Skin Care – External FixatorsSECTION: 10.07

Strength of Evidence Level: 3__RN__LPN/LVN__HHA

PURPOSE:

To ensure that the skin around skeletal pin sites remains free of signs and symptoms of infection.

CONSIDERATIONS:

  1. Some types of braces, skeletal traction, and external fixators use pins. These pins make a direct pathway to the bone. This pathway increases the risk of infection.
  2. Pin care should be performed by the patient and/or caregiver as directed by the physician, generally 1 to 3 times per day.

EQUIPMENT:

1 Bottle of hydrogen peroxide

1 Bottle sterile normal saline

Sterile container with lid

Sterile cotton tipped applicators

Gloves

Sterile specimen cup

1 Protective barrier, such as a blue pad

PROCEDURE:

1.Adhere to Standard Precautions.

2.Explain procedure to patient/caregiver.

3.Gather equipment and supplies.

4.Don non-sterile gloves.

5.Mix Hydrogen peroxide (H2O2) and Normal Saline solution in equal amounts to achieve 1/2 (one-half) strength (or as ordered by physician).

6.Solution may be saved for up to 24 hours. Label container with name of solution and date. (See Integumentary - Preparing Solutions in the Home.)

7.Place protective barrier under extremity with pins.

8.Wet cotton tip applicator with solution.

9.Place the applicator where the pin enters the skin and gently clean skin surrounding pin making outward strokes away from pin.

10.Use a new applicator for each stroke until a complete circle has been made.

11.Pull the skin away from the pin using the cotton applicator to keep skin free from pin, using the applicator to remove any crust from pin site.

12.Assess for signs of infection at the pin site, including redness, increased pain, swelling, pus-like drainage or black tissue. Report presence of signs to physician.

13.Clean the pin itself with cotton tip applicator and the solution making strokes along the pin, using a new applicator with each stroke.

14.Continue Step 13 until all pin sites are free of drainage or crusting. Use a new applicator for each full circular motion then discard.

15.Discard soiled materials per agency procedure.

16.Wash hands.

17.Instruct patient and/or caregiver in pin care.

  1. Instruct patient and/or caregiver to report any of the following signs of infection immediately:
  2. Redness at the pin site.
  3. Increased pain at the pin site.
  4. Swelling at the pin site.
  5. Pus-like drainage at the pin site.
  6. Black tissue around the pin site.
  7. Fever of 101 degrees Fahrenheit (38.3 C) or above.
  8. Chills.

AFTER CARE:

1. Document in patient’s record:

a.Procedure and observations.

b.Instructions given to patient/caregiver.

c.Response to instruction.

d.Communication with physician.

REFERENCES:

Schoen, D.C. (2000). Adult Orthopaedic Nursing. Philadelphia, PA: Lippincott-Raven Publishers.