Page 200 - Orthopedic Casts and Splints2

Performance Steps
e. Call or send for physician if skin conditions are present. Follow physician's order.
f. Examine both legs for jewelry and remove if found.
NOTE: All jewelry must be removed. Give jewelry to family member or secure with patient's belongings
in locked NCOIC office
5. Check patient's capillary refill.
a. Squeeze patient's toes and nail beds will turn white.
b. Release patient's 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 scissors, orthopaedic bump, thigh holder, goniometer, marking pen,
bucket of tepid water with plastic bag. Place on work cart/station.
CAUTION: The temperature of the water must be tepid ( 70-80 degrees) to reduce further injury
(possible burns) to the patient. 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 webril, plaster rolls, examination gloves, hospital pad (chux), bed
sheet, box of plaster reinforcement sheets, box of alcohol pads and towel. Open and remove
(3) 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 cast padding ( webril).
a. Place hospital pad or bed sheet on patient's lap.
NOTE: All patient's should be given a covering( e.g. chux, bed sheet) to reduce damaging their clothing
during the casting procedure.
b. Locate the fibula head on the uninjured leg.
CAUTION: The peroneal nerve is located on the lateral side of the knee. If the nerve is constricted it
could die and cause drop foot( known as nerve palsy ). This is an irreversible condition. Measure 1
finger breadth below the fibula head and provide extra padding to the area to prevent further injury to
the patient.
c. Place the uninjured ankle at a 90 degree angle to the tibia.
NOTE: There are several ways to position and maintain a the ankle at a 90 degree angle. The patient
could maintain the angle, nursing personnel or family member can assist. It is the technician
preference.
d. Measure from 1 inch distal to the tips of the toes to 3 inches distal to the popliteal region.
NOTE: Webril, tape measure or plaster splint may be used to measure the distance from the toes to
the popliteal region.
e. Measure from one finger breadth from the fibula head on the lateral side of knee, around the
heel, up the leg ending opposite from the start.
f. Place measure webril on work station/cart.
g. Roll out second layer to the same length and place on the middle of the previous padding.
h. Layer the padding 2-4 thickness.
9. Prepare plaster splint.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edge of 6 stacks and remove from package. Place on work cart/station.

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