INDIRANI COLLEGE OF NURSING

LEVEL OF STUDENT - B.SC(N) II yrs

Presented by
Mrs. Dhanasundari. G
Lecturer in Nursing (MSN)
ICON

HOD PRINCIPAL

TRACTION
Definition.
Traction is the application of a pulling force to a part of the body with
countertraction a pull in the opposite direction. More specifically, orthopaedic traction
occurs when “ A pulling force is exerted on a part or parts of the body”(Davis, 1996)
Purposes
 To reduce a fracture and realign bone fragments by overcoming muscle spasms.
 To maintain skeletal length and alignment.
 To reduce and treat dislocations
 To immobilise and to prevent further tissue damage.
 To prevent the development of contractures when there is a pathologic condition
that causes the muscles to contract.
 To relieve muscle spasms that occur as a reaction to musculoskeletal trauma in
the absence of a fracture such as cervical sprain or low back pain.
 To lesson deformities, such as with arthritis.
 To rest a diseased joint.

Classification of Traction.
Skin Traction: is attached directly to the patient’s skin to immobilise a body part
continuously or intermittently over a short or extended period. The direct application of a
pulling force to the patients skin and soft tissues may be accomplished by using adhesive
or nonadhesive traction tape or other skin traction devices such as a cast, a boot, a belt or
a halter.
Skeletal Traction: is attached directly to the patients skeletal system to immobilise a
body part. The direct application of the pulling force may be accomplished by attaching
pins, screws, wires or tongs.
Manual Traction: is traction that is accomplished by a persons hands exerting a pulling
force. It is utilised to reduce fractures and dislocations and to apply a steady pull while
mechanical traction is released for adjustment or while a cast is being applied.
Fixed Traction: The pull is exerted against a fixed point; for example, the tapes are tied
to the crosspiece of a Thomas splint and pull the leg down.
 Balanced Traction: The pull is exerted against an opposing force provided by the
weight of the body when the foot of the bed is raised.

Acute management
 Ensure Order for Skin traction is documented by the Orthopaedic Team-(including
weight to be applied in kgs)
Preparation of equipment
o Hospital Traction bed with bar at the end of the bed
 o Traction kit paediatric OR adult size (foam stirrup with rope and bandage)
o Overhead traction frame
o Pulley
o Traction weight bag
o Water
o 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. 
 (Formula to calculate weight in kgs to come)
 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.
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 orthopaedic 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. 
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.
Potential complications
 Skin breakdown/pressure areas
 Neurovascular impairment
 Compartment syndrome
 Joint contractures
 Constipation from immobility and analgesics 
References
Black, Matassarin, Jacobs (1993). An Introduction to Orthopaedic Nursing 2nd Edition. Naon
Productions.

Davis, P.S. (1996) Nursing the Orthopaedic Patient. Churchill Livingstone.