Page 292 - Orthopedic Casts and Splints2

Performance Steps
a. On the volar side the distal edge of the cast rests at the DPC.
b. On the dorsal side the distal edge of the cast rests at the base of the MCPJ's.
c. The cast edge at the base of the thumb rests proximal to the snuff box.
d. The proximal edge of the cast rests 1 inch distal to the cubitum space.
e. Tape down edges of stockinette and webril.

26. Secure aluminum splint to volar aspect of cast.
a. Place padding between injured fingers.
b. Place aluminum splint on the volar aspect of cast.
NOTE: The splint can be formed to fit the contours of the wrist.
c. Tap the fingers to the aluminum splint.

27. Apply 3rd plaster roll( repeat steps 18-19 )
28. Apply 4th plaster roll( repeat steps 18-19 )
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.

29. Check patient's capillary refill.
a. Squeeze patient's finger tips and nail beds will turn white .
b. Release patient's finger tips and nail beds will return pink .
CAUTION: If capillary refill is delayed for more than 2 seconds inform physician and follow physician's
instruction.

30. Clean plaster resin off patient's skin using a damp wash cloth, towel or alcohol pad.
Note: Use alcohol pad or fresh water from the faucet and not from the casting bucket .

31. 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.)

32. Fit sling to patient as required.
NOTE: Consideration for applying a sling include elderly patient's, severity of fractures (e.g. colles',
smith's, bennett's), patient's comfort, physician's or technician's preference.
33. 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.
34. Escort patient or direct 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 patient's upper extremities. —— ——
5. Checked patient's capillary refill. —— ——

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