Page 115 - Orthopedic Casts and Splints2

Performance Steps
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, ear plugs, safety goggles, finger traps with
stand, lead apron with thyroid collar, fluro scan, scissors, padded felt with stockinette, (2) 5lb
weight plates, weight carrier, bucket of tepid water w/ plastic bag. Place on work cart/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 room temperature water 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 webril, plaster or fiberglass rolls, plaster
splints(4x15/5x30),examination gloves, fiberglass casting gloves, traction cord, alcohol
pads/damp towel, padded felt w/ stockinette. Open and remove (5) plaster rolls from packages
and place on work cart/station.
NOTE: Physician 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 a form of protection against the exothermic reaction caused by the casting
materials and generally used for all casts except on patients who have had recent surgery, recently
reduced fractures or as directed by the physician.
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.
b. Place work cart with orthopaedic bump at edge of bed.
NOTE: Technician preference will determine if orthopaedic bump is used. A number of props may be
use ( e.g. T stand, finger trap stand, nursing assistant )
c. Place patient's uninjured elbow on the orthopaedic bump at a 90 degree angle to the upper
torso.
NOTE: Measurements are taken on the uninjured arm to prevent further pain/discomfort to the patient.
Instruments of measurements may vary(e.g. tape measure, ruler, or webril)
d. Measure from 2 inches distal to the ulnar styloid to the axilla for stockinette length.
e. Pull down stockinette from stockinette container and cut measured length.
f. Roll the stockinette in a cuff leaving a 1-2 inch border at the distal edge. Place on work
cart/station for later use.

9. Prepare plaster reinforcement splint for the posterior aspect of cast.
a. Open box of 5 x 30 plaster sheets. Remove and unwrap package from box. Locate edge of
one stack( 5 thickness) and remove from package.
NOTE: 5 x 30 plaster sheets are usually stacked in increments of five from the manufacturer. If not pre
stacked, count out five layers.
b. Move uninjured elbow at a 90 degree angle to the upper torso.
c. Place distal end of plaster splint on the posterior aspect of the arm one inch proximal to the
ulnar styloid to 2 inches distal to the axilla region or resting at the base of the deltoid
muscle. Place sheet on work cart/station for later use.

10. Apply stockinette to patient's injured arm.
a. Hold the sides of the stockinette open.
b. Instruct patient to place injured hand in the opening of the stockinette.
c. Roll stockinet from the axilla region to 2 inch distal to the ulnar styloid .
NOTE: Rolling the stockinette on promotes a better fit.
d. Pinch the stockinette at the cubitum space and make a 45 degree angle cut.
NOTE: An alternative and authorized method is to cut the stockinette prior to application.

112
7