Page 156 - 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, hearing protection, goggles, standing bar set,
fracture table, goniometer, scissors, thermometer and bucket of tepid water w/ bag and place on
work cart or station. Place standing bar or fracture next to examination bed.
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 felt pads, stockinette, webril, plaster or fiberglass rolls, fiberglass
casting gloves, examination gloves, towel, hospital pad (chux), bed sheet, box of plaster
reinforcement sheets, surgical lubricant, box of alcohol pads and damp towel. Open and remove
(6) 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, technician's preference or as directed by the physician. Stockinette and webril
are forms of protection against the exothermic reaction of the casting materials.
a. With the patient standing erect or supine on the fracture table, measure from the head to 2
inches distal to the iliac crests for stockinette length.
Note: Instruments of measurements may vary ( e.g. tape measure, ruler, plaster sheet, or webril ).
b. Pull down stockinette from stockinette container and cut 1-2 inches past the measured length.
c. Roll stockinette leaving 1-2 inch border at the distal edge. Place on work cart/station for later
use.
9. Prepare 9 plaster reinforcement splints for the upper and lower cast.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edges of ten stacks and remove from package. Place on work cart/station.
NOTE: 5 x 30 inch plaster sheets are usually stacked in increments of five from the manufacturer. If not
pre stacked, count out five layers of plaster sheets.
b. Measure length of both anterior iliac crests.
c. Measure each shoulder from base of scapula to pectoralis muscle.
d. Measure circumferential around the forehead
e. Measure from the chin down the anterior surface of the neck to the upper abdominal region.
f. Measure from the occipital region posterior to mid back.
g. Measure length of sacrococcygeal region.
h. Place stack of ( 5) plaster sheets next to the measured length , cut off excess amount and
place on work cart/station.
NOTE: Discard excess material in the trash receptacle.
10. Prepare felt pads.
NOTE: Orthopaedic felt pads are used to reduce chafing at distal and proximal edges of cast.
a. Measure length of both anterior iliac crests.
b. Measure length of sacrococcygeal region.
c. Place orthopaedic felt next to the measured lengths , cut off excess amount and place on work
cart/station.
NOTE: Discard excess material in the trash receptacle.
11. Apply stockinette to patient's upper torso.

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