Page 185 - Orthopedic Casts and Splints2

Performance Steps
g. With casting material wrap a figure eight around the opposite end of the strut ,around the
cast and laminate the casting material.
22. 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.
c. Have patient rotate hips.
d. Have patient inhale and exhale to determine airway compliance.
NOTE. If patient is unable to accomplish a-d trim the cast as needed.
23. Trim cast to fit patient.
CAUTION: Patients in the cast room are always offered and encourage to use hearing/eye protection.
Technicians must wear hearing/eye protection when removing a cast.

NOTE: Patient's are under no obligation to wear hearing and eye protection, but are told of the
consequences of not using hearing and eye protection.
a. With scissors, cut the edge of the cast padding at the base of the thumb, distal palmar
crease and ac joint region.
b. Draw a curved line from the symphysis pubis arch upward and then downward above the
flexion crease of the hip joint to the greater trochanter.
NOTE: The markings can be done by a pen or grease pencil.
c. Continue the line across the lower buttock region in a curved fashion to the sacrococcygeal
junction and connect to the opposite trimming line.
d. Draw a 4 inch circular outline at the diaphragm.
e. Cut the out line with the cast saw, remove towel and place excess cast material in trash
receptacle.
f. Fold webril and stockinette edges over the trimmed cast ends and secure with adhesive
tape.
CAUTION: The finished edge of the cast should end proximal to the base of the thumb to avoid radial
nerve, superior to the ac joint, and to the distal palmar crease.

24. Check cast dimensions.
a. The cast incorporates the acromioclavicular joint( AC joint )
b. The lower edge of the scapula on the uninjured side is visible.
c. The distal aspect of the cast rests on the iliac crests.
d. The injured arm is at a 90 degree angle to the torso with strut fixed to casted torso.
e. The distal aspect of long arm cast rests at the distal palmar crest.
25. Apply 5th and 6th plaster/fiberglass rolls ( repeat steps 16-17).
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.

26. 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.

27. 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 .

28. 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.
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