Page 96 - Orthopedic Casts and Splints2

Performance Steps
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, ear plugs, safety goggles, finger trap set,
scissors, sheet padded felt with stockinette, (2) 5lb weight plates, weight carrier, bucket of tepid
water w/ plastic bag, ruler, goniometer. Place on work cart/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 or fiberglass rolls, plaster
splints(4x15/5x30),examination gloves, fiberglass casting gloves, spool of traction cord, alcohol
pads/damp towel, padded felt w/ stockinette. Open and remove (5) plaster rolls from packages
and place on work cart/station.
NOTE: Physician 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 a form of protection against the exothermic reaction caused by the casting
materials and generally used for all casts except on patients who have had recent surgery, recently
reduced fractures or as directed by the physician.
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 90 degree angle to the upper
torso.
NOTE: Measurements are taken on the uninjured arm to prevent further pain/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 the axilla region 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 cast .
NOTE: The volar aspect of the arm is located on the palm side of the hand.
a. Open box of 4 x 15 reinforcement plaster sheets. Remove the sheets and unwrap package.
Peel back the edges of (5) sheets. Remove sheets from stack. Place on work cart/station.
b. Place patient's uninjured hand supine (palm up) and locate the DPC.
NOTE: The DPC is furthest diagonal line on the volar aspect of the hand. The thenar muscle is at the
base of the thumb on the volar aspect of the hand. The crease is noticeable when the thumb and 5th
phalange (pinky finger ) are brought together. The deltoid muscle is on the lateral aspect of the upper
arm.
c. Remove (1) plaster sheet from the stack of (5).
d. Place sheet next to uninjured arm to obtain sheet length, the DPC and thenar muscle
contour .
NOTE: To increase patient cleanliness the 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 ROM of the fingers (extension and flexion).
f. Draw a curved line(half moon shape) on the plaster sheet that matches with the outer
border of the thenar muscle on the patient's hand.

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