Page 288 - Orthopedic Casts and Splints2

Performance Steps

5. Check patient's capillary refill.
a. Squeeze patient's fingers and nail beds will turn white .
b. Release patient's fingers 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, cast spreader, hearing protection, goggles, finger trap set
with stand and scissors, thermometer, aluminum splint and bucket of tepid water w/ bag. Open
and remove (4) plaster rolls from their packages and place on work cart/station. 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. 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 work cart with orthopaedic bump at edge of 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. Place patient's uninjured elbow on the orthopaedic bump at a 45 degree angle to the upper
torso.
NOTE: Measurements are taken on the uninjured arm to prevent further pain or discomfort to the patient.

NOTE: Instruments of measurements may vary (e.g. tape measure, ruler, or webril).
d. Measure from the cubitum space( bend of elbow) to 2 inches distal to the MCPJ's for
stockinette length.
e. Pull down stockinette from stockinette container and cut measured length.
f. 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 volar aspect of the cast.
NOTE: The volar aspect of the arm is located on the palm side of the hand/forearm.
a. Open box of 4 x 15 plaster reinforcement sheets. Remove sheets from box and unwrap
package . Peel back the edges of (5) sheets, remove from the stack. Place on work
cart/station.
b. Place patient's uninjured hand in the supine position(palm up) and locate distal palmar
crease(DPC), thenar muscle and the cubitum space.
NOTE: The DPC is furthest diagonal line on the volar aspect of the hand. The thenar muscle is at the
base of the thumb on the volar aspect of the hand. The crease is noticeable when the thumb and 5th
phalange (pinky finger ) are brought together. The cubitum space is located at the bend of the arm.
c. Remove (1) plaster sheet from the stack of (5).

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