Page 87 - Orthopedic Casts and Splints2

Performance Steps
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 cast saw, cast spreader, hearing protection, goggles, T stand,
orthopaedic bump, goniometer, scissors, thermometer 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 water that is room temperature 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 stockinette, webril, plaster or fiberglass rolls, fiberglass casting
gloves, examination gloves, hospital pad (chux), bed sheet, sling, box of plaster reinforcement
sheets, surgical lubricant, box of alcohol pads and damp wash towel. Open and remove (4)
plaster rolls from their 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/ortho flex) will be used. The technician
may choose to use ortho flex for the supracondylar area.

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 over 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 the work cart with orthopaedic bump at the side of bed.
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. Instruments of measurements may vary (e.g. tape measure, ruler, or webril).
d. Measure from 2 inches distal to the MCPJ's to mid humerus to obtain stockinette length.
e. Pull down stockinette from stockinette container and cut measured length.
f. Roll stockinette leaving a 1-2 inch cuff at the distal end. Place on work cart/station for later
use.

9. Prepare plaster reinforcement splint for the volar aspect of the cast..
NOTE: The volar aspect of the arm is located on the palm side of the hand/forearm.
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 hand in the supine position(palm up) and locate distal palmar crease(DPC),
thenar muscle, medial and lateral supracondylar and the cubitum space.
NOTE: The DPC is furthest diagonal line on the volar aspect of the hand. The thenar muscle is at the
base of the thumb ( heel of hand). The crease is noticeable when the thumb and 5th phalange ( pinky
finger ) are brought together. The supracondylar are on the lateral/medical sides of the elbow. The
cubitum space is at the bend of the arm.
c. Remove (1) plaster sheet from the stack of (5).
d. Place sheet next to injured arm to obtain sheet length, the DPC and thenar muscle contour .
NOTE: To increase patient cleanliness the plaster sheet does not have to rest on the hand/forearm.
e. Draw a diagonal line on the plaster sheet that matches with the DPC of patient's hand.
NOTE: The diagonal line facilitates free range of motion( ROM ) of the fingers (extension and flexion).

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