What nursing actions should be taken when caring for a child in skeletal traction?

Definition

• Traction is an orthopedic treatment that involves placing tension on a limb, bone or muscle group using various weight and pulley systems.

TYPES:

• Straight or running traction (e.g. Buck’s traction, pelvic traction) involves a straight pulling force in one plane.
• Balanced suspension traction (e.g. pelvic sling, Thomas leg splint) involves exertion a pull while the limb is supported by a hammock or splint held by balanced weights, which allows for some mobility without disruption of the line of pull.
• Skin traction (e.g. Buck’s traction, pelvic traction) involves weight applied and held to the skin with a Velcro splint.
• Skeletal traction involves weight applied and attached to metal inserted into bone (e.g. pins, wires, tongs).

Traction is applied to:

• Decrease muscle spasms
• Reduce, align, and immobilize fractures (e.g. femur fractures that cannot be immobilized in a cast).
• Correct or prevent deformity
• Increase space between joint surfaces

Assessment. Assess the client for the following while in traction.

• Monitor skin integrity of the affected part before and after traction placement.
• Assess the skin, especially bony prominences for breakdown.
• Assess neurovascular status.
• Monitor respiratory status, including rate and patter, breath and lung sounds, ability to cough and breathe deeply.
• Evaluate muscle strength and tone and mobility in affected and unaffected areas.
• Assess mental status, noting level of orientation, effectiveness of coping and behavior.
• Regularly check the condition of the traction equipment: ropes, pulleys, and weights.
• For the client in skeletal traction, assess the pin site for signs and symptoms of infection.

Nursing Diagnosis

• Deficient knowledge related to the treatment regimen
• Anxiety related to health status and the traction device
• Acute pain related to musculoskeletal disorder
• Self-care deficit: feeding, bathing/hygiene and/or toileting related to traction
• Impaired physical mobility related to musculoskeletal disorder and traction
• Impaired skin integrity related to traction

Nursing Management

1. Promote measures to prevent complication of immobility.
   • Place a bedboard under the client’s mattress to ensure extra firm support. Turn and reposition the client regularly within the limitation of traction.
   • Prevent constipation by increasing the client’s fluid intake to 2,000 to 2,500ml and provide a balanced diet high in fiber.
2. Promote skin integrity.
   • Use a special mattress to preserve skin integrity.
   • Keep bed linen free of wrinkles to prevent skin breakdown.
   • Provide frequent skin care to areas of potential pressures
   • Inspect the skin traction for signs of skin breakdown. Assess areas over traction tape for tenderness or skin irritation. Always apply weights after the client is in the traction apparatus, and remove the weights before removing the traction apparatus.
   • Inspect the skeletal traction sites for signs of irritation or infection. Assess pin entrance and exit sites and areas surrounding pin sites at least twice each day. Clean pin sites as prescribed; never remove weights.
3. Provide client teaching
   • Encourage active exercises for unaffected body parts.
   • Encourage the use of a trapeze, if indicated.
   • Promote deep-breathing exercises hourly
4. Promote self-care within traction limitations.