How to Apply a Skin Traction
Skin traction is a nonsurgical treatment option that can help heal fractured bones or orthopedic abnormalities. This treatment is often used for children, and almost always used to help treat leg injuries or abnormal leg development. Traction pulls the skin that lies on or near the affected bone, manipulating soft tissue and pulling the bone into a fixed, rigid position. This forces the bone to stay in the corrective spot. Skin traction should only be applied by a team of medical professionals, following a formal diagnosis and skin traction prescription.
Ensuring Safe, Consistent Traction
Clean and shave the leg.Use soap and water to clean the limb. Make sure to clean the entire limb, not just the site of the injury. Shave the patient’s skin wherever traction straps will be applied. A single blade razor should be sufficient. Wipe away any leftover soap or shaving cream with a wet cloth and then pat dry with a clean towel. Make sure that the limb is totally dry.
- Ask the patient if they are allergic to adhesive if adhesive skin traction has been prescribed (this is quite uncommon).
Do not apply skin traction to damaged skin.Avoid using skin traction on a patient that has cuts, scrapes, or surgical incisions where you would need to apply the wrap. Similarly, do not use skin traction on a patient experiencing ulcers or numbness.
Administer painkillers if prescribed.As skin traction can potentially be painful, a pain management strategy has likely been planned. Ensure that any necessary pain medication is administered and documented.
Explain the procedure.Tell the patient why skin traction has been prescribed, and how it will help them. The procedure requires more explanation than some others, as the visual and tangible experiences associated with skin traction can be frightening. If administering skin traction to a child, explain the procedure to them as well.
- For instance, explain what each piece of the traction apparatus is by saying something like "This material is called traction strapping. It adheres to the skin and helps pull your bone into the correct position." or "We will run this traction cord through this pulley, and attach a small amount of weight that will help keep your leg in alignment."
Applying Skin Traction to a Leg
Apply traction strapping.Gently lift the straightened leg and pull it away from the patient’s body in the direction of their sole. Apply traction starting at, but not above, the fracture line. Run strapping down one side of the leg, around a 3-inch (7.5 cm) spreader, and up the other side of the leg. The spreader should extend approximately 6 inches (15 cm) beyond the end of the patient’s leg. The extra strap beneath the foot will appear like a loose stirrup.
- Instead of a spreader, your facility may be equipped with a foam and metal stirrup that can be bent around the heel and ankle of the injured leg and wrapped onto the strap.
Pad the ankles while wrapping the leg.At this point, you will carefully wrap the leg in crepe wrapping or gauze. As you do so, pad the sides of the ankle and any other bony areas, such as the sides of the knee. Wrap the leg in alternative spirals instead of consistent circles to reduce tightness. Start at the ankle and move upward in slow, even rotations. Conclude the wrap just before the end of the adhesive strip. The bandage should not go past the fracture.
- If using a stirrup, make sure it is also wrapped securely into place above the traction tape.
Elevate the leg.Usually, skin traction is used in tandem with weight resistance that helps apply pressure to the leg through the adhesive strip. If you’re using weights as well, elevate the leg. If possible, do so by elevating the end of the bed where the leg is resting. Once elevated, attach a traction cord through the spreader at the midpoint of the adhesive tape.
Apply weighted resistance as prescribed.If weighted skin traction is to be used, a doctor will have prescribed a specific amount of weight to be attached to the end of the traction cords. Depending on the injury, this traction cord may run over the end of the bed with the weights hanging below. Alternatively, some scenarios may call for the use of pulley systems, with the weight on one side and the suspended leg on the other.
- Never exceed 11 lbs. (4.99 kg) of weight.
- You may need to shorten the traction cord to ensure that the weight is suspended in the air, as opposed to resting on the floor or bed.
Monitoring the Patient
Reduce pressure to keep skin healthy.The condition of the patient’s skin should be steadily monitored. In particular, blisters and pressure sores may develop. Check the patient’s legs, heels, and bottom for sores or discomfort from maintaining a constant position. Place a rolled up towel or pillow beneath the patient’s heel to relieve undesired pressure. Further, encourage the patient to slightly adjust their position once per hour.
- If using adhesive, watch out for a rash or other allergic reaction, as the pressure induced by traction may cause a reaction in patients who do not know they are mildly allergic.
- Remove and reset the weight, including the stirrup, once every few hours to check skin condition.
- Change wet sheets immediately.
Record neurovascular observations hourly.Neurovascular issues and/or compartment syndrome may develop from overly tight wraps. Watch out for signs that blood circulation has slowed, such as discoloration or numbness. Remove the wrap and reapply if any neurovascular signs change during application of skin treatment. Contact the orthopedic team if circulation doesn’t quickly return.
Keep the patient entertained.Though they are mostly immobile, try to keep the patient active. Have them sit up when able and read, do crafts, play games, or watch TV. This will improve comfort as well as hygiene. Further, constipation may also occur from immobility.
- If the patient reports constant pain, ensure medication schedules have been kept, and contact a doctor if you feel those schedules may need to be revised.
Should it be a single cord or two cords?
What are the nurses responsible for?
- Avoid wrapping in circular patterns around the injured limb, since this can easily cut off circulation. This is caused when the wrapping is wound too tightly.
- Because this treatment permanently alters the patient's bone structure, applying skin traction should always be done under the supervision of an orthopedic surgeon.
- Skin traction can easily cause blistering in older patients. Do not use this treatment option if your patient is more than 50 years of age.
Video: Skin traction video lecture CMU
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