Pin site care may be performed by a registered nurse (RN), licensed practical nurse (LPN), or a healthcare prescriber.
Pin sites should be assessed every shift.
Pin sites are redressed 24 to 72 hours after the procedure per healthcare prescriber’s orders and as warranted by the amount of drainage.
After the first 48 to 72 hours, pin site care is performed daily or weekly for sites with mechanically stable bone-pin interfaces. The frequency of a dressing change increases in the presence of infection or if the dressing becomes saturated.
Showering with bacterial soap and drying the pin site with a towel or hair dryer is permitted 10 days to 2 weeks after insertion.
Sterile gloves
Sterile applicators
Sterile container
Chlorhexidine 2 mg/mL solution or swabs
Absorbent nonstick dressing or foam dressing
Sterile water
Wrap or ace-type compression bandage (optional)
Explain the procedure you will be completing to the child and family.
Explain sensations the child may feel; for example, “There may be a feeling of cold when I put the cleansing solution on.”
Follow traction care guidelines (see Chapter 105) in regard to evaluation of the traction apparatus, skin, neurovascular status, and presence of pain.
Assess for indications of infection (Chart 100-1).
Medicating for pain is not necessary because skeletal pin site care is generally not painful. For the child who is anxious about the procedure, diversionary measures or relaxation techniques should be used (e.g., listening to selected music, watching a video).
Allow the child to watch the procedure if desired. Use of a hand mirror may assist the child to watch the procedure and view the pin site.
Allow children in middle childhood or adolescence who are willing and able to assist in the cleaning and dressing change process. The child’s physical skills and location (placement) of the pin must be considered.
KidKare Do not tell the child that he or she has a “hole” in his or her hurt extremity. Rather, use words such as “opening” or “small cut.” Emphasize that the cut will heal or the opening will close quickly after the pin is taken out.
Studies indicate that pins located in areas not considered soft tissue should be considered at greater risk for infection. Higher rates of infection have been reported in femoral pins compared with tibial pins and in proximal pins when compared with lower and middle pins (Holmes, Brown, & Pin Site Expert Panel, 2005).
CHART 100-1 The Checketts-Otterburn Grading System
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