Page 264 - Orthopedic Casts and Splints2

Performance Steps
f. Place additional layer of padding over folded edges.
g. Place the padded splint from the superior aspect of the AC joint, down the arm, over the elbow,
posteriorly up the arm, ending 2 inches distal to the axilla region.
NOTE: The elbow should be flexed at 90 degrees or according to physician's order.
12. Secure Coaptation splint to injured arm.
a. Hold elastic roll with one hand.
b. Place the edge of the elastic bandage on the AC joint and begin wrapping around the shoulder
two rotations to secure the edge .
c. Continue through the axilla, down the forearm and figure of eight around the elbow.
d. Secure elastic bandage with clips.
e. Tape down the elastic bandage between the clips.
f. Remove the clips and dispose in trash receptacle.

13. Mold casting material to elbow.
NOTE: Physician will mold the cast material.

14. Check ROM of phalanges and thumb.
a. Have patient extend, flex fingers and touch thumb to all fingers.
b. Have patient extend and flex wrist.

15. Check alignment of elbow with goniometer.
a. Place the stationary arm of the goniometer horizontally, bisecting the forearm.
b. Place the moving arm of the goniometer in a vertically, bisecting the lateral side of the
humerus.
c. Place the protractor of the goniometer on the olecranon ( elbow ) process.
d. The elbow is measured at 90 degrees of flexion.

16. Check splint dimensions.
a. The proximal edge of the splint is superior to the AC joint.
b. The proximal edge of the splint rests 2 inches distal to the axilla region.
17. Check patient's capillary refill.
a. Squeeze patient's fingers and nail beds will turn white .
b. Release patient's fingers and nail bed will return pink .
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.
18. Clean plaster resin off patient's skin using a damp wash cloth or towel or alcohol pad.
Note: Use alcohol pad or fresh water from the faucet and not from the casting bucket .
19. Give patient verbal and written instructions on cast care.
a. Instruct the 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 emergency room.
b. Present patient with cast care booklet( or written instructions).
c. Instruct patient to elevated the extremity above the heart , extend, flex and wiggle
fingers(demonstrate for patient) to reduce swelling.
d. Instruct patient not to stick anything down the cast, do not remove the cast and do not alter the
cast( e.g. writing on it, coloring.)
20. Fit sling to patient as required.
NOTE: Consideration for applying a sling include: elderly patient, severity of fractures (e.g. Colles',
Smith's, Bennett's), patient's comfort, physician's or technician's preference.
21. Annotate the procedure applied to patient in medical record or SF 513.
NOTE: Record the procedure applied and cast care instruction provided to patient in medical record or
Standard Form 513 and sign your name.

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