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CARE OF PATIENTS
IN TRACTION
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Traction means that a pulling force is
applied to a part of the body or an
extremity while a countertraction pulls in
the opposite direction. In straight orrunning traction countertraction is
supplied by the patients body with the
bed in one of the following positions.
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Basic types of tractions
Skin traction- is the application of a pulling force to the skin
from where it is transmitted to the muscles and then to the
bones by the use of:
Adhesie type material
! "xample: #ryant! $unlop
! #ucks "xtension
%on-adhesie type materials like: canas& slings leathers and
straps with buckles and laces
! "xamples: 'ead halter traction! 'ammock suspension traction
! (elic traction
!Anklet traction
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Skeletal traction ) the pulling force is applied
directly to the bone using pins and wires such
as *irshners wire. Steinmans pin& inkes
skull retractor and crutch field tongs. +anual traction ) the pulling force is applied
by the hands of the operator. It is a temporary
measure sometimes employed in handling
neck in,ury when a cerical spine is fractured.It is also used to apply the necessary pull to
an extremity when cast is being applied.
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Purposes of traction. Traction is often used in the treatment of fractured extremities.
To lessen muscle spasm
To reduce fracture
To proide immobiliation
To maintain alignment thus proe
/. Traction is also used to correct& lessen or preent deformities as inthe case of arthritis patient with flexion contraction or a child who
has scoliosis and is placed in traction to help lessen the curature of
the spice before correction surgery is carried out to insert a
'arlington rod.
0. (rior to total hip replacement& surgeons may apply skeletal traction&in an attempt to stretch muscles and obtain more 1working space2
within the ,oints.
3. It lessens muscles spasm in back pain and in resting a diseased ,oint
as in tuberculosis.
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Principles of traction
'ae an opposite pull or countertraction
#e free from any friction
4ollow an established line of pull that is
the line of pull must be in line with the
deformity
#e continuous
#e applied to a patient in a supineposition
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Nursing implication in varioustractions application
(hysicians ary in their methods of applying traction
according to the way they hae been taught& what
they hae practiced and what they hae found to be
effectie and efficient. This contributes to makingdifference in traction application regional as well as
personal. In addition hospitals ary in the types of
e5uipment they use.
All of these means that the nurse must beknowledgeable about principles first of all& before
she can understand the traction routines of the
hospitals and staff physicians. The nurse must
understands the basic care of a patient in traction.
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Observations to be made incaring for Patient in Traction
. (atient is free from the following:
Impaired circulation of the extremities
6espiratory distress
7ondition of the skin with emphasis on
the ischial& sacral& popliteal& achilles
tendon& dorsum of foot& heel.
$eformity like footdrop contracture of,oint.
Signs of infection
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/. #one alignment and position of
extremities which the purpose of traction
is being accomplished.
0. (atients comfort ) traction should neerbe a source of undue discomfort of the
patient. 7are of skin& mouth& hair& nails
and toes& genitalia must be included inthe plan of daily care.
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3. (roisions of exercises
68+ exercise of all unaffected ,oints
Static 5uadriceps exercises
$eep breathing and coughing exercises
4lexion and extension of the toes&
fingers in traction
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9. (roision of supportie therapy
. 7hecks the nutritional status of the
patient
;. "ery complaint of the patients in
traction should be inestigated
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=. (roide care to specific type of traction
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a. #ryant traction
Applied for fractures of the femur& in,uries to the hipamong children below 0 years old.
Specific obseration- care(ositions leel bed two legs suspended ertically& hips
flexed at right angle buttocks not resting against
mattress.
7heck for presence of pimples& blisters and purulent
discharges on tracted legs.
7heck for signs of impaired circulation of toesSkin traction snug and in place
(roper application of diaper
(roide toys for children to play on.
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b. #ucks extension traction Indication: affections of femur and hip
Specific obserations(osition- bed in trendelenburgh with the legs in
traction supported by a #raun splint or pillow.
7heck toes for signs of impaired circulation
7heck for signs of irritation and discharge on tracted
legs
(ressure around malleali and pepliteal region and
heel.
Skin traction snug and in place.
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c. 6ussel-
Indication: affections of femur and hip Specific obserations
(osition leel bed pillows to support the legs with
the hip in /> angle from the bed.
7hecks for signs of impaired circulation of toes
Signs of irritation or discharges on the ischial
tuberosity& popliteal region& melleoli and heel
(atient allowed to sit& turn and moe wall while intraction
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d. $unlop traction:
indication: supracondylar fracture& humerus specific obserations
position ) leel bed& tilted laterally
checks sign of impaired circulation
check radial pulse of fingers
check signs of irritation blisters and purulent
discharges on tracted arms
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e. 'ead 'alter Traction
indication: 7erical spine affections Specific obserations
(osition-semi fowlers
7heck for signs of respiratory distress7heck for signs of irritation on the chin& ,aw& face&
and ear and on the posterior portion of the head
7heck sensation of the extremities
7heck for urinary and bowel disturbances
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f. (elic traction
Indication: affections of the lumbar spine
such as '.%.(& low back syndrome
Specific 8bserations
(osition ) leel bed in slight trendelenburgh7heck for signs of irritation along the lumbo-
sacral region
(elic strap must not be applied directly to the
skin& proide padding material before applying
strap
7heck for free moement of the lower extremity
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g. 'ammock Suspension Traction
Indication: affection of the pelis region affection Specific obserations
(osition- leel bed& buttocks not resting on the mattress
(lace padding material first before applying the
hammock suspension
It is applied including the lumbar spine and mid-thigh
7heck for signs of intraabdominal in,ury& urinary and
bowel disturbance
7heck for irritations on edges of the hammock
suspension
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h.Skeletal traction
Skeletal traction is achieed by insertion of a Steinmann pin&*irshners wire& 7rutchfield tong or similar deices into the bone&
enabling direct longitudinal pull to be applied directly to the bone.
?hen wires or pins are used& the traction force itself is applied to
a traction bow @spreads stirrups or calliper which is attached to
the wire or pin. These attachment can withstand the stress of 9to 3> lbs. of weight for external periods of time and are therefore
effectie means of proiding traction when a strong steady force
is indicated.
Sites most commonly used on the extremities are the distal end
of the femur& the proximal end of the tibia& the calcareus and theproximal ulna. Skeletal traction of the toe or finger is also
employed although rarely. Tongs are used in the skull for traction
and immobiliation of the cerical spine fractures.
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%ursing 7arecheck the efficiency of traction by applying the
principle of tractiongiing diersional therapy
increase caloric diet& increase protein intake
encourage immobiliationencourage fluid intake to preent urinary
complication
personal hygiene
maintain stability of tractionaoid infection
deep breathing and coughing exercise
obsere for circulatory impairments
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Examples of skeletal traction andtheir corresponding indications
. Skeletal traction using *irschners wire
and Steinmans pin
indications ) affections of femur& hip&
tibia& supracondylar humerus it can be used either for a fixed or a
balance traction @discussion will follow
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STEIN!NN PINN "IT# #O$%E&
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/. 7rutchfield tong or Binkes skull calliper
Indications: affections of the upper dorsal and
cerical spine
(osition: semi-4owler position
#ed preparation: bed with fracture board& firm
mattress& ariables sies of pillows for the nape&
for the back& for the legs and foot support and /
sandbags.
#ed with: / ertical bars& cure bar& pulley&
sash cord& and / clamps
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)inke*s skull caliper
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'rutch(eld Traction
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76CT7'4I"D$ T8%E A%$ BI%*"S
S*CDD 7ADI("6 ) 486 7"6BI7AD
A44"7TI8%
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Specific 8bseration8bsere signs of respiratory distress
8bsere alignment of traction
6egular check-up for signs of loosening of thescrews of the tong
?eights must be hanging freely
(recautions:
'ead halter traction must be ready at the bedsideTraction must not be released at anytime
Turning the patient as unit by the 1turning2 team
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0 . 'alo ) femoral
'alo ) pelic tractionindication ) scoliosis& kyphosis
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#alo+pelvic traction
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0. (reparationIdentify the different parts of the orthopaedic bed
Assemble the needed e5uipments:! Thomas splint F (earson Attachment
! Dateral side! Cpper potion
! +edial side @lower portion
! +edial upright
-know the affected extremity
G ?here to stand the demo side- look for the last
pulley and stand on that side
3. +ount the Thomas F (earson on the rest splint:
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9 (6I%7I(D"S I% T'" A((DI7ATI8% 84
SDI%ES T8 "+('ASIH"
%ot too tight not too loose
8ne @ inch distance in between theslings to promote aeration or entilation
(opliteal and heel portion should be free
from any sling Two @/ longer and wider slings for the
thigh portion and three @0 for the leg area
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'ow to apply sling
Start from the medial side to the lateral side&
secure both ends together& fan hold nicely on
the lateral aspect and secure with a pin orclip. 8bsere the principle of not too loose
and aoid hitting the patients extremely a pin.
The thigh rope should be attached on the
medial upright of the Thomas splint andsecure temporarily to the (earson screw
attachment.
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9. Insertion of the apparatus under the affected
extremity Three @0 manpower needed:
To insert whole apparatus under the affected extremity
+anual traction to be released after the completion of
traction weight on the third @0rd pulley
To lift the affected extremity
! -Simultaneous at the count of three
G Instruction to the patient:
- 'old the trapee& flex unaffected leg at the count of
three @0& the three @0 manpower to do their work
simultaneously
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. Application of Traction ?eight
6ope to be attached to the Steinman pin
holder to run along the third @0rd pulley
and attached the prescribed weight 7heck the principle of sling application&
and make the necessary ad,ustments&
also check the alignment.
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;. Apply suspension traction8ne @ end of the thigh rope to be attached to the
lateral aspect of the ischial ring with a slip knot
Attach suspension rope on the mid part of the
thigh rope& to the first @st pulley insert suspension
weight& hang it on the first @st pulley pass it on the
second @/nd pulley under the rest splint club hitch
knot on the Thomas spin tang another club hitch
on the (earson& close it with a knot to secure it.#e sure to maintain the traction rope inside& and
the suspension weight should be outside.
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Swing the patients to and form& side-to-side to check
the efficiency of traction.
a. (atient should be on dorsal recumbent positionb. Dine of pull should be in line with the deformity. (ositioning
the diagonal bar and positioning of a pulley. 4irst @st pulley
should be in line with the thigh& second @/nd pulley should be
in line with the knee or screw. Third @0rd pulley should be in
line with the first @st and second @/nd pulley.c. Should always be continuousJ emphasie the importance of
manual traction.
d. Aoid friction- rope should be running along the grooe of
the pulley& knots should be away from the pulley. ?eight
bags should be hanging freely. 8bsere for wear and tear of
the rope and bags.
e. (roide counter traction- patients body weight will
sere as a counter traction.
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&EO)!$ O, T&!'TION
.Apply rest splint
/.'ang suspension weight on the first @st pulley
0.7omplete remoal of suspension weight-
remoe the knot on the (earson and Thomas3.+anual traction on the Steinman pin holder&
remoe the traction weight on the third @0rd
pulley& secure the traction rope on the rest
splint another on the Thomas and (earsonattachment.
) i T f T ti d
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)arious Types of Traction andtheir 'orresponding Indication
'alo- femoral tractionSkin
Indication seere scoliosis
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'ead 'alter TractionSkin
Cse: seere cerical sprains& cerical
strains& torticollis& mild serical spine
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7ruthfield Tong Traction and 'alo-
tractionSkeletal
7erical fracture& subluxation
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$unlop TractionSkin
Cse: supracondylar 4racture humerus
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(elic tractionSkin @non-adhesie type
Cse: low back pain
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7otrelSkin @combination of head halter F (elic
Traction
Cse: scoliosis
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#ead halter - Pelvic girdle for
Scoliosis
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#ryant TractionSkin @adhesie type
Cse: 4emur 4racture& congenital hp
dislocation in infants less than 0 years old&less than 0 lbs.
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#ucks "xtensionSkin @adhesie type
Cse : In,uries to the hip and femur knee
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6ussell TractionSkin @adhesie Type
Cse: in,uries to the hip and femur knee
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- ower ex rem y rac onSkin or skeletalCse: $isplaced femoral 4racture
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=>-=> lower extremity tractionSkin or skeletal
Cse: $isplaced femoral 4racture
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Ad,unct to traction: #alance suspensionwith Thomas splint and (earsons
attachment
$eice that support the extremity andoercomes the force of graity thus allowing
the patient to moe in bed while in traction
Cse: used in skin or skeletal traction for
femur fractures to allow for exercise& tomaintain eleation& to support a dependent
part and correct alignment.
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Boot leg traction
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Boot leg traction
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Stoe in chest
4or multiple rib fracture
Sto e in chest
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Stove in chest
#!O'. S/SPENSION
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pelvic a0ection
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Gallows traction@oerhead #ryant skin
tractionis useful for children younger than / years
who weigh >-/ kg for 4racture shaft of
femur.
The traction should be enough to ,ust lift the
buttocks of the child off the bed.
7areful examination of the neuroascular
status of the extremity is mandatory in theearly period after application of traction.
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T&!'TIONS !N%
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IN%I'!TIONS 'ead 'alter ) cerical spine affection (elic Eirdle ) Dumbo sacral affection&
'erniated %ucleus (ulposus
8erhead Skeletal ) fracture of humerus #ucks "xtension ) femoral fractures&
hipo in,uries among kids below 0 years
old #oot 7ast ) hip and femoral affection&
post polio& knee contracture
Tractions and indications
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Tractions and indications
'alo (elic ) scoliosis 'alo 4emoral ) seere scoliosis
%inety $egrees ) subtrochonteric
fracture of femur Stoe-in-7hest ) seere chest in,ury
with multiple rib fracture
$unlops Skin Traction ) supracondylarfracture of the humerus
'ammock Suspension- pelic affection
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(arts of an 8rthopedic bed:
4irm mattress
4racture board
#ed eleator or shock
block
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#alkan frame:
3 ertical bars
/ horiontal bars
diagonal bar
straight bar or cross bar
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(ulleys @0
7lamps ) to hold bars in
place
8erhead trapee
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Traction e5uipments:
Thomas splint with (earson attachment
6est splint
7ord sash @0Short-thigh
Dong-traction
Dongest suspension
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Safety pins7lips
4oot restSlings @/ sies
?eights and bags- Suspension
weight is K lighter than the
weight of the traction
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