Page 164 - Orthopedic Casts and Splints2

Performance Steps
f. Examine both legs and arms for jewelry and remove if found.
NOTE: All jewelry must be removed. Give jewelry and clothing to family member or secure with
patient's belongings in NCOIC office.

5. 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 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. Place
on work cart or station.Place fracture table / support stand next 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
(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, 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 axilla region
to 2 inches distal to the iliac crests for stockinette length.
Note: Instruments of measurements may vary ( e.g. tape measure, ruler, 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 3 plaster reinforcement splints for the posterior,medial and lateral aspects of the cast.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edges of three 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 the patient's upper thigh from medial to lateral.
c. Measure the patient's upper thigh from medial to lateral.
d. Measure length of sacrococcygeal region.
e. 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 the patient's upper thigh from medial to lateral.
b. Measure length of both anterior iliac crest.
c. Measure length of sacrococcygeal region.

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