Med-Surg - Musculoskeletal System, part 8: Immobilization Devices


Immobilization devices, including casts and traction. The different types of traction (skin traction, skeletal traction, halo traction). Nursing care of patients with traction devices, including the management of weights, muscle spasms, and pin site care.

Full Transcript: Med-Surg - Musculoskeletal System, part 8: Immobilization Devices

Hi. I'm Cathy with Level Up RN. In this video, I will be talking about immobilization devices such as traction and casts. And I'll be talking about nursing care of these devices as well. At the end of the video, I'm going to give you guys a little quiz to test your understanding of some of the key points I'll be making in this video. So definitely stay tuned for that. And if you have our Level Up RN medical-surgical nursing flashcards, definitely pull those out so you can follow along with me.

Let's first talk about nursing care and patient teaching for cast.

So if your patient has a plaster cast, you want to make sure you handle that cast initially with the palms of your hands and not your fingertips until that cast is completely dry. So this will prevent you from denting the cast with your fingertips. Also, you want to elevate the patient's extremity with the cast above the level of the heart, especially during those first 48 hours to decrease swelling.

And then in terms of patient teaching, you want to advise your patient, do not place anything inside that cast. So if they have itching inside that cast, they can use a blow dryer set on a cool setting and blow that cool air into that cast to help relieve that itching. And then when you are discharging your patient, you need to make sure that they notify their provider if they have an increase in pain, if they have any hot spots that show up around the cast, if they have malodor or increased drainage as well.

Let's now talk about traction. So there are several different types of traction.

Skin traction is where we apply weights to the patient's skin in order to immobilize the affected area and decrease muscle spasms. Skin traction can also help to reduce a fracture. So when I say reduce a fracture, I mean that we're setting the bone back into its proper position.

Examples of skin traction include Bryants 'traction and Buck's traction.

With Bryant's traction, this is typically used in children for hip dysplasia.

Buck's traction is used in adults for hip fractures.

So our little cool chicken hint here on the card, if you look at Bryant's, it looks like B-R-Y and then ants. And the ants are very small like children, so that will help you remember that with Bryant's traction, that's for children. And then adults make a lot of money or the big bucks. So Buck's traction is for adults.

We also have skeletal traction. So this is obviously more invasive than skin traction. With skeletal traction, we have screws or pins that are inserted into the bones. And this would typically be used for long bone fractures.

And then finally, we have halo traction, and this device would be used for cervical bone fractures.

With all of these immobilization devices, you're going to have weights and pins and rods, and it's going to be really important for you as the nurse to know how to take care of these things and of your patient.

So in terms of weights, you should never lift or remove weights from the traction device. So weights need to be hanging freely. You want to make sure weights are never resting on the floor.

And then if your patient has muscle spasms, muscle spasms are expected when a patient has a fracture and they are undergoing traction. So you want to address these muscle spasms by providing medications such as analgesics and muscle relaxants. You can also help the patient with repositioning or try heat or massage to relieve these muscle spasms. If all of these interventions are not successful in reducing the muscle spasms, then you would want to notify the provider.

In terms of halo traction - again, this would be used for cervical fractures, and it's a big device with rods that go into the skull - it is really uncomfortable.
And if you look in your nursing textbook, you will likely see a picture of this device with somebody looking very unhappy in the device, which you can't blame them. Anyway, when you are moving the patient, you need to move them as a unit and you never want to apply pressure to those rods or move the patient by grabbing those rods. Definitely don't do that. We also want to make sure a wrench or a screwdriver is attached to the vest - that comes as part of that halo traction - so that we can remove the device from the patient if needed for emergency. For example, if we need to perform CPR.

In terms of pin site care, you really want to take good care of your patient's pins that are associated with their immobilization device. So you're going to want to monitor the pins for loosening, which would definitely be a complication that you'd want to notify your provider about. In addition, you want to monitor for signs and symptoms of infection. So this can include increased drainage, increased redness or swelling. And it can also include tenting, so tenting at the pins site. If you notice one of these things taking place, then that would be something you'd want to notify the provider about. When you are cleaning the pins, you want to use a new cotton tip swab to clean each pin, so you don't want to reuse that swab. And then if there is crusting at the pin site, you don't want to remove that. So that crusting kind of provides a barrier which prevents bacteria from getting into the pin site.

All right. You guys ready for your quiz? I have three questions for you. First question. How should a plaster cast be handled until it is dry? The answer is with the palms of your hands to avoid denting that plaster cast while it's wet.
Question number two. When caring for a patient in traction, you need to make sure weights are resting on the floor. True or false? The answer is false. So those weights need to be hanging freely and should not be resting on the floor.
Question number three. Increased drainage and skin tenting at the pins site are signs of possible infection. True or false? The answer is true.

Okay. I hope this video has been super helpful. If so, be sure to like the video. Leave me a comment. And if you haven't already done so, be sure to subscribe to our channel. Take care and good luck with studying.

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1 comment

Also, hot spots are a sign of infection inside the cast. You should always cut the edge of the plaster cast because the end is rough and hard. And last, a hesi favorite is to apply wool strips at the edges of the cast to avoid the rough edges pressing against the patient’s skin.


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