Page 233 - Orthopedic Casts and Splints2

Performance Steps

5. Check patient's capillary refill.
a. Squeeze patient's phalanges and nail beds will turn white .
b. Release patient's phalanges 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, T stand, 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, package of purified cotton, kerlix fluffs, elastic
bandages, box of alcohol pads and damp wash cloth or towel 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 splint materials.
a. If applying compression dressing to lower extremity, go to step 9.
b. If applying compression dressing to upper extremity, go to step 20.

9. Prepare Bulky Jones for lower extremity.
a. Place hospital pad or bed sheet on patient's lap.
NOTE: All patients should be given a covering (e.g. chux, bed sheet ) to reduce damaging their clothing
during the casting process and for privacy.
b. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edge of three to four stacks and remove from package. Place on work cart/station.
NOTE: 15-20 plaster sheets are needed for all lower extremity splints.

NOTE: 5 x 30 inch plaster splints are usually stacked in increments of five from the manufacturer. If not
pre-stacked, count out in groups of five (20-30 layers of plaster sheets).

NOTE: The technician may choose to use(3) 6 inch plaster rolls.
c. Locate the fibula head.
CAUTION: The fibula head is located on the lateral side of the patella. Along side the fibula head is the
peroneal nerve . If the peroneal is constricted the nerve may die and cause drop foot (nerve palsy). This
is an irreversible condition. Measure one finger width below the fibula head and provide extra padding to
the area to prevent further injury to the patient.
d. Place the uninjured ankle at a 90 degree angle to the tibia.
NOTE: There are several ways to position and maintain the ankle at a 90 degree angle. The patient could
flex their toes, press their heel down or nursing personnel/ family member can assist. It is the technician
preference.
e. Measure from 1 inch distal to the tips of the toes to 3 inches distal to the popliteal region.
NOTE: Measuring devices such as webril, tape measure or plaster sheets may be used.
f. Place measured plaster sheets on work cart/station.
10. Prepare purified cotton roll ( Bulky Jones).
a. Open the package and remove cotton roll.
b. Locate edge of protective wrap and extend the cotton roll.
c. Unroll the cotton.
d. Tear the cotton roll in half. Place on work cart/station.
NOTE: The cotton roll is design to be torn easily, however, scissors may be used.
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