Page 320 - Orthopedic Casts and Splints2

APPLY LONG ARM THUMB SPICA CAST
081-834-0062
Conditions: Given an orthopaedic patient requiring a Long Arm Thumb Spica Cast ( LATSC ), in supine
or sitting position on a orthopaedic examination bed or /chair , family member, nursing personnel,
physician, physician's verbal or written orders, patient's medical record, or Standard Form(consultation
form) 513, work cart/station, roll of 2 or 3 inch stockinette, roll of 3 or 4 inch stockinette, stockinette
container, (3) rolls of 2 or 3 inch webril , (2) rolls of 4 inch webril, (3) rolls of 3 inch plaster (3) rolls of 4
inch plaster, box of 4 x 15 plaster reinforcement sheets, box of 5 x 30 plaster reinforcement sheets, (2)
rolls of 2 inch fiberglass (3) rolls of 3 or 4 inch fiberglass, fiberglass casting gloves, examination gloves,
scissors, hospital pad( chux), (2) bed sheets, goniometer, ruler, bucket of tepid water w/ plastic bag,
sink, tube of surgical lubricant , orthopaedic bump, roll of adhesive 2 inch tape, box of alcohol pads,
damp wash cloth or towel, pillow, finger trap set, sling, tape measure, cast care booklet, or equivalent,
pen, and trash receptacle.

Standards: Is reached when the wrist is immobilized, between 0-15 degrees of dorsal extension, by the
cast from the tip of the thumb and distal palmar crease (DPC)/metacarpophalangeal joints(MCPJ'S) to 2
inches distal to the axilla. The elbow is immobilized at 90 degrees of flexion. Ulnar, radial deviation,
pronation and supination are eliminated from the wrist and forearm. The cast eliminates rotation of the
thumb, wrist, forearm and elbow, with free range of motion of the fingers. Capillary refill test is
administered to the fingers/thumb and 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 Long Arm Thumb Spica cast will be applied from the tip of the thumb to 2 inches distal to the
axilla region with the wrist between 0-15 degrees of dorsal extension and the elbow at 90 degrees of
flexion. The wrist will be absent of radial, ulnar deviation, pronation, supination with the uninjured fingers
having 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. Remove patient's shirt.
d. 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.
e. 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 .

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