NURSING
PRACTICE
& SKILL
Author
Nathalie Smith, RN, MSN, CNP
Reviewers
Darlene A. Strayer, RN, MBA
Cinahl Information Systems
Glendale, California
Nursing Practice Council
Glendale Adventist Medical Center
Glendale, California
Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems
September 30, 2011
Published by Cinahl Information Systems, a division of EBSCO Publishing. Copyright2013, Cinahl Information Systems. All rights reserved. No
part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information
storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information
given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.
Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
Abduction Pillow: Applying and Removing
What is Applying and Removing an Abduction Pillow?
What: An abduction pillow (also called an abduction splint) is a specially designed wedge-shaped pillow that is
used to reduce risk of hip dislocation in patients who have undergone hip arthroplasty (i.e., surgery to replace
the hip joint with a prosthetic implant). The abduction pillow is placed and secured between the patients legs
to prevent the patient from moving his/her legs into an adducted position (i.e., moving the legs toward or to
the midline) or into a position of internal rotation, which can cause dislocation of the hip prosthesis. The use
of an abduction pillow also permits clinicians and other caregivers to turn the patient onto his/her unaffected
hip without increasing risk for dislocation of the joint prosthesis in the affected hip joint. An abduction pillow is
used whenever the patient is lying down and is removed for toileting, bathing, and whenever the patient is sitting,
standing, ambulating, or attending physical therapy sessions
How: When the patient is in bed, the abduction pillow is placed between the legs and secured with straps to
maintain both legs in the abducted position (e.g., moved laterally away from the midline) instead of the adducted
position. The straps are loosened and the abduction pillow is removed when the patient is not lying down
Where: Abduction pillows are typically used in inpatient settings and in the home care setting
Who: Because of the need for skilled patient assessment, the abduction pillow is applied and removed by a nurse,
physician, or physical therapist. This responsibility cannot be delegated to assistive healthcare staff members.
Assistive staff members can, however, observe the patient for changes in leg-hip alignment or other problems
when an abduction pillow is in place, and notify the nurse of these changes so that a nursing intervention can be
made if necessary. After receiving postsurgical patient care in an inpatient healthcare setting and education of the
patient/family members, it is appropriate for the abduction pillow to be applied and removed by family members
or other caregivers in the home care setting
What is the Desired Outcome of Applying and Removing an
Abduction Pillow?
The desired outcome of applying and removing an abduction pillow is to keep patients from adducting their legs
after hip arthroplasty to reduce risk of hip dislocation
Why is Applying and Removing an Abduction Pillow
Important?
Applying an abduction pillow is important because it reduces risk for dislocation of the femoral head of a newly
placed artificial hip prosthesis from the acetabular cup (i.e., socket) of the prosthetic hip joint
Prevention of dislocation of the femoral head from the socket of the prosthetic hip joint is important because
its dislocation can cause pain, interfere with normal function of the prosthetic hip joint, and necessitate further
surgery to restore function
Facts and Figures
Abductor pillows are widely used in the healthcare setting to promote hip joint abduction after surgical repair of a
fractured hip. Each year, more than 300,000 persons over age 65 years will fracture a hip in the United States and
require hip fracture repair surgery (Centers for Disease Control and Prevention, 2010)
In children following hip surgery, an abduction pillow is sometimes used instead of a hip spica cast (i.e., a
fiberglass or plaster cast extending from the torso level to the knees or feet that has an opening in the perineal
area to permit patient elimination and the performance of hygiene). Compared with the hip spica cast, the
advantages of the abduction pillow include the following (Albrektson et al., 2007):
Increased comfort
Improved access for skin care and toileting
Facilitates neurovascular assessment
Complications such as pressure ulcers and osteopenic disuse fractures are more easily prevented
As an illustration of the advantages described above, the findings of investigators who undertook a retrospective
review of the medical records of 32 children who underwent hip surgery during the period 19992005 noted
that use of an abduction pillow provides appropriate hip joint stabilization after hip surgeries. In this study,
investigators recorded the method of postoperative immobilization (hip spica cast or the use of an abduction
 pillow with knee immobilizer) and complications for each patient. Of the 32 patients involved in the study, 11
(all of whom had a diagnosis of developmental dysplasia of the hip) were treated using a hip spica cast. In the
21 patients treated with an abduction pillow/knee immobilizer, 4 children (19%) were switched to a hip spica
cast due to distal femoral fractures as a result of either vigorous resuscitation during a choking episode, parental
preference, to increase immobilization and reduce risk of implant loss of fixation, or to correct unstable hip
position after the joint repair surgery. Abduction pillows/knee immobilizers provided acceptable treatment in 17
of the children (81%); (Albrektson et al., 2007)
The investigators concluded that one child who was successfully resuscitated after a choking incident might have had a worse outcome if he/she was in a
spica cast. When the choking incident occurred, the abduction pillow was easily and quickly removed to allow successful resuscitation, although the child
subsequently received a hip spica cast as treatment of a distal femoral fracture that occurred during the resuscitation effort. The investigators concluded that
an abduction pillow can provide appropriate hip joint stabilization in the majority of cases, but children with osteopenic bone who are at risk for fracture
and possible implant failure and those with unstable hip reductions may be best treated with immobilization using a hip spica cast

What You Need to Know Before Applying and Removing an Abduction Pillow
The most common indications for hip joint arthroplasty are to relieve pain caused by arthritis, correct deformity of the hip joint, and restore range of motion
and function after disease or injury of the hip joint
To reduce the risk of displacement of the hip prosthesis, patients should avoid passive and active adduction and active abduction for at least the first 6 weeks
following surgery. To promote this activity restriction, the abduction pillow is used to provide lower limb abduction whenever patients are lying down
Following hip joint arthroplasty, patients are allowed gentle (e.g., 2030) internal and external rotation of the affected lower extremity and passive abduction
as tolerated. Flexing the hip joint to an angle of 8090 for sitting, fully extending the affected leg, and ambulating with assistance is also appropriate
Abduction pillows are typically used for 612 weeks until the joint capsule has reformed around the hip joint and the musculature around the joint is
sufficiently strengthened to allow proprioceptive control and joint stability
Patients who have had previous hip surgery are at higher risk for dislocation and often require longer-term use of an abduction pillow
An abduction pillow is a wedge-shaped device made of sturdy foam that is designed to conform to the inner aspects of the legs. For proper placement of the
abduction pillow, the wider bottom edge should be aligned with the ankles and the top edge should be approximately halfway up the thigh. The abduction
pillow should extend no higher than halfway up the patients thigh in order to avoid pressure on the genital area
Commercially available abduction pillows include a single pediatric size and small, medium, large, and extra large adult sizes. Velcro or buckle closures allow
abduction pillows to be adjusted to fit most patients
The most commonly used type of abduction pillow is secured to both legs by two wide straps that are placed across the upper and lower legs. Other models
of abduction pillows contain separate straps for each leg. This Nursing Practice & Skill describes the process of applying the most commonly used type of
abduction pillow
Abduction pillows are easy to remove for skin care, bathing, neurovascular assessment, and when the patient is not lying down
Necessary nursing skills and areas of nursing knowledge include the following:
Knowledge of postsurgical patient care
Neurovascular and skin assessment
Preliminary steps that should be performed before applying or removing an abduction pillow include the following:
Review the facility protocol for applying/removing an abduction pillow, if one is available
Review the treating clinicians order for applying and removing an abduction pillow from a patients legs, noting any activity restrictions prescribed for the
patient
Note if analgesia is prescribed prior to repositioning activity
Review the manufacturers instructions, if available, for the type of abduction pillow to be used
Identify the patient using facility protocol
Ensure completion of facility informed consent documents. The general consent for treatment executed by patients at the outset of admission to a
healthcare facility commonly includes provisions for application and removal of an abduction pillow
Review the patients medical history and medical record for any allergies (e.g., to latex, medications, or other substances); use alternative materials as
appropriate
Gather the following supplies:
Personal protective equipment (PPE; e.g., nonsterile gloves, gown, mask, eye protection). Typically only nonsterile gloves are required for applying or
removing an abduction pillow, although other PPE may be necessary if exposure to body fluids is anticipated
Abduction pillow in a size appropriate for the patient (e.g., pediatric size; small, medium, large, or extra large adult size)
A facility-approved pain assessment tool
Prescribed analgesia
Manufacturers instructions, if available, for the abduction pillow
Written information, if available, to reinforce verbal education

How to Apply and Remove an Abduction Pillow

Perform hand hygiene
Don PPE to avoid transfer of microorganisms if risk of exposure to body fluids exists
Introduce yourself and assess the coping ability of the patient and family and for knowledge deficits and anxiety regarding applying and removing the
abduction pillow
Determine if the patient/family requires special considerations regarding communication (e.g., due to illiteracy, language barriers, or deafness); make
arrangements to meet these needs if they are present
Use professional certified medical interpreters, either in person or via phone, when language barriers exist
Explain the procedure, its purpose, and what outcome to expect from the procedure; answer any questions and provide emotional support as needed
 Educate the patient/family that the purpose of the abduction pillow is to prevent the patient from moving his/her affected leg toward or past the midline
of the body to protect the femoral head of the hip prosthesis from being displaced from the socket of the prosthesis, and that this protective abduction
pillow should be in place anytime the patient is lying down. Explain that this activity restriction will continue for at least 6 weeks or for the period of time
prescribed by the treating clinician, and that the patients in-home caregiver will need to apply and remove the pillow as needed if the patient is discharged
to home
Assess the patients general status, including his/her pain level using a facility-approved pain assessment tool
If appropriate, premedicate patient with prescribed analgesia; allow for therapeutic level to be reached before beginning repositioning of the pillow
Provide an explanation of the procedure while applying the abduction pillow, as described below:
Assist the patient into a comfortable supine position with his/her legs extended and abducted from the midline
Place the abduction pillow between the patients legs with the narrow end above the knees and the wider end extending to the ankles
Position the pillow so that the two lateral sides of the pillow are in contact with the inner aspects of the patients legs
Fasten the straps of the abduction pillow securely across the upper and lower aspects of both of the patients legs according to facility protocol and
manufacturers instructions
When properly secured, the pillow should be placed snugly enough against the inner aspects of the patients legs to cause the pillow to conform to his/her
legs and to immobilize his/her knees, with enough space under the straps to allow placement of one finger between the strap and the skin
After the pillow is secured to the patients legs, confirm that his/her knees are immobilized by asking him/her to attempt to gently flex his/her knees.
If the pillow has been applied appropriately, he/she will be unable to flex his/her knees and will report feeling comfortable with the abduction pillow in
place
Place a pillow under the lower legs of the patient to prevent heel pain and skin breakdown in the heel area
Provide an explanation of the procedure when removing the abduction pillow, as described below:
Assist the patient into a comfortable supine position
Detach the straps of the abduction pillow
Gently pull the pillow from between the patients legs
Store the pillow in a safe, dry location in the patients room
Observe the following precautions regarding the use of an abduction pillow:
Do not use an abduction pillow that is not an appropriate size for the patient (e.g., too short or too long)
To avoid exerting pressure on the patients lower extremity vasculature or peroneal nerve (i.e., a nerve that passes along the lateral aspect of each knee), do
not fasten the straps too tightly on the abduction pillow
Straps on abduction pillows should be released with caution in patients who are disoriented and/or have a history of hip dislocation
After the abduction pillow has been applied or removed, remove PPE, discard appropriately, and perform hand hygiene
Document applying or removing the abduction pillow in the patients medical record, including
the time the abduction pillow was applied or removed
patient assessment results, including lower extremity neurovascular status and skin assessment every time the patient is turned (every 2 hours or according to
facility protocols)
any unexpected events that occurred, whether or not the treating clinician was notified, and interventions performed
patient outcome
all patient/family education

Other Tests, Treatments, or Procedures That May Be Necessary Before or After

Applying and Removing an Abduction Pillow
The abduction pillow will be removed during toileting, bathing, physical therapy, and whenever the patient is sitting, standing, or ambulating. The patient
will be repositioned at regular intervals while the abduction pillow is in place according to facility protocol and with appropriate staff assistance. Certain
precautions regarding repositioning should be followed:
Reposition the patient every 2 hours to prevent pressure on the skin and decrease the risk of developing pressure ulcers
To avoid placing pressure on the operative site and hip prosthesis, do not turn the patient to the operative side. Turning patients with the abduction pillow
in place is limited to turning from the supine position to the nonsurgical/unaffected side and back to the supine position. Place pillows behind the patients
back to maintain his/her position when in a side-lying position
To promote patient safety, do not turn him/her onto the unaffected side unless both legs are strapped securely to the abduction pillow
Assess neurovascular status and the skin integrity of the legs and feet every 4 hours and as needed
Following the inpatient postoperative period, the patient will be discharged from the patient care facility to home or to another healthcare facility (e.g., a
rehabilitation facility) for recovery according to orders of the treating clinician

What to Expect After Applying and Removing an Abduction Pillow

The patient will not experience displacement of his/her hip joint prosthesis due to active or passive adduction of the affected leg
The presence of the abduction pillow will cause no alterations in neurovascular status to the patients lower extremity(s)

Red Flags
The straps of the abduction pillow may be too tight if paleness or cyanosis of the skin of the lower extremities distal to the abduction pillow develops;
capillary refill of the lower extremities is delayed (e.g., > 3 seconds for capillary refill); or the patient reports pain, tingling, or numbness in the lower
extremities. If these signs and symptoms develop, loosen the straps so you can slip one finger between the straps of the abduction pillow and the patients legs.
This will allow adequate circulation to the patients lower extremities and prevent pressure on the peroneal nerve
What Do I Need to Tell the Patient/Patients Family?
Educate the patient/family about what to expect during and after application of the abduction pillow, and what outcome to expect
After demonstrating the application and removal of the abduction pillow to the patient/family/other in-home caregivers, ask whether they understand how
to perform the procedure and whether they have any questions. Encourage the family/other in-home caregivers to provide a return demonstration so you
can supervise their technique
Educate regarding the following:
How to contact the treating clinician if questions or problems arise
Signs and symptoms that may indicate the development of complications (e.g., pressure ulcers) after application of the abduction pillow and should be
immediately reported to the treating clinician. Signs and symptoms of developing pressure ulcers include paleness, numbness, pain, and/or breakdown of
skin over bony prominences in the lower extremity distal to the abduction pillow
Emphasize the importance of keeping scheduled follow-up medical appointments to allow continued medical surveillance of the patients condition
Provide written information, if available, to reinforce verbal education

References
1. Albrektson, J., Kay, R. M., Tolo, V. T., & Skaggs, D. L. (2007). Abduction pillow immobilization following hip surgery: A welcome alternative for selected patients. Journal of
Children's Orthopaedics, 1(5), 299-305.
2. Burton, M. A., & Ludwig, L. J. M. (2011). Musculoskeletal care. In Fundamentals of nursing care concepts, connections and skills (pp. 596). Philadelphia: F. A. Davis Company.
3. Centers for Disease Control and Prevention. (2010). Hip fractures among older adults. Retrieved September 21, 2011, from http://www.cdc.gov/homeandrecreationalsafety/
falls/adulthipfx.html
4. Dubuisson, W. C. (2010). Orthopedic measures. In A. G. Perry & P. A. Potter (Eds.), Clinical nursing skills & techniques (7th ed., p. 290). St. Louis: Mosby Elsevier.
5. McConnell, E. A. (2001). Applying a hip abduction pillow. Retrieved September 21, 2011, from http://findarticles.com/p/articles/mi_qa3689/is_200112/ai_n9013808/