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New guidance on orthopaedic pin sites  

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Guidance on the effective care of orthopaedic pin sites and infection prevention has been published by the Royal College of Nursing.

The guidance was developed by a group of multidisciplinary experts brought together by the RCN Society of Orthopaedic and Trauma Nursing.  

Elaine Collins, chair of the society and head of clinical services at the Nuffield Health Bristol Hospital, highlighted that external fixation and limb reconstruction procedures were a vital part of trauma and orthopaedic care.

But she said there was a “pressing need for research which can drive future practice in this area” and that the RCN’s new guidance had been drawn up in “recognition” of that need.

She added that the document was “not intended to be a set of rules, but is instead designed to be used as guidance for those wishing to ensure that their care delivery meets current views on practice”

The guidance recommends that in the absence of skin sensitivity, pin sites should be cleaned weekly using alcoholic chlorhexidine solution and non-shedding gauze.

Sites should then be covered with a wound dressing that “keeps excess moisture and exudates away fro the wound”.

The dressings should be held in situ with a clip or “bung” in order to apply light compression, and the frequency of dressing changes should be increased in the presence of an infection or if the dressing “becomes saturated”.

The guidance also says that on the day of a dressing change patients may swim, attend hydrotherapy and shower, but not bath, the limb. The surrounding skin should be moisturised with an emollient where necessary.

In addition, it highlights that patient reported symptoms and perceptions of the presence of infection should “be taken seriously”.

For example, it cites infection indicators including increasing pain at the pin site, decreased movement and mobility, spreading redness or increased swelling and discharge.

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