occipital protuberance. A pulley rope is attached to the spreader bar that hooks to the
top of the harness. The prescribed weights at the end of the pulley rope keep the
patient's neck and cervical spine in a position specified by the physician.
b. The patient's bed may be positioned in reverse to allow easier access to the
patient's head. The head of the bed may be elevated to provide counter traction and to
help prevent the patient's head or the spreader bar from resting against the bed frame.
When positioning the bed, allow for plenty of room around the head of the bed in order
to prevent bumping the weights.
c. Feed the patient slowly and carefully. If turning is not permitted, remind the
patient to face forward and not turn toward the spoon, fork, or straw. Allow plenty of
time for him to chew and swallow. Check to be certain that the chinstrap is not pressing
on his throat. More importantly, keep suction equipment on hand for immediate use to
prevent the patient from aspirating when eating, drinking, or receiving mouth care.
Remember, if the patient chokes or vomits, he cannot be turned to the side or raised
1-34. SKELETAL TRACTION
a. Skeletal traction is used most frequently in the treatment of fractures of the
femur, the tibia, the humerus, and the cervical spine. The traction is applied directly to
the bone by use of a metal pin or wire inserted into or through the bone or by tongs
inserted into the skull. The pin, wire, or tong is then attached to the traction apparatus.
b. A significant problem with skeletal traction is the potential for infection, which
could develop in or around the insertion site. The site must be inspected daily for
drainage and odor. Daily cleaning and dressing changes may be prescribed by the
physician or by local standing operating procedures.
c. The insertion of pins, wires, or tongs is often done in the operating room
under anesthesia. Frequently, the patient will arrive on the ward with most of the
traction apparatus already in place. Assist the physician or the orthopedic technician
with positioning of the patient and arrangement of the traction apparatus. Because of
differences in age, weight, body type, and the nature of the fracture itself, no two
fractures can be considered alike and each patient will require individualized treatment.
Therefore, traction procedures are modified for the requirements of each patient. It is
extremely important that nursing personnel understand the nature of the traction in use
and the patient movement that is permissible while still maintaining the desired traction
pull. These factors will affect the planning of basic nursing care for that patient. The
following paragraphs discuss several of the most commonly used forms of skeletal