Page 195 - Orthopedic Casts and Splints2

Performance Steps
h. Fold webril and stockinette edges over the trimmed cast ends and secure with paper tape.

27. Check cast dimensions.
a. The nipple line is visible.
b. The cast edge on the uninjured leg is 2-4 inches above the knee.
c. The cast edge on the injured leg rests at the web spacing of the toes.

28. Apply 4th and 5th plaster/fiberglass rolls ( repeat steps 21-22 ).
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. Technician preference will determine where that last roll is started.
29. Attach wooden bar(strut) to the medial aspect of the injured and uninjured leg above the knee.
NOTE: A wooden bar from an old/unusable crutch or metal bar can be used .The strut is used to
assist in moving the child.
a. Measure distance between legs with tape measure or ruler.
NOTE: Physician's order will determine at what distance the legs are either adducted or abducted .
b. Place strut next to the measured length and cut off excess amount .
NOTE: The cast saw is used to cut the strut.
CAUTION: For safety purposes do not cut the strut in front of the child.
c. Place strut end on cast above knee on the injured side.
NOTE: The physician will determine the location of the strut .
d. Wrap a figure-of-8 around the end of the strut and cast.
e. Continue wrapping the casting material across the strut and laminate the casting material.
f. Place opposite strut end above knee on the uninjured side.
NOTE: The physician will determine the location of the strut ends.
g. Wrap a figure-of-8 around the opposite end of the strut ,around the cast and laminate the
casting material.
30. Check child' 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.

31. Clean plaster resin off child'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 .
32. Give parent (s) verbal and written instructions on cast care.
a. Instruct the parent (s) to call the cast clinic should they have any concerns or questions
regarding their cast . Provide parent (s) with a copy of the clinic hours and telephone
number. After duty hours instruct parent (s)to report to emergency room.
b. Provide parent(s) with cast care booklet or equivalent.
c. Instruct parent (s) not to stick anything down the cast, do not remove the cast and do not
alter the cast( e.g. writing on it, coloring.)

33. Annotate the procedure applied in child's medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to parent (s) and sign your
name.

34. Escort parent (s) or direct parent (s) to front desk to make a follow up appointment.

Performance Measures GO NO GO
1. Received the order from the physician (reviewed if in writing). —— ——

2. Identified yourself to parent(s) —— ——

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