Page 172 - Orthopedic Casts and Splints2

Performance Steps
e. Check patient's upper torso for any skin conditions ( e. g. cuts, abrasions, lacerations and
skin rashes.
NOTE: Inform physician if conditions are present and follow physician's order.
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, goniometer,
scissors, thermometer and bucket of tepid water w/ plastic 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, tape measure, 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 or webril ).
b. Pull down stockinette from stockinette container and cut 1-2 inches past the measured
length.
c. Roll stockinette up leaving a 1-2 inch border at the distal end. Place on work cart/station for
later use.

9. Prepare plaster reinforcement splints for the cast.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap 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 for each splint.
b. Place the edge of (1) sheet from the base of the deltoid muscle to one inch proximal to the
ulnar styloid on the uninjured arm, fold edge and tear/cut excess. Place sheet on top of
remaining stack of 4 and tear/cut other sheets to obtained length. Place on work cart/station
for later use.
c. Place the edge of (1) sheet from the 2nd stack starting at the medial thigh extending to
the lateral thigh until sheet ends connect. Place sheet on top of remaining stack of 4 and
tear/cut other sheets to obtained length. Place on work cart/station for later use.
NOTE: Depending on the patient's size folding and cutting off excess may be needed.

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