Page 176 - Orthopedic Casts and Splints2

Performance Steps
(3) Cut a 4 inch radius outline at the diaphragm, remove cast material excess and small
towel.
NOTE: Use the costal margin and navel as landmarks.
b. Draw and cut the upper trimming line:
(1) Draw a curved line from the upper sternum, going laterally and downward to the lower
portion of the axilla and then proceed medial and upward to the lateral border of the
scapula and connect to the opposite trimming line.
(2) Cut the outline with a cast saw and place excess casting material in trash receptacle.
(3) Fold webril and stockinette edges over the trimmed cast ends and secure with
adhesive tape.
26. Check range of motion ( ROM ) of uninjured shoulder and hips.
a. Have patient sit in chair from a standing position.
b. Have patient rotate uninjured shoulder and both wrists.
c. Have patient rotate hips.
d. Have patient inhale and exhale to determine airway compliance.
NOTE: If patient is unable to accomplish step 26 a-d, continue to trim cast.

27. Check cast dimensions.
a. There is 2-4 inch distance from the axilla on the uninjured side to the edge of the cast.
b. The cast edge on the injured side is proximal to the ac joint and proximal to the ulnar styloid.
c. The cast arm is at a 45 degree angle and resting diagonally across the chest.
d. The distal aspect of the cast rests on the iliac crests.

28. Measure patient's injured arm with goniometer go to step 12.
29. Apply 5th and 6th plaster/fiberglass rolls ( repeat steps 19-20 )
NOTE: The last roll in all casting applications is commonly referred to as the beautification roll or the
money roll. Take pride in your work.

30. 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.

31. Clean plaster resin off patient's skin using a damp wash cloth, towel or alcohol pad.
Note: Use alcohol pad or fresh water from the faucet and not from the casting bucket .

32. Give patient verbal and written instructions on cast care.
a. Instruct the patient to call the cast clinic should they have any concerns or questions
regarding their cast .
b. Provide patient with a copy of the clinic hours and telephone number. After duty hours
instruct patient to report to emergency room.
c. Provide patient with cast care booklet or equivalent.
d. Instruct patient not to stick anything down the cast, do not remove the cast and do not alter
the cast( e.g. writing on it, coloring.)
33. Annotate the procedure applied to the patient in medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to patient and sign your name.
34. Escort patient or direct patient to front desk to make a follow up appointment.

Performance Measures GO NO GO
1. Received the order from the physician (reviewed if in writing). —— ——

2. Identified yourself to patient. —— ——

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