Safe Patient Turning Techniques with Skin Traction: A Step-by-Step Guide

Turning a patient in skin traction (e.g., Buck's traction for femoral fracture) requires maintaining continuous traction force while repositioning to prevent pressure injuries and ensure alignment.

Preparation

• Explain procedure; obtain cooperation.
• Gather: turning sheet/slider, pillows, ≥2 staff (3 ideal).
• Verify traction setup: weight hanging freely, ropes in pulleys, straps secure but not constricting.
• Assess skin under straps/boots.

Log-Roll Turn (to side)

1. Place turning sheet under patient (shoulders to thighs).
2. Position pillows along dependent side (back, between knees, under upper arm).
3. Staff on each side: grasp sheet firmly.
4. Synchronized log roll: Move as unit; maintain spinal alignment. One staff monitors traction – ensures weight moves smoothly, no sudden jerk.
5. Support affected limb: slight abduction, neutral rotation (per surgeon order).
6. Place pillows: behind back, between knees, under upper arm/leg.
7. Reposition traction ropes if needed; confirm weight free.
8. Assess skin, neurovascular status (color, temp, sensation, movement, capillary refill) of affected limb.
9. Document: time, position, skin condition, patient tolerance.

Supine Repositioning (Up in Bed)

• Use slider sheet + mechanical lift or coordinated team lift.
• Slightly increase traction weight during move (if ordered) to counter friction.
• Never drag – shear forces cause skin breakdown.

Key Principles

• Never release traction.
• Smooth, coordinated movements.
• Frequent skin checks (q2h).
• Pin care if skeletal traction (not skin).

Competency validation required per facility policy.