Skin breakdown is a common complication of Pavlik harness therapy. The primary nursing intervention is to relieve the source of pressure and educate the family on prevention.
Assessment: Inspect all skin surfaces in contact with the harness at every visit. Pay close attention to the thighs, groin, shoulders, and popliteal fossae. Document the stage of any skin breakdown.
Intervention Protocol:
- Adjust the Straps: Check that the harness is applied correctly per the provider's order. The thigh straps should be snug but allow one finger to fit between the strap and the skin. Loosen straps that are causing focal pressure points. Never discontinue the harness without a direct order.
- Skin Care Routine: Teach parents to clean the skin under the harness daily with water and a soft cloth, ensuring the skin is completely dry before reapplying. A thin cotton onesie or stockinette can be worn under the harness to wick moisture and reduce friction.
- Barrier Application: If skin is intact but red, a moisture barrier cream or zinc oxide paste may be applied to clean, dry skin after pressure points are relieved. Do not apply creams to open skin.
Parent Education Points:
- Instruct parents not to apply lotions, powders, or oils under the harness unless specifically directed, as these can macerate the skin.
- Explain that the infant's discomfort and crying may be due to skin irritation; addressing this can improve tolerance of the harness.
- Teach parents to check the skin under the straps several times a day and to report any open areas, blisters, foul odor, or drainage immediately.
When to Escalate: Notify the orthopedic provider if skin breakdown progresses to an open wound, shows signs of infection (purulent drainage, warmth, erythema beyond the contact area), or if strap adjustment does not resolve the redness within 24 hours. A temporary change in treatment (e.g., a different orthosis or scheduled harness-free periods) may be required.