Page 101 - Orthopedic Casts and Splints2

Performance Steps
b. The cast edge on the radial side rests proximal to the snuff box .
NOTE: The proximal aspect of the thumb should have full ROM.
c. The proximal edge of the cast should be 2 inches distal to the axilla region.
d. Pull down webril and stockinette.
e. Tape down edges of stockinette and webril

32. Apply 4th roll of plaster/fiberglass( repeat steps 19-20).
NOTE: The last roll in all casting applications is commonly referred to as the beautification roll or the
money roll. Take pride in your work. Technician preference will determine where that last roll is started.
NOTE: Depending on the size of the patient's arm a fifth roll of plaster can be used.

33. Check patient's capillary refill.
a. Squeeze patient's fingers and nail beds will turn white
b. Release patient's fingers and nail beds will return to pink
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.
34. Clean plaster resin off patient's skin using a damp wash cloth, towel or alcohol pad.
NOTE: Use alcohol pads or fresh water from the faucet ,not from the casting bucket..

35. Give patient verbal and written instruction on cast care.
a. Instruct the patient to call the cast clinic should they have any concerns or questions
regarding their cast. Provide patient with a copy of the clinic hours and telephone number.
After duty hours instruct patient to report to the Emergency Room.
b. Present patient with cast care booklet ( or written instruction)
c. Instruct patient to extend, flex, and wiggle fingers ( demonstrate for patient) to reduce
swelling.
d. Instruct patient not to stick anything down the cast, do not remove the cast, and do not alter
the cast ( e. g. writing on it, coloring )

36. Fit sling as needed.
NOTE: Consideration for applying a sling include elderly patient's, severity of fractures (e.g. Colles',
Smith's, Bennett's), patient's comfort, physician's or technician's preference.
37. Annotate the procedure.
NOTE: Record the procedure applied and cast care instruction provided to patient in medical record or
Standard Form 513 and sign your name.

38. Escort patient or direct family member to front desk to make a follow-up appointment.
Performance Measures GO NO GO

1. Received the order from the physician ( reviewed if in writing). —— ——
2. Identified yourself to the patient. —— ——

3. Explained the procedure to the patient. —— ——
4. Inspected patient's arms. —— ——

5. Checked patient's capillary refill of both hands. —— ——
6. Gathered equipment. —— ——

7. Assembled materials. —— ——
8. Prepared stockinette. —— ——
9. Prepared plaster reinforcement splint for the volar aspect of cast . —— ——
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