Page 14 - Orthopedic Casts and Splints2

Performance Steps
a. Squeeze patient's fingers and nail beds will turn white .
b. Release patient's fingers 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, ear plugs, safety goggles, finger trap set
with stand, scissors, sheet padded felt with stockinette, (2) 5lb weight plates, weight carrier,
bucket of tepid water w/ 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 (6) plaster rolls from 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.
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. L 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 to the patient's injured
arm. Instruments of measurements may vary(e.g. tape measure, ruler, or webril).
d. Measure from the axilla to 2 inches distal to metacarpophalangeal joints (MCPJ's) to obtain
stockinette length.
e. Pull down stockinette from stockinette container and cut measured length.
f. Cuff the stockinette 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 volar aspect of cast.
NOTE: The volar aspect of the injured arm, located on the palm side of the hand.
a. Open box of 4 x15 plaster reinforcement sheets. Remove and unwrap package. Peel back
the edges of (5) sheets and remove from stack. Place on work cart/station.
b. Place patient's uninjured hand in the supine position(palm up) and locate the distal palmer
crease(DPC),thenar muscle and base of deltoid muscle.
NOTE: The DPC is furthest diagonal line on the volar aspect of the hand. The thenar muscle is at the
base of the thumb on the volar aspect of the hand. The crease is noticeable when the thumb and 5th
phalange (pinky finger ) are brought together. The deltoid muscle is on the lateral aspect of the upper
are.
c. Remove (1) plaster sheet from the stack of (5).
d. Place sheet next to injured arm to obtain sheet length, the DPC and thenar muscle contour .

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