We cleaned Daniel’s pin sites daily, sometimes in the morning and sometimes at night depending what worked best for him at the time.
We found it a two-person job initially. One person to distract, calm and stop him touching the sites or prevent us from cleaning and one person to clean. But once Daniel got used to it and the pin sites were not as fresh, one person was able to do it.
It was awful at the beginning and I felt like I would never be able to cope. The pin sites are really fresh at the beginning but once they settle down and you all get used to the process, it just becomes part of daily life and not such a big thing.
We tried to be positive about the pin site cleaning and focus on having fun in the shower and about the treat at the end. We avoided saying things like, “Sorry, Daniel but it is the dreaded pin site cleaning time again” or “Poor Daniel, pin site cleaning is so awful”. We tried to have an attitude like, “Let’s just get it done and then you can have a reward”.
Materials
Note: We found it difficult to get supplies in the UK of exactly what we needed, particularly the bandages. See what is available in your hometown, as you might want to stock up in the US. Otherwise, we just bought it online from the US or UK.
1 packet of gauze swabs –
Crest Medical 5 sterile gauze swabs 8 ply, 7.5cm x 7.5cm (we got these online from the UK)
1 packet of sterile gauze bandage
Medline Bulkee II Medium Gauze Bandage 3.4 in x 3.6 yds (we got these online from the US)
Saline solution (the spray one is the best) -
Stericlens which was available at our local pharmacy in the UK.
Antibacterial liquid hand soap (use any brand but we started with one from Walgreens)
Pair of medical scissors to cut bandage
Pair of medical tweezers
Step 1: Preparation
Prepare everything you need (out of sight) before you even mention the idea of pin site cleaning.
Boil a mug of water and disinfect the scissors and tweezers.
Wash your hands thoroughly with antibacterial soap.
Open 1 packet of gauze swaps and 1 packet of bandage and cut the bandage into sections for wrapping using the scissors.
Daniel had two areas on his fixator where the pins are grouped together so we used one section on each area. If you use the entire bandage length to wrap around all the pins it is difficult and fiddly to unwrap when you come to removing them.
Get the scissors, tweezers, gauze, saline and bandages ready to use on a clean plate (it makes it easier to carry).
Step 2: Shower time
When Daniel was 2 years old, we would shower with him, but we found it easier once he got heavier to sit him in the bottom of the shower, leaning up against the shower wall. You could also use a chair in the shower if that works best. Baths are not recommended as he would be sitting in the dirty water, increasing the chance of any infections spreading from one pin to the others.
We let him enjoy the shower for a bit and let the water soften the discharge from the pin-sites that soaks into the wrappings (or bandages). That way they would peel away from the pin sites with less pain.
It was best to take the bandages off while he was in the shower rather than taking him out and then doing it.
Once the bandages were off, we soaped up our hands with antibacterial soap and washed around each pin site making sure the soap got around each pin. Then we made sure the running water would then rinse each pin site thoroughly. You don’t need to be aggressive with this part.
Step 3: Cleaning the pin site
We found it easy to sit on the sofa with Daniel’s head on a pillow or cushion and his hip across our lap. We would let him watch TV or play with the iPad during this time to distract him (very important!).
Wash your hands again with antibacterial soap.
Dampen a piece of gauze swap with the saline solution and hold onto each end. Wrap the gauze swap around the pin site and clean it using a shoe-shine approach (they will show you this at the clinic). Clean the metal pin first to prevent pushing any dead material into the pinsite.
After you have cleaned the pin, clean the skin around the pin, pushing the skin downwards but still using the shoe shine approach. This stops the skin from riding up the pin site. If there is any loose skin, try and remove this as you clean the pin. If it bleeds, this is actually good because the blood is cleaning the site. If you can’t get the loose skin off, use the pair of tweezers to remove it (don't dig into the pin site though as you risk pushing some dead skin into the site).
There seems to a difference of opinion about how aggressive you should be. Some people will say aggressive is better but others will say if it looks okay, don’t mess with it too much. This is a bit of a learning process to see what works. If the pin sites look good on a daily basis without aggressive cleaning then stick with that. The hard thing is that you have to be more aggressive in the beginning when it is more painful for them but there is a lot of additional tissue and skin that needs to be removed.
The pin sites on Daniel’s hip were more painful to clean as they were closer to the bone than the pin sites in the fleshy part of his leg. Even though it is more uncomfortable, it is important to clean all the pin sites thoroughly.
Step 4: Wrapping the pin site
Once the pin sites are dry (we were recommended to use a hair-dryer from a distance), take the section of bandage and wrap it firmly around the pin site, pushing downwards as you wrap, until you have used the whole section. Tuck it in to make sure it does not come loose. You can use one section on several pin sites if they are close together by weaving in and out between the pin sites. If you trim the bandage, make sure you keep the cut ends away from the pin sites, as a small piece of cotton in the site would make a perfect breeding ground for bacteria.
We used a lot of bandage to make sure that it is fully padded between the pin site and the fixator which you can see in the picture. It helped keep the skin from riding up the pin site which could cause irritation for Daniel. It also reduced the gap between the bandage and the pin site, reducing the chance of bacteria getting into the pin site.
Step 5: Reward
Reward yourself and your patient for a job well done. This usually meant a chocolate for us all (and a glass or wine or beer after bedtime)!
Pin Site Infections
We found pin site infections difficult to diagnose, especially since we have no medical training. Pin sites usually ooze discharge, some a lot more than others, and on some days a lot more than others, sometimes clear and sometimes more yellow. Because of the danger of an infection getting into the bone, please get medical advice or start a course of antibiotics if in any doubt. We started on antibiotics on several occasions thinking it was a pin site infection but a swab showed later that it wasn’t. But it was better to be safe than sorry.
Some of the symptoms of the pin site infections we saw (not necessarily all at the same time) with Daniel included:
- Fever
- Fixator leg was quite warm compared to the other leg
- Oozing yellow tinged liquid that saturated the pin site wrapping
- Thick yellow pus
- Pain (localised to the pin area or deeper pain)
- Increased redness around the pins
- The discharge became smelly
- Generally not himself
After an infection during our second fixator did not clear up after a couple of courses of antibiotics, an x-ray showed that the pins had become loose in the bone (which apparently provides an infection with a good place to take hold. We had the fixator removed, and during the removal, swabs were taken from within the bone, and they tested positive for bacteria.
If we had any concerns though, we emailed Dr Paley or one of the PAs a photo of the pin site and they would quickly respond to our email.
It is a pretty common thing to get a pin site infection so don't beat yourself up, its just part of life in a fixator!
