, gases, liquid, and solids, solutions, chemical reactions, acid, bases, and salt;
organic and biochemistry including hydrocarbons and their derivatives, carbohydrates, lipids, proteins, enzymes, vitamins, and minerals, nucleic acids; principles of physics and applications to nursing including gravity and mechanics, pressure, heat and electricity; nuclear chemistry and nuclear physics, effects of radiation on human beings, and protection and disposal. The aim of the course is to acquire knowledge and skills in general biological science, general chemistry and physics.
Concept about Traction
Traction is a form of medical treatment, in which weights and pulleys are used to gently pull or stretch an injured part of the body for a period of time.
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Traction is the application of a pulling force to a part of the body.
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Traction is a method of pulling structures of the musculoskeletal system to reduce and immobilize a fracture.
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Traction can be applied as an alternative to surgery, is used to ensure proper positioning of an affected extremity and can be used in the correction of deformity
Purposes of Traction:
- To reduce fracture and realign bone fragments.
- To maintain skeletal length and alignment.
- To reduce and treat dislocation.
- To hold the bone in correct positions.
- To immobilize to prevent further soft tissue damage.
- To prevent the development of contracture.
- To relieve muscle spasms.
- To prevent deformity.
- To give the patient freedom for “in-bed” activities
- To reduce pain.
- To rest a diseased joint.
- To improve the function of the joint.
Principles of effective traction:
- Maintain proper body alignment.
- Apply the exact amount of weight prescribed.
- Ensure that the weights hang freely and do not touch the floor
- Do not remove or lift the weights without a physician’s order.
- Suspend splints and slings without interference.
- Ensure that the pulleys are not obstructed and that ropes in the pulleys move freely.
- Place notes in the ropes to prevent slipping.
- Check the ropes for fraying.
Methods/Application of Traction:
Traction may be applied to the skin or to the skeletal system.
A. Skeletal traction
1. Skull traction
2. Halo traction
B. Skin traction
1. Cervical traction
2. Buck’s traction
3. Bryant’s traction
4. Pelvic traction
5. Russell’s traction
C. Cervical traction
D. Pelvic skin traction
Methods of applying traction:
1. Skeletal Traction: Skeletal traction involves placing a pin, wire, or screw in the fractured bone.
2. Skin Traction: Skin traction is far less invasive than skeletal traction.
3. Cervical Traction: During cervical traction, a metal brace is placed around your neck.
Types of Traction:
On the basis of method of application:
A. Manual traction: Manual traction is accomplished by a person hand exerting a pulling force. It is utilize to reduce fracture and dislocation and apply a steady pull.
B. Mechanical traction: Mechanically repair the injured part by using pulleys, ropes, halters, bandage, stinmen pin etc. It is again divided into the followings
- Skin traction.
- Skeletal traction.
On the basis of duration of traction:
A. Continuous traction: It means that traction is maintained at all the time or continuously, e.g. gallows traction, skeletal traction, Skin traction etc.
B. Intermittent traction: Intermittent traction refers to the traction that is applied for short duration and give rest for some hours and give traction again.
Rules of pins application:
- Skeletal traction should be applied in a major OT under general or local anesthesia.
- Follow strict aseptic measures.
- Drive the pin from lateral to medial in case of upper tibial traction, to avoid injuring the lateral popliteal nerve.
- Pin should be at right angles to the limb and parallel to the ground.
- Cover the sharp tip on the medial side with a stopper bottle to prevent damage to the normal limb
Precaution During Traction For A Nurse:
1. Carefully watch the pin tract sites every day. Cleaning these sites with aseptic solutions should be daily routine.
2. Bedsores should be prevented at all costs. For these regular back care, use of water beds, turning the patient over for every 2 hours are some of the effective time tested methods to prevent bedsores.
3. The feet should not be left touching the pulleys.
4. The weight of the traction should not touch the ground.
5. Ensure that the bandages are not too tight.
6. Prevent chest complications by proper chest physiotherapy measures.
7. To prevent stiffness, active exercise of the unimmobilised joints should be begun at the earliest.
8. Proper bowel and bladder care is mandatory to prevent urinary tract infection and constipation.
Nursing Care of A Patient With Traction:
Nursing care of the patient with traction
A. Nursing Assessment
1. Assess for pain, deformity, swelling, motor and sensory function, and circulatory status of the affected extremity.
2. Assess skin condition of the affected extremity, under skin traction and around skeletal traction, as well as over body prominences throughout the body.
3. Assess for signs and symptoms of complications.
4. Assess traction equipment for safety and effectiveness
a. The patient is placed on a firm mattress.
b. The ropes and the pulleys should be in alignment.
c. The pull should be in line with long axis of the bone,
d. Any factor that might reduce the pull or alter its direction must be eliminated.
- Weights should hang freely.
- Ropes should be unobstructed and not in contact with the bed or equipment.
- Help the patient to pull him or herself up in bed at frequent intervals.
B. Nursing Diagnosis
1. Impaired physical mobility related to traction therapy and underlying pathology.
2. Risk for impaired skin integrity related to pressure on soft tissues.
3. Risk for infection related to bacterial invasion at skeletal traction site
4. Ineffective tissue perfusion: Peripheral related to injury or traction therapy.
C. Nursing Interventions
Minimizing the Effects of Immobility
1. Encourage active exercise of uninvolved muscles and joints to maintain strength and function. Dorsiflex feet hourly to avoid development of footdrop and aid in venous return.
2. Encourage deep breathing hourly to facilitate expansion of lungs and movement of respiratory secretions.
3. Auscultate lung fields twice per day.
4. Encourage fluid intake of 2-2.5L daily.
5. Provide balanced high-fiber diet rich in protein; avoid excessive calcium intake.
6. Establish bowel routine through use of diet and stool softeners, laxatives, and enema, as prescribed
7. Prevent pressure on the calf, and evaluate twice daily for the development of thrombophlebitis. 8. Check traction apparatus at repeated intervals – the traction must be continuous to be effective, unless prescribed as intermittent, as with pelvic traction.
- With running traction, the patient may not be turned without disrupting the line of pull.
- With balanced suspension traction, the patient may be elevated, turned slightly, and moved as desired.
- Maintaining Skin Integrity
1. Examine bony prominences frequently for evidence of pressure or friction irritation.
2. Observe for skin irritation around the traction bandage.
3. Observe for pressure at traction-skin contact points.
4. Report complaint of burning sensation under traction,
5. Relieve pressure without disrupting traction effectiveness
a. Ensure that linens and clothing are wrinkle free.
b. Use lambs wool pads, heel/elbow protectors, and special mattresses as needed.
6. Special care must be given to the back every two hours because the patient maintains a supine position.
- Have patient use trapeze to pull self up and relieve back pressure.
- Provide backrubs.
Avoiding Infection at Pin Site
1. Monitor vital signs for fever or tachycardia.
2. Watch for signs of infection, especially around the pin tract.
- The pin should be immobile in the bone, and the skin wound should be dry. Small amount of serous oozing from pin site may occur.
- If infection is suspected, percuss gently over the tibia; this may elicit pain if infection is developing.
- Assess for other signs of infection: heat, redness, fever.
3. If directed, clean the pin tract with sterile applicators and prescribed solution/ointment- to clear drainage at the entrance of tract and around the pin, because plugging at this site can predispose to bacterial invasion of the tract and bone.
Promoting Tissue Perfusion
1. Assess motor and sensory function of specific nerves that might be compromised.
- Peroneal nerve – have patient point great toe toward nose; check sensation on dorsum of foot; presence of footdrop.
- Radial nerve have patient extend thumb; check sensation in web between thumb and index finger.
- Median nerve – thumb-middle finger apposition; check sensation of index finger.
2. Determine adequacy of circulation (eg, color, temperature, motion, capillary refill of peripheral finger or toes).
- With Buck’s traction, inspect the foot for circulatory difficulties within a few minutes and then periodically after the elastic bandage has been applied.
3. Report promptly if change in neurovascular status is identified.
Patient Education and Health Maintenance
1. Teach the patient the purpose of traction therapy.
2. Delineate limitations of activity necessary to maintain effective traction.
3. Teach use of patient aids (eg, trapze).
4. Instruct the patient to adjust or modify traction apparatus.
5. Instruct the patient in activities designed to minimize effects of immobility on body systems
6. Teach the patient necessity for reporting changes in sensations, pain, and movement.
D. Evaluation: expected outcomes
1. Exercise as instructed; deep breathes hourly; fluid intake 2-2.5 L/day.
2. No signs of skin breakdown under traction bandage or over bony prominences.
3. No drainage, redness, or odor at pin site.
4. No motor or sensory impairment; good capillary refill, color, and warmth of extremity.
[A Short Textbook of Traumatology and Orthopedic Nursing/Kibria/34/72-4]
Complications of Traction:
1. Skin Trauma
2. Nerve Trauma
3. Infection at pin site.
4. Non-union
5. Delayed union.
6. Neuro vascular damage.
7. Skin breakdown
8. Dermatitis under skin traction.
9. Wound infection.
10. dermatitis under skin traction
11. Compartment Syndrome
12. Urine retention, UTI
13. constipation,
14. Oedema, thrombophlebitis.
15. Inadequate Immobilization
16. Complications of immobility:
- Stasis pneumonia
- Thrombophlebitis
- Pressure ulcers
- Urinary infection and calculi
- Constipation
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