Page 182 - Orthopedic Casts and Splints2

Performance Steps
NOTE: Orthopaedic felt pads are used to reduce chafing at distal and proximal edges of cast.
a. Measure anterior/posterior iliac crests
b. Measure length of sacrococcygeal region.
c. Place felt pads next to measured lengths, cut off excess amount and place on work
cart/station.

11. Apply stockinette to patient's upper torso.
a. Place bed sheets on floor and patient step onto sheets.
NOTE: Bed sheets are used to keep the floor clean during the casting process.
b. Have patient remove gown.
CAUTION: Always use the same gender chaperone when patient's are disrobing.
c. Hold open sides of the stockinette.
d. Place the stockinette on patient.
NOTE: The patient can either step into the stockinette and pull it on, or place stockinette over the
patient's head and pull stockinette down.
e. Pinch the stockinette at the base of the shoulder and cut the stockinette at a 45 degree
angle.
f. Have patient place arms through the pre cut hole and adjust stockinette.
NOTE: Stockinette should be 3 inches proximal to the nipple line and 3 inches distal to the iliac crests.
g. Place stockinette on patient's arm from medial aspect of the ac joint to 1 inch distal to the
palmar crease.
NOTE: Pull the end of the stockinette over the adjacent cut end of the body stockinette.

12. Apply cast padding( webril) to patient's injured arm and torso.
a. Place felt padding to the iliac crests, spine and axilla region. Have technician hold the
padding in place until secured by the webril.
NOTE: The felt pads can be applied horizontally or vertically to the iliac crests and to the axilla region
to reduce chaffing of the skin.
b. Place folded towel over the area of the diaphragm.
CAUTION: A small folded towel is placed over the diaphragm and top of the stomach for a later
cutaway of the area which will provide for breathing and digestion.
c. Hold webril with one hand.
d. With 2nd hand unroll the webril 1/2 - 1inch and grasp edge with index and middle finger.
e. Place webril end on the ulnar styloid and begin wrapping around the wrist two rotations.
NOTE: The webril application is started at the wrist to provide an anchor and extra padding to the ulnar
styloid.

CAUTION: Keep the cast padding on the extremity throughout the application to avoid circulation
compromise of the patient's hand/fingers.
f. Continue through the palmar crease, up the forearm, figure eight around the elbow and
shoulder ending 1/2 inch proximal to the edge of the stockinette superior to the
acromioclavicular joint( AC joint ).
g. Place the webril on the iliac crest and continue around the torso, figure eight around the
shoulder ending distal to the acromioclavicular joint.
h. With each turn overlap the webril by 1/2-1/4 the previous wrap.
NOTE: The top of the webril should bisect the middle of the previous layer covering up the shallow
line and present evenly applied padding.
13. Prepare casting materials.
a. If using fiberglass casting materials go to step 14 ,15 and 16.
b. If using plaster casting materials go to step 16.

14. Place fiberglass casting gloves on hands.

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