Page 306 - Orthopedic Casts and Splints2

Performance Steps
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 scissors, thermometer, goniometer, ruler and bucket of tepid water
w/ plastic bag. 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 webril, plaster rolls, examination gloves, hospital pad (chux), bed
sheet, sling, plaster reinforcement sheet, alcohol pads/damp towel. Open and remove (3) plaster
rolls from packages and 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 2 inch distal to the phalanges to the cubitum space( bend of elbow) for
stockinette length.
e. Pull down stockinette from stockinette container and cut measured length.
f. Roll stockinette leaving 1-2 inch cuff at the distal edge. Place on work cart/station for later
use
9. Prepare plaster reinforcement splint for the dorsal and volar aspects of the cast.
NOTE: The cobra cast can be applied to both the volar/dorsal aspects of the hand or to each side
separately. Physician's order will determine if the dorsal or volar aspect of the hand are encased.
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 phalanges between 70-90 degrees of flexion..
c. Remove (1) plaster sheet from the stack of (5).
d. Place sheet on the dorsal aspect of the hand from the tip of the phalanges to the cubital
space to obtain sheet length.
e. Place sheet on the volar aspect of the hand from the tip of the phalanges to the cubital
space to obtain sheet length.
NOTE: To increase patient cleanliness the sheet does not have to rest on the hand/forearm.

303