Page 210 - Orthopedic Casts and Splints2

APPLY A GUTTER SPLINT
081-834-0032
Conditions: Given an orthopaedic patient requiring a Gutter Splint, in supine or sitting position on a
orthopaedic examination bed, family members, nursing personnel, physician, physician's verbal or written
orders, patient's medical record, or Standard Form 513 (consultation form), work cart/station, sink, (3) roll
of 4 inch webril(cast padding), (2) rolls of 4 inch plaster, box of 4 x 15 plaster reinforcement sheets, box
of 5 x 30 plaster reinforcement sheets, examination gloves ,scissors, (3) hospital pads ( chux ), (2) bed
sheets, goniometer, ruler, tape measure, bucket of water w/ plastic bag, sink, orthopaedic bump, (3)
elastic bandages, box of alcohol pads/ damp wash cloth, towel, pillow, roll of 2 inch adhesive tape, cast
care booklet or equivalent, pen, sling, thermometer and trash receptacle.

Standards: Is reached when a splint is applied on the dorsal aspect of the injured hand from the tips of
the 4th and 5th phalanges to 1 inch distal to the cubitum space and secured with elastic bandages. The
wrist is measured between 0-15 degrees of dorsal extension(absent of ulnar or radial deviation) and the
4th and 5th metacarpals are measured between 70-90 degrees of flexion, with the uninjured phalanges
and thumb having full range of motion . Capillary refill test is administered to all phalanges and
successfully passed.

Performance Steps

1. Receive the order from the physician( review if in writing)
2. Identify yourself to the patient.
NOTE: Tell the patient your name and job title.
3. Explain the procedure to the patient.
NOTE: The Ulnar gutter splint is applied from the tips of the 4th and 5th phalanges to 1inch distal to the
cubitum space with wrist between 0-15 degrees of dorsal extension and phalanges between 70-90
degrees of flexion. The wrist will be absent of radial, ulnar deviation, pronation, supination with the
uninjured fingers and thumb having full range of motion(ROM).

CAUTION: During splinting application a chemical response(exothermic reaction) will occur between the
water (H2O) and the plaster (gypsum). This is a safe and common occurrence. The splint will initially
become warm and cool down within 2-5 minutes. However, if it doesn't cool down or there is an increase
of heat intensity during the cast application, the splint may need to be removed.

4. Inspect patient's arms.
a. Place examination gloves on hands.
CAUTION: Always practice Body Substance Isolation (BSI) prior to applying traction, splints or casts to
patients.
b. Inspect both arms for any skin conditions(e.g. cuts, abrasions, laceration and skin rashes).
NOTE: Inform physician if conditions are present and follow physician's instruction.
c. Examine both arms and wrists for jewelry and remove if found.
NOTE: All jewelry on both hands and wrist must be removed. Give jewelry to family member or secure
with patient's belongings in NCOIC office.

5. Check capillary refill of patient's hands/fingers.
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.

6. Gather equipment to include scissors, thermometer, goniometer, ruler and bucket of tepid water
w/ plastic bag. Place on work cart or station.

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