Page 105 - Orthopedic Casts and Splints2

Performance Steps

5. Check patient's capillary refill.
a. Squeeze patient's toes and nail beds will turn white .
b. Release patient's toes and nail beds will return pink .
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.

6. Gather equipment to include cast saw, cast spreader, hearing protection, goggles, T stand, thigh
holder, support bar, orthopaedic bump, goniometer, scissors, thermometer and bucket of tepid
water w/ plastic bag . Place on work cart or station.
CAUTION: The temperature of the water must be tepid ( 70-80 degrees) to reduce further injury (possible
burns) to the patient. The technician should draw water that is room temperature and initially use a
thermometer to gauge water temperature.

CAUTION: The technician must change the water after each application as the residue in the cast
bucket will act as an accelerator causing the casting material to increase in heat emission.

7. Assemble materials to include stockinette, webril, plaster or fiberglass rolls, fiberglass casting
gloves, examination gloves, hospital pad (chux), bed sheet, box of plaster reinforcement sheets,
surgical lubricant, box of alcohol pads and damp wash towel. Open and remove (5) plaster rolls
from their packages and place on work cart/station.
NOTE: Physician's order, technician's preference, availability of supplies, and/or patient's extremity size
will determine which casting material (fiberglass/plaster) will be used.
8. Prepare stockinette.
NOTE: Stockinette is generally used for all casts except on patients who have had recent surgery,
recently reduced fractures or as directed by physician.

CAUTION: Stockinette and webril are forms of protection against the exothermic reaction of the casting
materials. Technician and physician preference will dictate whether stockinette is used.
a. Place hospital pad or bed sheet on patient's lap.
NOTE: All patient's should be given a covering( e.g. chux, bed sheet) to reduce damaging their clothing
during the casting process and protect their privacy.
b. Place the patient's uninjured ankle at a 90 degree angle to the tibia and knee between 0-15
degree of flexion.
NOTE: Measurements are taken on the uninjured leg to prevent further pain to the patient's injured leg.

NOTE: Assistance( nursing personnel ) may assist with taking measurements.

NOTE: Instruments of measurements may vary ( e.g. tape measure, ruler, or webril ).
c. Measure from 2 inches distal to the toes to 4 inches distal to the groin and 2 inches proximal
to the greater trochanter to obtain stockinette length.
d. Pull down stockinette from stockinette container and cut measured length.
e. Roll stockinette leaving a 1-2 inch cuff at the distal end. Place on work cart/station for later
use.
9. Prepare plaster reinforcement splint for the posterior aspect of the cast.
NOTE: The plaster reinforcement splint will be prepared for the posterior side of the injured leg/ankle.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edge of one stack and remove from package. Place on work cart/station.
NOTE: 5 x 30 inch plaster splints are usually stacked in increments of five from the manufacturer. If not
pre stacked, count out five layers of plaster sheets.
b. Measure from 3 inches distal to the popliteal space, to the web spacing of the toes.
CAUTION: The peroneal nerve is located on the lateral side of the leg. If the nerve is constricted it
could die and cause drop foot( known as nerve palsy ). This is an irreversible condition. Locate the fibula
notch/ head and measure 1 finger breadth below to prevent this condition.

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