Page 181 - 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 any of the above conditions are present and follow physician's order.
f. Examine both legs and arms for jewelry and remove if found.
Note: Give jewelry to family members or secure in NCOIC's 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/ bag. Place on work cart /station. Place
standing bar set and /or fracture table 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, wooden bar
12 inches in length, 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 for torso stockinette and from
acromioclavicular region to 1 inch distal to the metacarpal phalanges joint (MCPJ's) for the
arm stockinette.
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
lengths.
c. Roll each stockinette leaving 1-2 inch border at the distal edge. Place on work cart/station for
later use.
9. Prepare 4 plaster reinforcement splints for the posterior aspect of the arm, anterior and posterior
iliac crests and sacrococcygeal region.
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.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edges of four stacks and remove from package. Place on work cart/station.
b. Measure the patient's arm from the ac joint to palmar crease.
c. Measure anterior/posterior iliac crests
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.
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