Page 284 - Orthopedic Casts and Splints2

Performance Steps
NOTE: To assist in alignment of the hinges, nursing assistant , physician or orthopaedic technician
may be used.
b. Place the edge of the casting material on the distal arm of the hinge and begin wrapping
around the lower leg two rotations to secure the edge.
c. Bring the casting material between the hinge and leg and lock in hinge.
d. Continue down the leg and laminate as you roll.
e. Repeat steps 30 b-d for the proximal end of the hinge brace.
f. Place stationary arm of the second hinge on the medial aspect of the leg bisecting the femur
and the moving arm bisecting the fibula. The rotation part of the hinge should be in line with
the middle of the patella.
g. Place the edge of the casting material on the distal arm of the hinge and begin wrapping
around the lower leg two rotations to secure the edge
h. Bring the casting material between the hinge and leg and lock in hinge.
i. Continue down the leg and laminate as you roll.
j. Repeat steps 30 g-i for the proximal end of the hinge brace.
31. Apply 5th roll of plaster/fiberglass ( repeat step 20-21).
NOTE: The last roll in all casting applications is commonly referred to as the beautification roll or the
money roll. Take pride in your work.
32. 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's
instruction.

33. Clean plaster off patient's skin using a damp wash cloth, towel or alcohol pad.
NOTE: Fresh water from the faucet and not from the casting bucket should be used.
34. Apply a cast shoe.

35. Administer a crutch ambulation instruction ( See task number 081-836-0041)
36. 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 leg elevated and flex and extend toes to increase circulation in the
foot.
d. Instruct patient not to stick anything down the cast, do not remove the cast, and do not alter
the cast ( e. g. writing or coloring the cast).
e. Instruct patient not to place any pressure on the cast for 24-48 hrs.

37. 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.
38. 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 patient. —— ——
3. Explained the procedure to the patient. —— ——

4. Inspected injured leg/ankle with patient supine on the examination bed. —— ——

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