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Pediatric Orthopaedic Practitioners Society POPS

Question from member Leslie Rhodes

Posted over 2 years ago by Suzanne Hilt

I have a new nurse doing an EBP project on pin site care. I would like to know if everyone does pin site care? If so, when do you initiate it (POD 1, 2, etc), and what solutions and ratios do you use?

Leslie Rhodes


Comments

Colleen Ditro about 2 years ago

Hi, Leslie-
Our PTs do the Pin care in house and use the bottles of NSS with qtips. We send families home with either some bottles or I have them get the squirt bottles of contact lens solution cleaner-it's a great squirt bottle. We start on POD1 or 2 depending on the patient.
colleen

Kathleen Doyle about 2 years ago

Hi Leslie, our nurses do the pin care here in Boston. We use 1:1 Hydrogen peroxide and normal saline. Generally we start on POD2

Amanda Mccullough about 2 years ago

Our nurses do the pin site care starting on POD #2. We do half strength hydrogen peroxide on the pin sites twice daily.

Suzanne Hilt about 2 years ago

In Peds, our NPs do the initial pin care with NS on POD #2. Then it is done by the nurses in-hospital, teaching the family to do at home 1-2 times daily. We have the families do just soap & water. But even within out own institution, there is a lot of variability between departments in the solution used and frequency. I wish it was more standardized.
Suzanne

Susan Laham about 2 years ago

For our lengthening/deformity correction ex fix we start pin cleaning 1 week post op at the time of first lengthening. Pins are cleaned daily at home with iodine swabs and then wrapped with gauze or kerlix. One of our providers uses 50/50 normal saline and hydrogen peroxide as the solution instead of the iodine swabs.

Jesica Archie about 2 years ago

Ours are seen in clinic by NP a week after discharge. The outer dressing is removed and sites cleaned with warm soapy water and clean wash cloth. Families are able to demonstrate pin care by end of that visit. Pins are cleaned as often as needed, generally 1-3 times a day at home. In my experience, the soapy wash cloth helps to remove scabs/dry drainage without causing trauma/bleeding to pin sites. I agree there is a great deal of variability within our institution re: pin care.

Leslie Rhodes about 2 years ago

Thank you all for your responses. I wanted to show the nurses that the literature is correct in that practice varies across the country and you helped me show them that is true. We begin POD 2, using 1:1 sterile water and hydrogen peroxide. The BS nurses teach them, have the patients/parents return demonstrate and then we send them home with supplies and instructions to perform at least BID and PRN.

Anne Stuedemann about 2 years ago

Hi Leslie! Ortho here at CMH typically use soap and water for both our halo pin sites and our external fixators. Here is our guideline:
CMH Ortho preferred pin care
Cleaning the pin site
a. Must shower daily if able for pin care; wash each pin site gently with soap and water.
b. If unable to shower proceed as follows:
1. Wash hands. Apply clean gloves
2. Use soap and water for cleaning solution
3. Clean each pin site with cotton swab dipped in soap and water solution, rinse with water and dry with clean swab.
4. Use new cotton swab for each pin
5. Remove all crusting and dried drainage
6. Use circular motion
c. If pin site is red and draining a provider may increase pin care frequency, add topical antibiotic, peroxide, and/or oral /IV antibiotics
1. Hydrogen peroxide when prescribed is a mixture of ½ strength peroxide and ½ strength normal saline

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