Page 256 - Orthopedic Casts and Splints2

Performance Steps
b. Release patient's toes 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 cast saw with vacuum, cast spreader, hearing protection, goggles, T
stand, thigh holder, support bar, orthopaedic bump, goniometer, scissors, thermometer 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 stockinette, webril, plaster or fiberglass rolls, fiberglass casting
gloves, examination gloves, hospital pad (chux), bed sheet, sling, plaster reinforcement splint,
surgical lubricant, alcohol pads/damp towel. Open and remove (5) plaster rolls from their
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 stockinette.
NOTE: Stockinette is generally used for all casts except on patients who have had recent surgery,
recently reduced fractures, technician's preference or as directed by the physician. Stockinette and
webril are forms of protection against the exothermic reaction of the casting materials .
a. 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.
b. Place orthopaedic bump on bed.
NOTE: Technician preference will determine if orthopaedic bump is used. A number of props may be
use ( e.g. T stand, finger trap stand, nursing assistant )
c. Measure the distance from tip of toes to 3 inches distal to the popliteal space.
NOTE: Measurements are taken on the uninjured leg to prevent further pain or discomfort to the
patient. Instruments of measurements may vary (e.g. tape measure, ruler, or webril).
d. Pull down stockinette from stockinette container and cut measured length.
e. Roll stockinette in a cuff leaving a 1-2 inch border at the distal edge. Place on work
cart/station for later use.
9. Prepare plaster reinforcement splint for the posterior aspect of the cast.
NOTE: The plaster reinforcement splint will be prepared for the posterior side of the injured leg/ankle.
a. Open box of 5 x 30 inch plaster reinforcement sheets. Remove and unwrap package. Locate
edge of one stack and remove from package. Place on work cart/station.
NOTE: 5 x 30 inch plaster splints are usually stacked in increments of five from the manufacturer. If
not pre stacked, count out five layers of plaster sheets.
b. Measure from 3 inches distal to the popliteal space ( or 1 finger breadth from the fibula
notch/head) to the tip of the toes.
CAUTION: The peroneal nerve is located on the lateral side of the leg. If the nerve is constricted it
could die and cause drop foot( known as nerve palsy ). This is an irreversible condition. Locate the
fibula notch/ head and measure 1 flinger width below to prevent this condition.
c. Place stack of ( 5) plaster sheets next to the measured length , cut off excess amount and
place on work cart/station.
10. Place cotton between toes to absorb moisture.
NOTE: Kerlix fluffs or strips of webril may be used.

11. Apply stockinette to patient's injured leg.

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