Page 19 - Orthopedic Casts and Splints2

Performance Steps

33. Place pre manufacturer loop on cast.
NOTE: The hanging portion of this cast is design to have gravity assist in aligning the broken bones.
Physician's preference will determine where on the cast the loop is applied. The weight of the cast and
location of the loop is vital to the reduction of the fracture.
a. Place the plaster or fiberglass loop 1inch from the base of the thumb on the radial side of
cast, or according to physician's order .
34. Place 2 inch roll of plaster/fiberglass roll in tepid water.
a. Hold the plaster /fiberglass roll with one hand
b. Grasp the edge of the plaster/fiberglass with opposite fingers.
c. Pull plaster/fiberglass roll taunt and place excess between index and middle finger.
d. Place in water.
35. Remove plaster/fiberglass roll from water.
a. Wait for the bubbles to subside before removing plaster/fiberglass roll.
b. Squeeze the roll together to eliminate excess water.

36. Incorporate loop.
a. Hold the plaster /fiberglass roll with one hand.
b. Apply the plaster/fiberglass roll twice around the loop and bring the roll through the loop
ensuring to tie the edge down .
c. Using the same roll or a 2nd 2 inch roll, complete the same steps for the opposite edge.

37. Prepare collar and traction cord.
a. Pull stockinette over the felt pad.
b. Cut a hole in both ends of the felt/stockinette.
c. Cut 6 feet length of traction cord.
d. Insert one end of the traction cord through the hole in the felt pad and thread it through the
opposite end .
38. Apply the collar to patient's neck.
a. Place padded collar centered and posteriorly to the patient's neck.
NOTE: The traction cord should be centered and on the posterior side of the felt pad to reduce chafing
of the patient's neck.
b. Insert one cord ends through the loop .
c. Tie and tape cord ends together.
d. Instruct the patient to let the cast hang.
NOTE: The weight of the cast and the location of the loop have a definite relationship to the reduction
of the fracture. Instruct patient not to remove the collar or the traction cord. Provide patient with extra
padding should chafing and rubbing occur.

39. 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
40. Clean plaster 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 .
41. 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. Provide patient with a copy of the clinic hours and telephone number.
After duty hours instruct patient to report to the Emergency Room.
b. Present patient with cast care booklet (or written instructions).
c. Instruct patient to extend, flex and wiggle fingers(demonstrate for patient) to reduce swelling.

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