Page 225 - Orthopedic Casts and Splints2

Performance Steps
b. Place the moving arm of the goniometer vertically, bisecting the lateral side of the 5th
phalange (little finger)
c. Place the protractor of the goniometer on the ulnar styloid.
d. The wrist is measured between 0-15 degrees of dorsal extension.
NOTE: If wrist is not within 0-15 degrees of dorsal extension, ulnar or radial deviation are present,
remove splint and go to step 11.
e. The elbow is measured at 90 degrees of flexion.

18. Check splint dimensions.
a. The dorsal edge of the splint is at the base of the MCPJ's.
b. The volar edge of the splint is flush with the DPC.

19. 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.
20. 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 .

21. Fit patient with a sling.
NOTE: Consideration for applying a sling include elderly patient's, severity of fractures (e.g. Colles',
Smith's, Bennett's), patient's comfort, physician's or technician's preference.
22. 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 uninjured 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 ).
23. 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.

24. 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. —— ——
8. Prepared cast padding ( webril) for sugar tong splint. —— ——
9. Prepared plaster splint for the volar and dorsal aspects of the forearm —— ——
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