Page 326 - Orthopedic Casts and Splints2

Performance Steps
NOTE: If wrist is not within 0-15 degrees of dorsal extension, ulnar or radial deviation are present or the
thumb is not in opposition to the index finger, or elbow is not flexed at 90 degrees, remove cast and go
to step 8.

33. Check cast dimensions.
a. The cast edge rests 1/2 inch distal to the tip of the thumb.
CAUTION: To avoid further injury to the patient, the finished edge of the cast should end distal to the tip
of the thumb.
b. The cast edge rests at the distal palmar crease.
c. The cast edge should rests 2 inches distal to the axilla region.
d. Tape down edges of stockinette and webril.

34. Apply 5th roll of plaster/fiberglass( repeat steps 19-20).
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. Technician's preference will determine where that last roll is started.
35. 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.
36. 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 .
37. 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.)
38. 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.

39. 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.

40. 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 the patient. —— ——
3. Explained the procedure to the patient. —— ——

4. Inspected patient's arms. —— ——
5. Checked capillary refill of patient's hands/fingers. —— ——
6. Gathered equipment. —— ——

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