Page 329 - Orthopedic Casts and Splints2

APPLY DOUBLE SUGAR TONG SPLINT
081-834-0064
Conditions: Given an orthopaedic patient requiring a Double Sugar Tong (DST) 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, (4) rolls
of 4 or 6 inch plaster, box of 4 x 15 inch plaster reinforcement sheets, box of 5 x 30 inch plaster
reinforcement sheets, (5) rolls of 4 inch webril, (4) 3 inch elastic bandages, examination gloves,
scissors, roll of 2 inch adhesive tape, (2) hospital pads (chux), bed sheet, pillow, goniometer, ruler, tape
measure, 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 patient's injured arm, from the base of the metacarpophalangeal
joints(MCPJ's) and distal palmar crease (DPC) to the base of the deltoid muscle or 2 inches distal to the
axilla, is immobilized by a double sugar splint and secured with (4) elastic bandages. The elbow is
measured at 90 degrees of flexion(absent of pronation or supination). The wrist is measured between
0-15 degrees of dorsal extension(absent of ulnar or radial deviation) with the fingers having full range of
motion and thumb having restricted movement . Capillary refill test is administered to the fingers 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 Double Sugar Tong Splint (DSTS) is applied from the base of the metacarpophalangeal
joints( MCPJ's), posteriorly around the elbow to the distal palmar crease (DPC ) and from the base of the
deltoid to 2 inches distal to the axilla region. The elbow will be flexed at 90 degrees, with the wrist
between 0-15 degrees of dorsal extension and absent of radial, ulnar deviation, pronation, supination.
The fingers will have full range of motion(ROM) with the thumb having restricted movement.

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 cast 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 and clothing 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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