External fixation is an accepted treatment modality for pelvic and long-bone fractures in children following a traumatic injury. One aspect of nursing care in children receiving external fixation is pin site care to prevent pin tract infection. A review of the nursing and medical literature reveals common clinical guidelines for pin site care, such as observing for infection, cleaning the sites, removing crusts, and applying dressings. There is no evidence-based practice for the care of pin sites in children or adults receiving external fixation devices for pelvic or long bone fractures to prevent infection. While the nursing literature describes pin site care techniques, the surgical literature describes the prevalence of pin tract infection. Neither set of literature consistently addresses the protocols for and outcomes in pin site care. Experimental research is needed to create evidence-based practice guidelines for pin site care to prevent pin tract infection.
External fixation is a recognized treatment for pelvic and long-bone fractures in the adult and pediatric trauma populations. One aspect of nursing care of patients with external fixation is pin site care to prevent infection. In its simplest terms, pin site care involves inspecting the site for signs of infection (tenting, redness, tenderness, purulent drainage) and cleansing the pin sites. Cleansing is further divided into frequency, technique for applying cleansing agent(s), removal of crusts, and use of dressings.
The most common complication in external fixation is pin tract infection (Collinge et al., 1994). Factors associated with pin tract infection include necrosis of tissue around the pin site and excessive movement of the pin site tissue (Green, 1983).
Accepted pin care regimens for preventing pin tract infection in pediatric patients with external fixation have not been subjected to rigorous study. Therefore, acceptable regimens for preventing pin tract infection in pediatric trauma patients receiving external fixation must be extrapolated from the adult literature and carefully evaluated before their initiation in pediatric patients.
This review applies the model of evidence-based practice to evaluate the research literature on what pin care regimens appear to be effective in preventing pin tract infections in pediatric trauma patients and places these findings in the context of clinical nursing practice.