Page 223 - Orthopedic Casts and Splints2

Performance Steps

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.
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 room temperature water 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, sling, plaster reinforcement sheet, alcohol pads/damp towel. Open and remove (2) plaster
rolls from 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) for sugar tong splint.
a. Place work cart with orthopaedic bump at the edge of the bed.
b. 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 process .
c. Position the patient's uninjured elbow on the bump at a 90 degree angle to the floor. Locate
the DPC and MCPJ's.
NOTE: The DPC is the distal diagonal line on the volar aspect of the hand. The MCPJ's are the
knuckles on the dorsal side of the hand.
d. Measure from distal to the MCPJ's, posteriorly around the elbow, to the DPC.
NOTE: Instruments of measurement may vary ( e. g. tape measure, plaster sheet or webril ).
e. Place instrument of measure on work cart/station.
f. Roll out two layers of webril bisecting each other.
g. Layer the padding 2-4 thickness.

9. Prepare plaster splint for the volar and dorsal aspects of the forearm
a. Open box of 4 x 15 plaster reinforcement sheets. Remove sheets from box and unwrap
package . Peel back the edges of (10-15) sheets, remove from the stack. Place on work
cart/station.
NOTE: The technician may choose to use 4 inch plaster rolls.
b. Locate DPC and the MCPJ's .
c. Remove (1) plaster sheet from the stack of (10-15).
d. Place sheet next to uninjured arm to obtain sheet length, the DPC and MCPJ's contours.
NOTE: To increase patient cleanliness the sheet does not have to rest on the
e. Place sheet on stack , cut excess length for all sheets, and place on work cart/station for
later use.
NOTE: Discard excess materials in the trash receptacle.

10. Measure patient's injured wrist w/ goniometer.
a. Position the patient's injured elbow on the bump at a 90 degree angle to the upper torso.
b. Place the stationary arm of the goniometer bisecting the lateral aspect of the ulnar.
c. Place the moving arm of the goniometer bisecting the 5th phalange.
d. Place the protractor of the goniometer on the ulnar styloid.
e. Set the wrist until the goniometer measures between 0-15 degrees of dorsal extension.

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