a procedure in which a patient is maintained in a device attached by ropes and pulleys to weights that pull on an extremity or body part while countertraction is maintained. Traction is applied most often to reduce and immobilize fractures, but it also is used to overcome muscle spasm, stretch adhesions, correct certain deformities, and help release arthritic contractures. Side arm traction is a kind of skin traction used to align a fractured humerus after open reduction. Skeletal traction is exerted directly on a bone by means of a wire or pin inserted under anesthesia during the open reduction of a fracture; the ends of the pin protruding through the skin on both sides of the bone are sometimes covered with corks and are attached to a metal U-shaped spreader or bow, which in turn is attached to the traction rope. Skin or skeletal traction applied to a lower extremity by a balanced suspension apparatus, such as the Thomas splint and Pearson's attachment, permits the patient to move more freely in bed. The leg is balanced with countertraction, and any slack in traction caused by the patient's movements is taken up by the suspension apparatus. Bryant's traction, for treating fractures of the femur shaft in young children, uses a suspension apparatus to hold the legs at right angles to the body. A girdle that fits over the iliac crests and pelvis is used to apply traction for the relief of low back pain, and a cervical halter is used in applying traction to reduce neck pain. Cervical traction also may be used when a fracture of the cervical spine is suspected. Traction may be applied directly to the skin if the rope-pulley-weight system is attached to bands of adhesive, moleskin, or foam rubber or to a splint affixed to the affected limb.
method To maintain the required constant pull, the traction ropes are kept taut, free to ride over the pulleys, and securely tied to the weights, which must hang free-away from the bed and off the floor. Countertraction is maintained by elevating the patient's bed under the body part to which traction is applied. A chest restraint sheet may be applied to the patient in side arm traction for countertraction if necessary. During the initial stages of traction, the involved extremity is checked every 2 hours for quality of the distal pulse, color, warmth, motion, sensation, pain, and swelling. Blood pressure, temperature, pulse, and respirations are recorded every 4 hours until stable. Pain is controlled, and the patient is positioned as ordered. If the patient is in balanced suspension, abduction of the leg and a 20-degree angle between the thigh and bed are maintained; the heel is kept free of the sling under the calf. A harness restraint is used to prevent a child in Bryant's traction from turning over, and the child's buttocks are raised slightly from the mattress. Bed linen is changed only as necessary, and an air mattress is used when required. Every 2 hours the patient is helped with deep breathing and coughing exercises. Bony prominences are massaged, but vigorous rubbing is avoided. Lotion is applied to the skin, which is periodically inspected for signs of redness, abrasions, blisters, dryness, itching, excoriation, and pressure areas. For patients in skeletal traction, the pin insertion sites are inspected for signs of infection. The patient is observed every 4 hours for neurological signs, such as tingling, numbness, and loss of sensation or motion; for thrombophlebitis in the involved extremity; and for evidence of a pulmonary blood clot or fat embolus, as indicated by decreased breath sounds, fever, tachypnea, diaphoresis, anxiety, pallor, bloody or purulent sputum, tachycardia, or acute, severe chest pain. Oral hygiene is administered every 4 hours, and, unless contraindicated, a daily intake of 2 to 3 L of fluids is encouraged. As the patient's condition improves, his or her position is changed every 4 hours; if the kind of traction permits and if the upper extremities are not involved, a trapeze is added to the bed. The patient is taught to perform range-of-motion exercises with the uninvolved extremities, dorsiflexion and plantar flexion of the ankles, and isometric exercises, such as gluteal and abdominal contraction. A high-protein, low-carbohydrate diet is served, and vitamin and iron therapy may be ordered. The immobilized patient uses a flat, fracture bedpan and usually requires stool softeners or a mild laxative.
interventions The patient in traction often needs extensive physical care and emotional support. The patient is encouraged to verbalize feelings and concerns about prolonged hospitalization and absence from work or school. To the greatest degree possible, the nurse encourages the patient to participate in self-care and to engage in diversions, such as handicrafts, reading, watching television, and listening to the radio. If the patient is not allowed to elevate to the head of the bed, specialized glasses called prism glasses aid in the ability to watch television.
outcome criteria Diligent attention and nursing care are necessary to prevent pressure ulcers, infection, constipation, kidney stones, and other sequelae of immobility.