Care of external fixator pin sites.

External fixators include pins and wires placed by surgeons to stabilize fractures such as those involving the tibia. In critical care, external fixators are more commonly used to stabilize cervical spine fractures. Because halo fixators secure cervical alignment, these devices allow early mobilization and shortened stays. However, halo-fixator complications include cranial pin loosening, localized infection, and superficial pressure sores. Loosening of cranial pins for halo fixators with signs of local infection, fever, headaches, or seizures deserves rapid notification of the surgeon and neuroimaging. Likewise, any tracking (open area with skin pulled away from pins) or clicking noises necessitate prompt assessment by the surgeon for potential loosening of pins. Although daily assessment of pin sites to monitor for complications is not debated, the approach to pin-site care to prevent infection is less clear-cut. A common method of site care involves using normal saline to clean around each pin. Clinicians may question if this treatment is aggressive enough to prevent infection. Pin sites located in significant softtissue areas have a higher risk of infection. A skin infection surrounding pins can produce complications such as increased pain, delayed healing or fracture misalignment, osteomyelitis, or a systemic infection resulting in prolonged stay or readmission, and increased health care costs. Since this type of infection occurs in up to 20% of patients with external fixation devices, it is imperative that nurses take appropriate preventive measures, prompting the following PICO question: “In patients with external fixators, what solution and cleansing frequency of pin sites is associated with the lowest pin site infection rates?” A regular feature of the American Journal of Critical Care, Clinical Evidence Review unveils available scientific evidence to answer questions faced in contemporary clinical practice. It is intended to support, refute, or shed light on health care practices where little evidence exists. To send an eLetter or to contribute to an online discussion about this article, visit www.ajcconline.org and click “Respond to This Article” on either the full-text or PDF view of the article. We welcome letters regarding this feature and encourage the submission of questions for future review.