Traction Care

CLINICAL GUIDELINES

The registered nurse (RN), licensed practical nurse (LPN), or orthopedic technician (where applicable) is responsible for daily care needs of the child in traction.
Weights may not be added or removed without a healthcare prescriber’s order.
Skeletal traction may not be removed without a healthcare prescriber’s order.
Remove skin traction straps every 4 hours or as ordered.
Remove skin traction boot every 8 hours or as ordered.
Assess neurovascular status every 4 hours.
Assess skin integrity before the application of the traction and every 4 hours.
Assess for pain every 2 to 4 hours during the acute phase and every 4 hours thereafter.
Evaluate integrity of traction and stabilizing devices every shift.
Employ safe patient handling and movement procedures, including no-lift practices to maintain patient’s safety and prevent caregiver injury when moving or transferring the child.

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Review the medical record to determine the following:
- Diagnosis and type of fracture/surgery the child has sustained
- Physical condition and integrity of the skeletal system
- Purpose and type of traction being used (Tables 105-1 and 105-2)
- Age and weight of the child
- Traction weights ordered by the healthcare prescriber
- The presence of possible adhesive or latex allergies
Assess the child’s vital signs to determine presence of fever, increased respiratory rate, and/or increased heart rate that may indicate presence of infection.
Assess the child for pain and muscle spasms and provide interventions as indicated (see Chapter 7).
Administer pain medication when indicated, at least 30 minutes before moving or assessing the child.
Use diversional activities and other nonpharmacological interventions (e.g., music, stroking of unaffected extremities) to distract the child and assist in pain management during the procedure. Collaborate with the child-life specialist to provide diversional activities.
Perform range-of-motion exercises to all extremities, unless contraindicated, every shift. (see Chapter 95).
Explain to the child and family the care you will be providing.
Encourage family members to stay with the child during traction care.

TABLE 105-1 Types of Skin Traction^a

Type	Illustration	Uses	Nursing Considerations
Cervical skin		Neck sprains or strains Torticollis Cervical nerve trauma Nerve root compression	There is a 5-7 pound limit of weights Avoid compressing the throat or ears with the chin strap
Side-arm 90-90		Fractures and dislocations of the upper arm or shoulder	Hand may feel cool because of its elevation. Hand can be covered with sock or mitten if desired
Dunlop		Supracondylar elbow fracture of the humerus	Avoid pressure over bony prominences or nerves
Pelvis sling		Pelvic fractures	There is a 10-25 pound limit of weights Ensure proper size of belt and apply it just over iliac crest
Bryant’s traction		Infant with a femur fracture or developmental dislocated hip	Supply plenty of diversional activities If the child flips over, a sheet or Posey restraint may be used; avoid pressure over dorsum of foot and heel
Buck’s traction		Hip and knee contracture Legg-Calvé-Perthes disease Slipped capital femur epiphysis (SCFE)	Remove boot every 8 hour and assess the skin Leg may be slightly abducted
Russell’s traction		Supracondylar femur fracture Hip and knee contracture	Sling may need to be repositioned often; mark the leg to ensure proper placement
Split Russell’s		Femur fracture SCFE Legg-Calvé-Perthes disease	Avoid pressure over bony prominences or nerves Weights are not added or removed without a physician’s order
^aSkin traction refers to any traction apparatus where the pull force is applied to the affected body part via the soft tissue. Traction is applied to the skin by using skin adherents, ace wraps, commercial traction tapes, or special foam boots. Weights applied to skin traction should not exceed 3.5 kg or 8 lb.

TABLE 105-2 Types of Skeletal Traction^a

Type	Illustration	Uses	Nursing Considerations
Cervical skeletal tongs		Preoperative spine distraction Fractures or dislocations of cervical or high thoracic vertebrae	A special bed may be used to assist with turning patient Logroll patient
Halo cast or vest		Postoperative immobilization after cervical fusion Fracture or dislocation of cervical or high thoracic vertebrae	A small wrench is taped to the front of the brace to remove front panel in case of emergency If patient is in halo cast, a cast saw must be with her or him in case of emergency. Balance is altered with a halo cast; patients ambulating need close supervision
Dunlop’s side-arm 00-90		Fractures of upper arm	Turn the patient toward the affected side only Hand may feel cool despite intact neurovascular status; cover hand with mitten or sock if desired
Knee 90-90		Femur fractures	Encourage the child to dorsiflex foot often to prevent foot drop; apply splint if necessary Ensure that weights do not catch on bottom of the bed
Thomas ring with Pearson attachment (balanced suspension)		Femur fracture Hip fracture Tibial fracture	Avoid pressure to the area behind the knee, which could cause popliteal nerve injury If the system is truly balanced, the splint can be placed at any height and it will remain there
^aSkeletal fracture refers to any traction apparatus where the pull force is applied directly to the skeleton via pins, wires, screws, and/or tongs that are inserted into the appropriate area of bone. Weights applied can be 4.5 kg or 10 lb, up to 11.5 kg or 25 lb. Skeletal traction is beneficial for unstable or fragmented fractures that are not amenable to surgical intervention. Skeletal traction would also be used if there were skin damage associated with the fracture.