Pin site cleaning

This page explains about pin site cleaning and what to expect when your child comes to Great Ormond Street Hospital (GOSH).

Pin sites are where wires or pins enter the skin when a surgeon has fitted an external fixator, either an Ilizarov frame, spatial frame or ex/ortho fix to your child's leg.

It is very important to keep the frame and pin sites clean. The frame is fitted to the outside of a limb and is held in place with pins or wires that pass through the skin into the bone.

Any germs on the outside of the frame, pins or skin can cause an infection at the pin site. In serious cases this infection can pass into the tissues under the skin and on rare occasions into the bone itself.

• changes in skin colour, increased redness

• swelling

• increased tenderness, pain or discomfort at the pin site

• increased discharge or oozing around the pin site, changes in colour or smell of ooze

• the pin site feels hotter than the surrounding skin

• high temperature of 38°C or higher

Your child will usually be discharged home with two pain relief medicines: paracetamol and codeine. We will give you a small supply and ask you to see your family doctor (GP) for a prescription to continue these at home. To begin with, you may find your child needs regular pain relief but as time passes, he or she may need pain relief less often. We advise that you give your child pain relief 45 minutes to one hour before pin site cleaning to make it more comfortable.

Sometimes your child will experience pain that does not respond to this medication so may need additional pain relief. If you are concerned that your child is in pain, please discuss with us.

1. Wash your hands thoroughly with soap and water.
2. Wash a plastic tray with warm, soapy water and dry with kitchen towel. Any plastic tray, for example a plastic food container, can be used but keep it only for pin site cleaning.
3. Prepare the dressing on the tray. Cut the gauze squares into four (see picture 1) and then cut a slit halfway through each one (see picture 2). Place on the tray and pour over the pink chlorhexidine solution.
4. Remove all the dressings from the pin sites moving the clips away from the skin as you do so. If dressings are ‘stuck’ with ooze or blood, gently moisten them with cooled, boiled water. As you remove the dressings place them into a plastic bag or bin.
5. Wash your hands thoroughly with soap and water.
6. Clean each pin with a sterile wipe using a circular motion, cleaning around the pin and the skin in one go. Use a new sterile wipe each time.
7. Wash your hands thoroughly with soap and water.
8. Take two pieces of gauze and squeeze out any excess chlorhexidine solution. Lay the first piece of gauze around the pin (see picture 3) and then lay the second with the slit in the opposite direction, so that the entire pin is covered.
9. Move the pin site clip downwards to keep the dressing in place but not so far as it digs into the skin.

Pin sites should be cleaned every day until the pins and any other wounds on the limb are dry and have stopped oozing, usually three to four days after surgery. After that, they should be cleaned at least weekly or after showers or swimming. Clean any infected pins daily as above.

Once the pin sites have stopped oozing and any other wounds are dry, usually five to seven days after surgery, your child can have a shower. Please check with the surgeon regarding swimming.

We will make a referral to a community children’s nurse or the practice nurse at your local GP surgery before your child is discharged home so that there is support and advice available to you locally. We will discuss the details of this with you before you go home.