Page 299 - Orthopedic Casts and Splints2

Performance Steps
d. Apply firm and gradual pressure beginning at the wrist and progress up the forearm while
maintaining the wrist in correct position.
CAUTION: Excessive pressure may result in further patient injury. Talk to the patient while performing
this procedure ( e. g. How do you feel?, Is the pressure too much ? )
e. Remove heels of each hand from cast when contours of the wrist and forearm have been
shaped and cast is cured.
21. Mold cast material to phalanges.
NOTE: The physician will mold the phalanges.
22. Check range of motion ( ROM ) of phalanges and thumb.
a. Have patient extend, flex uninjured fingers and touch thumb to all fingers.
CAUTION: The finished edge of the cast should end proximal to the base of the thumb to avoid radial
nerve impingement.

Caution: The finished edge of the cast should end distal to the volar and dorsal sides of the 1st and 2nd
phalanges.
b. Have patient extend and flex elbow.
23. Check alignment of wrist with goniometer. Go to step 11.
NOTE: If wrist is not within 0-15 degrees of dorsal extension, ulnar or radial deviation are present, 1st
and 2nd phalanges are not between 70-90 degrees of flexion, remove cast and go to step 8.

24. Check cast dimensions.
a. The cast edge rests at the distal palmar crease.
b. The cast edge rests proximal to the snuff box.
c. The cast extends 1/2 to 1 inch distal to the tips of the 1st and 2nd phalanges.
d. The 1st and 2nd metacarpophalangeal joints( MCPJ's) are covered.
e. Tape down edges of stockinette and webril.

25. Apply 3rd plaster roll( repeat steps 16-17 ).
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.

26. 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.

27. 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 .

28. 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.)

29. 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.
30. Annotate the procedure applied to patient in medical record or SF 513.
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