Page 191 - Orthopedic Casts and Splints2

Performance Steps
d. Check child's upper torso and legs for any skin conditions ( e. g. cuts, abrasions, lacerations
and skin rashes).
NOTE: Inform physician if conditions are present and follow physician's order.
e. Examine both legs and arms for jewelry and remove if found.
NOTE: All jewelry must be removed. Give jewelry to family member or secure with child's belongings
in NCOIC office
f. Place a full size blanket or sheet over child's body.
NOTE: Keep the child warm during gather equipment and materials.
5. Check child's capillary refill.
a. Squeeze child's fingers/toes and nail beds will turn white .
b. Release child's fingers/toes 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, support bar
set, fracture table or hip spica table, 18 inch wooden bar, goniometer, scissors, thermometer and
bucket of tepid water w/ plastic bag. Place on work cart or station.
NOTE: The peroneal post and spinous process bar are padded with webril or ortho felt for child's
comfort.

CAUTION: The temperature of the water must be tepid ( 70-80 degrees) to reduce further injury
(possible burns) to the child. 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 orthopaedic felt pads, stockinette, webril, plaster or fiberglass rolls,
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 (7) 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 child supine on the orthopaedic examination bed measure from the axilla to mid thigh
and from mid thigh to one inch distal of the toes.
Note: Instruments of measurements may vary ( e.g. tape measure, ruler, or webril ).

NOTE: All measurements are taken on the uninjured side for patient comfort.
b. Pull down stockinette from stockinette container and cut measured lengths.
c. Roll up each stockinette leaving a 1-2 inch cuff at the distal edge. Place on work cart/station
for later use.

9. Prepare 1 plaster reinforcement splint for the posterior, lateral and groin aspects of the cast on
injured side.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edges of three stacks and remove from package. Place on work cart/station.
NOTE: 5 x 30 inch plaster splints are usually stacked in increments of five from the manufacturer. If
not pre stacked, count out 15-20 layers of plaster sheets.
b. Measure across the sacral region over both hips.

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