Traction Application Nursing Management

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 bed board 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.

BALANCE SKELETAL TRACTION (BST)

BALANCE SKELETAL TRACTION (BST) PROCEDURE
4. Traction should be continuous and weights should be hanging freely.
SKIN TRACTION

Introduction

Femoral fractures are often managed using skin traction prior to their definitive surgical management.
Some require short term traction that is 24 hours whereas others require it for a number of weeks that is
6 weeks. Traction limits movement and reduces the fracture to help decrease pain, spasms and swelling.
It aims to restore and maintain straight alignment and length of bone following fractures.

Aim

This clinical practice guideline aims to ensure that the application and management of skin traction is
consistent and that potential complications are identified early and managed correctly.

Definition of terms

Fracture: Any type of break in a bone.

Traction: Traction is the application of a pulling force to an injured part of the body or extremity.

Skin Traction (Bucks Traction): Skin traction is applied by strapping the patient’s affected lower limb and
attaching weights.

Counter Traction: Application of force in the opposite direction used to oppose/offset traction.

Neurovascular observations: Is an assessment of circulation, oxygenation and nerve function of limbs

within the body.

Compartment syndrome: Increased pressure within one of the bodies compartments which contain
muscles and nerves.

Management

Acute management

Ensure order for skin traction is documented by the Orthopedic Team-(including weight to be applied in
kilograms)

Preparation of equipment

Hospital Traction bed with bar at the end of the bed

Traction kit pediatric OR adult size (foam stirrup with rope and bandage)

Overhead traction frame

Pulley

Traction weight bag

Water

Sleek
Pain relief

A femoral nerve block is the preferred pain management strategy and should be administered in the
emergency department prior to being admitted to the ward.

Diazepam and Oxycodone should always be charted and used in conjunction with the femoral nerve block.

Distraction and education

Explain the procedure to the parents and patient before commencing.

Plan appropriate distraction from play therapy, parents or other nursing staff.

Application of traction

Ensure the correct amount of water has been added to the traction weight bag as per medical orders.

Fold foam stirrup around the heel, ankle and lower leg of affected limb. Apply bandage, starting at the
ankle, up the lower leg using a figure 8 technique, secure with sleek tape.

Place rope over the pulley and attach traction weight bag. If necessary, trim rope to ensure traction weigh
bag is suspended in air and does not sit on the floor.

Ongoing management

Maintain skin integrity

Patient’s legs, heels, elbows and buttocks may develop pressure areas due to remaining in the same
position and the bandages.

Position a rolled up towel/pillow under the heel to relieve potential pressure.

Encourage the patient to reposition themselves or complete pressure area care four hourly.

Remove the foam stirrup and bandage once per shift, to relieve potential pressure and observe condition
patients skin.

Keep the sheets dry.

Document the condition of skin throughout care in the progress notes and care plan

Ensure that the pressure injury prevention score and plan is assessed and documented.

Traction care

Ensure that the traction weight bag is hanging freely, the bag must not rest on the bed or the floor

If the rope becomes frayed replace them

The rope must be in the pulley tracks

Ensure the bandages are free from wrinkles

Tilt the bed to maintain counter traction

Observations

Check the patient’s neurovascular observations hourly and record in the medical record.

If the bandage is too tight it can cause blood circulation to be slowed.

Monitoring of swelling of the femur should also occur to monitor for compartment syndrome.

If neurovascular compromise is detected remove the bandage and reapply bandage not as tight. If
circulation does not improve notify the orthopedic team.

Pain Assessment and Management

Assessment of pain is essential to ensure that the correct analgesic is administered for the desired effect

Paracetamol, Diazepam and Oxycodone should all be charted and administered as necessary.

Pre-emptive analgesia ensures that the patient’s pain is sufficiently managed and should be considered
prior to pressure area care.

Assess and document outcomes of pain management strategies employed

Activity

The patient is able to sit up in bed and participate in quiet activities such as craft, board games and
watching TV. Play therapy will be beneficial for patients in traction long term.

Non-pharmacological distraction and activity will improve patient comfort.

The patient is able to move in bed as tolerated for hygiene to be completed.

Patients who are in traction for a number of weeks may require a referral to the education
department/kinder.

Theatre time

The patient should be transported to theatre in traction to reduce pain and maintain alignment.

Special considerations

The foam stirrup, bandage and rope are single patient use only.

Potential complications

Skin breakdown/pressure areas

Neurovascular impairment

Compartment syndrome

Joint contractures

Constipation from immobility and analgesics

Companion documents

Neurovascular observation nursing guideline

Theatre fasting guidelines

Procedural Pain Management nursing guideline

Constipation clinical practice guideline

Pressure Injury nursing guideline

Nursing Management of Patients in Traction

Role of the Nurse in Caring for Patients in Traction
1. RNs shall not apply or set up skeletal or cervical traction.
2. RNs shall not remove, add, or lift up on weight when the patient is in traction for the treatment of
fractures.
3. RNs may remove or add weights to balance suspension (slings), which is used with skeletal traction.
4. RNs shall not release a patient from traction for the purpose of transfer to and from bed, stretcher,
or procedure tables. The nurse shall notify the physician, so the physician may come and remove traction
for transfer and to replace traction.
5. RNs shall provide pin care per physician order.
Maintenance of the Traction Apparatus
1. The traction apparatus shall be maintained at all times so that the alignment of pull is correct.
2. If traction is not in alignment or there appears to be a discrepancy in the number of pounds, the nurse
shall notify the physician. The nurse shall document in a quick note.
3. The nurse shall document the number of pounds of traction every twelve (12) hours.
4. The nurse shall check the traction apparatus to verify that the following are allowed. The ropes are
unobstructed, not in contact with the bed or equipment, and move smoothly over the pulleys and the
weights are hanging freely.
Assessment of the Patient in Traction
1. The nurse shall perform neurovascular, sensory, motor assessments, and document as ordered.
2. What are his needs? What are his limitations? The nurses shall determine which activities the patient
can do by himself and with which activities he requires assistance. Basic considerations are nutritional
needs, hygiene, and elimination needs and the need for some sort of diversional activities.
3. The nurse shall notify the physician immediately of any acute changes in sensation, movement, or
neurovascular status.
Care for Patients in Traction
1. When assisting with a.m. and p.m. care, encourage the patient to do as much for himself as is possible
within the constraints of his immobilization. Assist with or perform those tasks that the patient cannot
perform.
2. Assess the patient and the traction set-up to determine the best method for changing the bed linen.
There are several acceptable methods for making an occupied bed and, depending upon the type of
traction in use, you will want to use the method that is easiest. For some patients, a head-to-toe technique
may work better than side-to-side. Always be sure that the linen is smooth and dry. Utilize draw sheets
when appropriate. Reposition supporting pillows and change the pillow cases as often as needed to
prevent the patient from being supported by soiled, damp, wrinkled, or flattened pillows.
3. When assisting with the bedpan or urinal, provide adequate time and privacy for the patient. Many
patients do not adjust easily to the awkwardness of using a bedpan or urinal. The presence of roommates,
visitors, or hospital personnel just outside the privacy curtain is enough to make anyone uncomfortable.
Always place toilet tissue, moist towelettes, and call bell within easy reach. Check daily to see whether
the patient has had a bowel movement. Treating constipation will prevent the more serious problem of
fecal impaction. Physicians will routinely prescribe a stool softener for immobilized patients in order to
prevent constipation.
4. Encourage the patient to eat all of the prescribed diet. If permitted by the physician, suggest that
family and friends bring fruit or a “healthy” favorite food from home. A recovering patient’s diet should
be high in calcium, protein, iron, and vitamins. Plenty of fluids and foods high in roughage will help prevent
bowel and bladder complications.
5. Assist the patient to take several deep breaths each hour. Coughing and deep breathing will help
prevent respiratory complications. Encourage the patient to actively exercise the unaffected extremities.
6. Eliminate any factors that reduce the traction pull or alter its direction. Ropes and pulleys should be
in straight alignment and the ropes should be unobstructed. Traction is NOT accomplished if the knot in
the rope is touching the pulley or the foot of the bed. The weights must be suspended and not in contact
with the bed or resting on the floor. The patient’s body should always be in alignment with the force of
traction. Check the patient’s position each time you enter the room and help the patient slide up in bed
if necessary. Encourage the patient to use the overhead trapeze instead of elbows to move in bed.
7. Check the extremities for color (pallor, cyanosis), numbness, edema, signs of infection, and pain. Look
for areas of skin breakdown or pressure sores on all skin surfaces.
8. Orthopedic patients confined in traction will need some sort of diversional activity to relieve boredom
and prevent depression. If your treatment facility has no occupational therapy department, encourage
family and friends to visit frequently and bring books or games for the patient. Television and radio may
also help to pass the time. The nursing personnel should make opportunities to stop and chat with the
patient, both to distract the patient from boredom and to assess the patient’s mental status. It is often
easy to see a state of depression beginning and it will be easier to dispel in its early stages.
Care of Patients in Cervical Traction
For patients in cervical traction, the nurse shall do the following.
1. Verify that the head of the bed (HOB) is adjusted per physician’s order.
2. Verify that suction is available at the patient’s bedside.
3. When conducting Cardiopulmonary resuscitation (CPR), use jaw lift maneuver to open the airway
without hyperextending the neck. Realign patient horizontally if HOB is elevated and put board behind
patient’s neck.
4. If the patient requires logrolling, the RN or licensed practitioner shall direct patient movement from
head of bed.
5. Patients shall be turned every two (2) hours per physician order. The skin shall be assessed with each
turn for evidence of pressure, paying close attention to the occipital area, any bony prominences and
traction sites.
Sources:
http://nursing411.org/Courses/MD0916_Nursing_Care_Related_to_the_Musculoskeletal_system/1-
39_Nursing_Care_related_to_the_musculoskeletal_system.html

https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Skin_traction/#:~:text=Traction%3A%
20Traction%20is%20the%20application,lower%20limb%20and%20attaching%20weights
 TYPES OF SKIN TRACTIONS

Type Illustration Uses Nursing Considerations

Cervical Neck sprains or There is a 5-7-pound limit of

skin strains weights
Torticollis Avoid compressing the throat or
Cervical nerve trauma ears with the chin strap
Nerve root
compression

Side-arm Fractures and Hand may feel cool because of its

90-90 dislocations of the elevation. Hand can be covered
upper arm or with sock or mitten if desired
shoulder

Dunlop Supracondylar elbow Avoid pressure over bony

fracture of the prominences or nerves
humerus

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 Infant with a femur Supply plenty of diversional

traction fracture or activities If the child flips over, a
developmental sheet or Posey restraint may be
dislocated hip used; avoid pressure over
dorsum of foot and heel
Buck’s Hip and knee Remove boot every 8 hours and
traction contracture assess the skin
Legg-Calvé-Perthes Leg may be slightly abducted
disease
Slipped capital femur
epiphysis (SCFE)

Russell’s Supracondylar femur Sling may need to be

traction fracture repositioned often; mark the leg
Hip and knee to ensure proper placement
contracture

Split Femur fracture SCFE Avoid pressure over bony

Russell’s Legg-Calvé-Perthes prominences or nerves
disease Weights are not added or
removed without a physician’s
order

Skin 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.
TYPES OF SKELETAL TRACTION

Type Illustration Uses Nursing Considerations

Cervical skeletal Preoperative spine A special bed may be used to

tongs distraction assist with turning patient
Fractures or Logroll patient
dislocations of
 cervical or high
thoracic vertebrae

Halo cast or vest Postoperative A small wrench is taped to

immobilization the front of the brace to
after cervical remove front panel in case of
fusion emergency
Fracture or If patient is in halo cast, a
dislocation of cast saw must be with her or
cervical or high him in case of emergency.
thoracic vertebrae Balance is altered with a halo
cast; patients ambulating
need close supervision

Dunlop’s side- Fractures of upper Turn the patient toward the

arm 00-90 arm 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 Femur fracture Avoid pressure to the area
with Pearson Hip fracture behind the knee, which could
attachment Tibial fracture cause popliteal nerve injury
(balanced If the system is truly
suspension) balanced, the splint can be
placed at any height and it
will remain there

Skeletal traction 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.