Page 208 - Orthopedic Casts and Splints2

Performance Steps
a. Have patient extend, flex fingers.
b. Have patient adduct and abduct arm.
18. Check alignment of injured elbow with goniometer.
a. Place the stationary arm of the goniometer parallel to the forearm bisecting the 2nd and 3rd
phalanges.
b. Place the moving arm of the goniometer vertically, bisecting the humerus.
c. Place the protractor of the goniometer on the lateral olecernon ( elbow ).
d. The goniometer should measure 90 degrees of flexion.
NOTE: If the elbow is not at 90 degrees of flexion, supinated or pronated remove splint and go to step
8.

19. Check splint dimensions.
a. The distal edge of the cast rests at the DPC .
b. The splint proximal edge rests two inches distal to the axilla region or at base of deltoid
muscle.

20. 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.

21. 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.

22. Fit patient with a sling.
23. Give patient verbal and written instructions on cast care.
a. Instruct 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 instruction )
c. Instruct patient to keep arm elevated and flex and extend fingers to increase circulation in the
hand
d. Instruct patient not to stick any objects down the splint, do not remove the splint, and do not
alter the cast ( e. g. cutting,removing padding ).
24. Annotate the procedure applied to patient in medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to the patient in patient's medical
record or Standard Form 513 and sign your name.
25. Escort patient 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 the patient. —— ——

3. Explained the procedure to the patient. —— ——
4. Inspected patient's arms. —— ——
5. Checked capillary refill of patient's hands/fingers. —— ——

6. Gathered equipment —— ——
7. Assembled materials —— ——

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