Pin Care for External Fixators

a male leg with an Ilizarov's external fixator on it
a male leg with an Ilizarov's external fixator on it

Jenny is a 3rd year nursing student. For years, she had been studying really hard to get good grades and earn as much learnings as she could. She participates well in lectures, studies religiously every night for classes the next day and even takes her clinical duties seriously.

Today, she and her classmates are assigned to go on duty at the surgical ward. Together with their Clinical Instructor, they conduct their rounds. They go from bed to bed, assessing the patients. She is trying to take in all they have learned so far until a patient with a metal emerging from the leg intrigues her.

“Wait, Ma’am, what is that? Is that really attached to the patient’s leg?” she asks her Clinical Instructor and can’t seem to take her eyes off the patient’s leg.

Is Pin Care really necessary?

First, to give us an overview, there are two types of external fixators. One is the monolateral fixator and the other is the ring fixator. Both of them are special devices that hold an arm or leg in place with pins or wires while the bone mends or lengthens and help to straighten, lengthen or turn the bone as well.

The device is fitted to the outside of the arm or leg and is held in place with pins or wires that pass through the skin and into the bone. Some devices also may have rods and clamps that help hold broken bones in place while they heal. Because of this, and because germs live on the outside of the fixator, pins or skin, they can cause an infection at the pin site since a pin makes a direct pathway to the bone. It can cause pain and swelling and prevent the bone from healing, and can even cause a deeper infection close to or in the bone itself.

Pin care is the process of cleaning a pin and the skin around where the pin enters the body. By performing pin care, we are preventing infection.

Preparation

Pin care may be done 1-3 times a day, depending on the doctor’s orders. Before performing the procedure, the nurse must first make sure that all needed equipment and materials are ready, such as:

  • A clean, 4- to 8-ounce container with lid
  • Normal saline and hydrogen peroxide
  • A pen or marker
  • Blue pads or a clean towel
  • Clean cotton swabs
  • 4×4 gauze pads (if there is drainage)
  • Betadine or antibiotic ointment, if ordered by the doctor
  • New soft bristle brush
  • 2 clean dry towels
  • Foam sponges for ring fixator device if ordered by your doctor
  • Roll of surgical tape

In the container, mix equal amounts of hydrogen peroxide and normal saline. Mix 1/4 cup of hydrogen peroxide with 1/4 cup of normal saline. Mark the container with the name of the solution and the date it was mixed. The same solution may be saved and used for up to 24 hours.

Steps in Cleaning Pin sites and wound

  1. Gather all of the supplies.
  2. Wash your hands well with soap and water for 15 seconds.
  3. Before starting to clean, place a clean, dry towel under the leg.
  4. Wipe any drainage or loose crust from around the pin with a clean cotton swab.
  5. Dip a clean cotton swab into the sterile saline. Clean the skin around the pin in a circular motion.
  6. Push the skin down and away from the pin.

This prevents the drainage from building up at the pin sites. It also keeps the skin from sticking to the pins. Make sure no crust is left at the pin site or on the skin around the pin. Repeat these steps for each pin and wire site. Use a clean cotton swab for each pin site. Do not touch or use the same swab from one site to another.

  1. If the patient has an incision or wound where the bone was cut:
  • Stitches or steri-strips may be used to close the wound.
  • Check the site closely for any signs of infection. Change the bandage only if there is excess drainage, if it has fallen off or as your doctor instructs you to do.

Cleaning the wires and pins

  1. Dip a clean cotton swab and soft bristle toothbrush into the sterile saline.
  2. Clean the exposed metal parts of each pin and wire all the way up to the fixator and down to the skin.
  3. Remove all crust, dried blood and scabs from the pins and wires.
  4. If the crusts are hard to remove with the cotton swab, gently scrub the pins and wires with the soft bristle toothbrush.
  5. Wipe clean with a new cotton swab. Extra cleaning may be needed on pins with threads or screw lines.
  6. Rinse the toothbrush and container with sterile saline after each cleaning. Wipe them dry and store in a clean area.

Cleaning the external fixator device

  1. Use a clean cotton swab or clean washcloth soaked with sterile saline to clean the device. Remove all dust or dirt.
  2. Dry with a clean towel.
  3. The patient may shower once your doctor gives a signal that it is okay. In the shower, gently clean the fixator with soap and water.
  4. Dry with a clean towel.
  5. The pin sites and pins must still be cleansed. The shower does not replace cleaning the pin sites and pins.

During each pin site cleaning, signs of infection must also be checked as evidenced by the following:

  • Changes in skin color, increased redness or streaking of the skin around the pin
  • Swelling
  • Increased tenderness, pain or hardness at the pin site
  • Increased drainage
  • Change in color or smell of drainage
  • Increased warmth to touch at the pin site
  • Fever over 100.3°

 

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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