Page 279 - Orthopedic Casts and Splints2

Performance Steps

5. Check patient's capillary refill.
a. Squeeze patient's toes and nail beds will turn white .
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
instructions.

6. Gather equipment to include cast saw, cast spreader, hearing protection, goggles, T stand, thigh
holder,support bar,orthopaedic bump, goniometer, scissors, thermometer and bucket of tepid
water w/ 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 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 stockinette, webril, plaster or fiberglass rolls, fiberglass casting
gloves, examination gloves, hospital pad (chux), bed sheet, box of plaster reinforcement sheets,
surgical lubricant, box of alcohol pads , damp towel, (2) knee hinges, elastic knee cage, and
Quadrilateral socket. Open and remove (7) 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 or as directed by physician.
CAUTION: Stockinette and webril are forms of protection against the exothermic reaction of the
casting materials. Technician and physician preference will dictate whether stockinette is used.
a. Place hospital pad or bed sheet over 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 and protect their privacy.
b. Place the patient's uninjured ankle at a 90 degree angle to the tibia and knee between 0-15
degree of flexion.
NOTE: Measurements are taken on the uninjured leg to prevent further pain to the patient's injured leg.

NOTE: Instruments of measurements may vary ( e.g. tape measure, ruler, or webril ).
c. Measure from the groin and 2 inches proximal to the greater trochanter to the web spacing
of the toes to obtain stockinette length.
d. Pull down stockinette from stockinette container and cut measured length .
e. Roll stockinette leaving a 1-2 inch cuff at the distal end. 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 the gluteal crease to the web spacing of the toes.
c. Place stack of ( 5) plaster sheets next to the measured length , cut off excess amount and
place on work cart/station.
NOTE: Discard all excess material in the trash receptacle.
10. Prepare plaster reinforcement splint for use at the femoral condyles.
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