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By :

Miss. Sanaa AL-Sulami


Definition of Traction
Indication for Traction
Classification of Traction
Complications of Traction
Assessment and Diagnostic Evaluation of Traction
Principles to follow when caring for the patient in
traction
Types of Traction
Nursing Management

At the end of this lecture the students will be able
to:
Define the traction
discuss the indication for traction
List the classification of traction
list the complications of traction
Describe the assessment of client with traction
Discuss the Principles to follow when caring for the
patient in traction
List the types of traction
Discuss the nursing management for client with
traction
Traction is the application of a pulling force
to a part of the body.

Traction must be applied in the correct
direction and magnitude to obtain its
therapeutic effects.
Indications:

Traction is used to
To minimize muscle spasm.
To reduce align, and immobilize fractures
To reduce deformity .
Classification of Traction :
Skin Traction : is maintained by direct
application of a pulling force on the clients
skin . It is generally used as a temporary
measure.
To reduce muscle spasms
To maintain immobilization before surgery.

Skeletal Traction : is attaches directly to
bone , providing a strong steady, continuous
pull, and can be used for prolonged periods .
Classification of Traction :
The amount of weight used depends on
the injury, pathologic condition, body size,
and degree of muscle spasm.
Manual Traction :
is applied with hands to temporarily immobilize
an injured part. A firm, smooth, steady pull is
maintained . Manual Traction is used during
casting, reduction of a fracture or dislocated
joint.
complications:
potential complications that may develop include the
following:
Neurovascular compromise.
Inadequate fracture alignment..
Skin breakdown .
Soft tissue injury.
complications:
potential complications that may develop include
the following:
Pin tract infection .
Osteomyelitis can occur with skeletal traction.
In additional, complications from immobility can
be encountered , especially with long term
traction and in older adult.


The nurse must be consider the psychological and
physiological impact of the musculoskeletal
problem, traction device, and immobility.

The nurse must assess and monitor the patients
anxiety level and psychological responses to
traction.
It is important to evaluate the body part to be
placed in traction and its neurovascular status
and compare it to the unaffected extremity.
As long as the client is in traction, skin
integrity must be assessed and documented,
examining especially for redness, bruises,
and lacerations.

Radiological Evaluation while the client is in
traction determines the extent of injury,
maintenance of bony alignment, and the
progress of healing.

Additional principles to follow when caring
for the patient in traction:

1. Traction must be continuous to be effective
in reducing and immobilizing fractures.
2. Skeletal traction is never interrupted.
3. weights are not removed unless intermittent
traction is prescribed.
4. Any factor that might reduce the effective
pull or alter its resultant line of pull must be
eliminated:

4. The factor that might reduce the effective pull
or alter its resultant line of pull must be
eliminated:
1. The patient must be in good alignment in the center
of the bed when traction is applied.
2. Ropes must be unobstructed.
3. Weights must hang free and not rest on the bed or
floor .
4. Knots in the rope or the footplate must not touch the
pulley or the foot of the bed.

Types of Traction :
Cervical skeletal tongs; Gardner-wells
crutch field vinke


Halo vest


Skin chin halter straps
Types of Traction :
Lower Extremity Bryants Traction



Bucks Traction



Balanced Traction
Alteration in Peripheral Tissue Perfusion:
Circulatory Care: tissue perfusion is enhanced
by client exercises within the limitations of the
traction.
Exercises, regular deep breathing and
coughing, adequate fluids, and elastic
stocking work together to prevent deep
venous thrombosis.
Teaching the client about anti-coagulant is
essential.
High risk for peripheral neurovascular dysfunction:
Peripheral sensation management :
Accurate assessment of neurovascular status
includes evaluating the clients pain, sensation,
active and passive ROM, color, temperature,
capillary refill time, and pulses.
Neurologic impairment specific to the location
of the traction should be assessed.
The client must be instructed to report changes
in sensation.
Taught the client about the appropriate
exercises.


Providing pin site care:
The wound at the pin insertion site requires attention .
The goals to avoid infection and development of
osteomyelitis.
Initially :
1. the site is covered with sterile dressing.
2. the nurse must keep the area clean.
3. Slight serous oozing at the pin site is expected.
4. the nurse assess the pin site and drainage for
signs of infection.
Attaining maximum mobility with traction:
During traction therapy:
1. The nurse encourage the patient to
exercise muscles and joints that are not in
traction to guard against their deterioration.
During the patient exercises :
1. The nurse ensures that traction forces are
maintained and that the patient is properly
positioned to prevent complications resulting
from poor alignment.
Maintaining the positioning :
1. The nurse must maintain alignment of the
patients body in traction as prescribed to
promote an effective line of pull.
2. The nurse positions the patients foot to avoid
foot drop , inward rotation, and outward
rotation.
3. The patients foot may be supported in a
neutral position by orthopedics devices.

Nursing Interventions:
Monitoring and managing potential
complications:
Pressure Ulcers
The nurse examines the patients skin frequently for evidence
of pressure or friction.
It is helpful to reposition the patient frequently and to use
protective devices to relieve pressure.
If the risk of skin breakdown is high, as in a patient with
multiple trauma or a debilitated elderly patient, use of a
specialized bed is considered to prevent skin breakdown.
If a pressure ulcer develops, the nurse consults with the
physician and the wound care nurse specialist.
Monitoring and managing
potential complications:

Pneumonia
The nurse auscultate the patients lungs every 4 to 8
hours to determine respiratory status and teaches the
patient deep-breathing and coughing exercises to aid
in fully expanding the lungs and moving pulmonary
secretions.
If the patient history and baseline assessment
indicate that the patient is at high risk for
development of respiratory complications, specific
therapies may be indicated.
If a respiratory problem develops, prompt institution of
prescribed therapy is needed.
Monitoring and managing
potential complications:

Venous Stasis and Deep Vein Thrombosis
Venous stasis occurs with immobility.
The nurse teaches the patient to perform ankle and
foot exercises within the limits of the traction therapy
every 1 to 2 hours when awake to prevent DVT, which
may result from venous stasis.
The patient is encouraged to drink fluids to prevent
dehydration.
The nurse monitors the patient for signs of DVT,
including calf tenderness, warmth, redness, swelling
(increased calf circumference).