Pin Site Care - My Routine

Link to Pin Site Care - Supplies is here.
Link to Pin Site Care - Video is here.

About a month ago I wrote a post about the supplies I use to take care of my pin sites. I intended to follow it with two other posts, one talking about my pin site care routine and the other an actual video of it, but then surgery happened and life in general got in the way. We all know how it goes - priorities change and thing soon get forgotten. But I still actually really wanted to blog about pin site care. I just had to find the time. Yeah, I know that I technically have all the time in the world right now what with whole sitting on the sofa at home for months on end thing, but somehow other things like sleeping, cross word puzzles, Netflix, and cross stitching always trump tapping away at my keyboard. With the whole blogging every day for a month thing, however, I have made the time. Also, I've discovered that blogging gets way more fun when you put on some music with a good beat in the back ground.

I perform pin site care once a day. Other than making adjustments to my fixator, it has been my primary and most important obligation over the last four months. It doesn't matter how I feel or how much I want to do something else with my time because it has to be done. No ifs and or buts. Why? Because the pins go through my skin, the underlying tissue and into my bone. A superficial pin site infection, meaning that it is just in the skin or soft tissue, could easily spread into my bone, which would leave me right where I started last August - with a bone infection. That is literally the worst case scenario and we desperately want to avoid. We do not want an infection, no matter how small! So I perform pin site care to keep things clean in the hopes of preventing an infection. That, and I taking antibiotics proactively. The literature out there about taking antibiotics during external fixation is unclear on whether or not doing so will prevent an infection, so it is up to an individual's doctors to make that decision. Mine decided, given my history with chronic osteomyelitis, that it would be in my best interest. So that's the other thing I am doing to help prevent pin site issues.

Back to pin site care. Pin site care involves cleaning my pin sites and the actual pins with a sterile saline solution and hydrogen peroxide, and applying a dressing around each pin site. I usually do it once a day but sometime more often if my pins are particularily gunky. Everybody does pin site care differently based on their doctor's preferences. This is how I do my pin site care:

1) Gather my supplies.

2) Site down on chair and clean my hands with hand sanitizer. Things are much easier if you can prop your leg out in front of you on a chair or stool. That way you are not awkwardly bending down to reach your leg. Plus, keeping your leg elevated helps prevent/reduce swelling.

3) Carefully remove the old dressing from my leg. Or, alternatively, just tear it off. It doesn't really matter. The skin around my pins never really hurts (unless there is an infection, I have just recently done my turns for the day or, like right now, my pins are bent and putting pressure on the surrounding tissue).

4) Now that I have touched the old dirty dressing, I clean my hands with sanitizer again.

5) Grab a bottle of sterile saline and some non-sterile gauze. Tilt my leg slightly to the side and place the gauze on the side of the leg facing downwards, a small distance away from the pins. I don't want this gauze to touch the pin site because this is non-sterile gauze. Read: lots of nasty germs. Uncap the bottle, point it towards one of the pins and squeeze. Let the water run over the pin site. It will be soaked up by the gauze. I do two pins at once. Then I turn my leg the other way, and repeat the whole thing so that I know the saline has gotten around the entire pin. Once this is done, I repeat for my bottom pins. I usually grab more gauze for the second set of pins because water will just run right through the first soaked piece. It helps to have a plastic bag around to place the wet gauze, otherwise it gets everything wet. Never let the nozzle of the bottle of saline touch the pin sites because that will contaminate it. If I would use it on another pin, I could be moving germs, and possibly an infection, from one pin to the next. That is bad.

5) Now it's time to dry the pins. I use sterile woven sponges for this. Each pack comes with two woven sponges - I use one per pin so I need two packs per dressing changes. Take a woven sponge and run it around one side of the pin. Don't be afraid to get rough with it - doing so helps get any gunk or crusty bits off of the pin. With a different side of the sponge, clean the other side of the pin. This, once more, helps prevent spreading germs around. I repeat this for all four pins.

6) At this point, I like to clean my hands with sanitizer again. This is a little bit redundant, but then I really don't want another bone infection so I am super careful.

7) After this, it is time to clean my pins with hydrogen peroxide. I use sterile cotton tipped applicators for this. I use two applicators per pin. Two come per pack, so I use eight applicators, or four packs, in total. I dip an applicator into the bottle of peroixde and keep it in there for a few second so that it becomes saturated with peroxide. I rub the applicator up and down the pin. Then I take the second applicator and do it all again, except this time I clean the opening where the pin enters my skin instead of the length of the pin. I do it in this order so that I am not potentially pushing germs down the pin towards the skin after I already cleaned the point of entry. I repeat this process for all four pins.

8) My pins are now clean and it is time to put on a new dressing. For this, I use sterile non-woven sponges. There are two of these per pack. I use one pack per two pins, so I use two pack. I cut the sponges myself so that they fit snugly around my pins. Unless I am using my scissors for the first time, which means they have literally just come out of sterile packaging, I need to clean the scissors myself. I do this my rubbing an alchol swab over them.

9) I pick up both pieces of sponge, which should be laying perfectly on top of each other in the package - I then cut this in half, resulting in to halves. I put one half back in the package. I take the other half and cut two slits into it, thus dividing the sponge into three sections. I cut the slits about halfway through the sponge, or just a bit more than half way. Then I place it onto the sterile part of the open package and repeat with the other half. Once done, I put the scissors in the package to keep them clean.

**note: when you open a package of sterile sponges, be they woven or non-woven, you have to open them a certain way. There should be an arrow at one end of the package. Open the package by pulling in the direction that the arrows instructs you to. Do not tear the package open - by doing so, the germs on the outside of the package can get inside of it, thus contaminating your now no longer sterile supplies.**

Do this:

 Not this:

10) I take one half of the sponge and place it around my pins. Remember that it was cut into thirds. The middle part is woven between my top pins, and the other two parts go around the other side of the pins respectively. Then I take the second half of sponge and do the same thing, but I weave the sponge through the pins from the other side.

11) I use per-perforated medical tape to secure the dressing to my leg - two pieces of tape on each side of the dressing.

12) Steps 9 to 11 are repeated on my bottom two pins.

13) After that I throw all the used supplies away. They go in the regular garbage.

14) Clean hands with hand sanitizer one more time. And that's it! Pin site care is done and I am good to go until the following day.

The finished product!

That is how I perform my pin site care. It takes about 15-20 minutes everyday. I either do it right away when I wake up or just before bed. I also like to change it after I go to physical therapy every Thursday because the extra exercises can cause the pin sites to leak more than they do during the rest of the week.

Note: sometimes I use different size sterile non-woven sponges, like in the video I am about to post, but the main principles of pin site care remain the same. The only difference is how I cut the sponges or the size of them.