Page 295 - Orthopedic Casts and Splints2

APPLY SHORT ARM RADIAL GUTTER CAST
081-834-0057
Conditions: Given an orthopaedic patient requiring a Radial Gutter cast , sitting or supine on a
orthopaedic examination bed, family member, nursing personnel, physician, physician's verbal or written
order, patient's medical record, or Standard Form 513(consultation form), pen , work cart/station, (2) rolls
of 4 inch plaster, (3) rolls of 3 inch plaster, box of 4 x 15 inch plaster reinforcement sheets, (2) rolls of
2 or 3 inch webril, roll of 2 or 3 inch stockinette, stockinette container, examination gloves, scissors, roll
of 2inch adhesive tape, (2) hospital pads (chux), bed sheet, pillow, goniometer, ruler, tape measure,
finger trap set with stand, bucket of tepid water w/ plastic bag, sling, cast care booklet or equivalent, box
of alcohol pads, damp wash cloth or towel, sink w/ faucet, orthopaedic bump, thermometer and trash
receptacle.

Standards: Is reached when the cast is applied to the radial aspect of the patient's injured arm from the
tips of the 1st and 2nd phalanges down the dorsal side of the hand completely covering the 1st and 2nd
metacarpophalangeal joints ( MCPJS) to 1 inch distal to the cubitum space( bend of elbow). The wrist is
immobilized by the cast between 0-15 degrees of dorsal extension( absent of ulnar, radial, supination or
pronation). The 1st and 2nd phalanges are measured between 70 - 90 degrees of flexion. The cast
eliminates rotation of the wrist with free range of motion of the elbow, thumb and uninjured fingers.
Capillary refill test is administered to the fingers/thumb and successfully passed.

Performance Steps

1. Receive the order from the physician( review if in writing)
2. Identify yourself to the patient.
NOTE: Tell the patient your name and job title.
3. Explain the procedure to the patient.
NOTE: The Radial gutter cast (RGC) is applied from the tip of the index and middle phalanges to 1 inch
distal to the cubitum space. The injured phalanges will be flexed between 70-90 degrees, with the wrist
between 0-15 degrees of dorsal extension and absent of radial, ulnar deviation, pronation and
supination. The uninjured fingers and thumb will have full range of motion(ROM).

CAUTION: During splinting application a chemical response(exothermic reaction) will occur between the
water (H2O) and the plaster (gypsum). This is a safe and common occurrence. The splint will initially
become warm and cool down within 2-5 minutes. However, if it doesn't cool down or there is an increase
of heat intensity during the cast application, the splint may need to be removed.
4. Inspect patient's arms.
a. Place examination gloves on hands.
CAUTION: Always practice Body Substance Isolation (BSI) prior to applying traction, splints or casts to
patients.
b. Place patient sitting or supine on examination bed.
c. Inspect both arms for any skin conditions(e.g. cuts, abrasions, laceration and skin rashes).
NOTE: Inform physician if conditions are present and follow physician's instruction.
d. Examine both arms and wrists for jewelry and remove if found.
NOTE: All jewelry on both hands and wrist must be removed. Give jewelry to family member or secure
with patient's belongings in NCOIC office.

5. Check capillary refill of patient's hands/fingers.
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

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