Standard Skeletal Pin Care Orders for Buck's Traction
Standard skeletal pin care for Buck's traction should include daily cleansing with normal saline, removal of crusts, and application of dry sterile dressings without routine use of antimicrobial agents.
Assessment and Monitoring
- Inspect pin sites daily for signs of infection:
- Redness
- Increased warmth
- Swelling
- Drainage (note color, amount, consistency)
- Pain at pin site
- Pin loosening
- Document findings using a standardized pin site assessment tool
- Monitor for early signs of pin tract infection using the Checketts-Otterburns classification:
- Grade I: Slight redness and minimal discharge
- Grade II: Redness, discharge, and pain at pin site
Cleansing Protocol
- Frequency: Once daily is sufficient for routine care 1
- Increase to three times daily if drainage is present 2
- Cleansing solution: Normal saline (0.9%) 2
- Avoid alcohol-based solutions as they may cause more irritation
- Avoid hydrogen peroxide as it can damage healing tissue
- Technique:
- Use sterile technique for hospitalized patients
- Clean technique may be used for outpatients 2
- Clean from pin site outward in a circular motion
- Use separate gauze/swab for each pin site to prevent cross-contamination
Crust Management
- Remove crusts gently during cleansing 2
- Crusts can harbor bacteria and prevent drainage
- Use moistened gauze to soften crusts before removal
- Avoid forceful removal that could cause trauma
Dressing Application
- Apply sterile dry gauze dressings to pin sites 2
- Keep initial surgical dressing undisturbed for at least 48 hours unless leakage occurs 3
- Avoid petroleum-based ointments or antimicrobial agents at pin sites unless specifically indicated for infection
- Secure dressings with tape that doesn't create tension on the skin
Pin Care Considerations
- Avoid excessive manipulation of pins during care
- Maintain stability of the external fixation device
- Ensure patient comfort during pin care procedures
- Educate patients and caregivers on proper pin care techniques if they will be performing care
Management of Complications
- For signs of pin site infection:
- Increase cleansing frequency to three times daily
- Obtain cultures if purulent drainage is present
- Consult physician for possible antibiotic therapy
- Monitor for signs of osteomyelitis (persistent pain, fever)
Documentation
- Record pin site appearance
- Document cleansing performed and dressings applied
- Note any signs of infection or complications
- Document patient education provided
Cautions and Pitfalls
- Avoid using antimicrobial agents unnecessarily on clean, healing pin sites 3
- Changing dressings too frequently can disrupt the healing process 3
- There is insufficient evidence to recommend one cleansing solution over another 4
- The most common bacteria found in pin site infections are coagulase-negative staphylococcus and corynebacterium 1
While there is limited high-quality evidence to establish a definitive standard for pin site care 4, 2, the protocol outlined above represents a practical approach based on available research and clinical practice principles. The evidence suggests that simple care with normal saline and regular monitoring is as effective as more complex regimens.