Page 164 - ASOP Orthopedic Casting Manual

“LONG ARM CAST” PRACTICAL EXAMINATION

COMPETENCY ASSESSMENT SHEET (Form 1A)

NAME:____________________ EVALUATOR:__________________
Date:_____________

Upper Extremity Casting Technique – Long Arm Cast Time allotted = 15 minutes
Patient Position and Preparation Exceeds Meets Approaching Does Not Meet
Standards Standard Standard Standard
Seated or standing (arm in position of function when possible) 3 2 1 0
Extremity is clean and free from dirt/debris 3 2 1 0
Rings, bracelets, and/or other appliances have been removed from hand and wrist area 3 2 1 0
Pre-application check – neurovascular status 3 2 1 0
Padding / Stockinet Technique
Stockinet should reach axilla to fingertips to allow for proper fold back (as proximal as possible) 3 2 1 0
Cuts opening in antecubital space and olecranon process 3 2 1 0
Thumb hole cut 6” from distal end (1/2”) 3 2 1 0
Appropriately cuts “Gumby” with hand/finger openings 3 2 1 0
Applies Gumby in position accordingly through finger and hand 3 2 1 0
Flexes elbow slightly past 90 3 2 1 0
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Starts wrapping padding around the distal end of extremity 3 2 1 0
Provides proper padding through web space 3 2 1 0
Applies sufficient layers of padding in palm area (2-3 layers) 3 2 1 0
Continues rolling padding directly up arm in spiral maneuver overlapping ½ the distance of 3 2 1 0
preceding layer
Does not over pad elbow area (minimize pistoning inside) 3 2 1 0
Continues back down arm with “flattening tire” technique to control firmness of cast 3 2 1 0
Cuts stockinet at the wrist and folds back to distal palmer crease 3 2 1 0
Folds/rolls stockinet back around the base of the thumb/fingers/deltoid area 3 2 1 0
Fiberglass Application
Selects 2” or 3” fiberglass appropriate for patient size 3 2 1 0
Starts along dorsal wrist & covers Gumby edge in circular fashion to create anchor effect 3 2 1 0
Does NOT “stretch” the fiberglass during application 3 2 1 0
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Positions cast tape distal to base 1 MCP jt. and continues with “pinch & wave” AND/OR 3 2 1 0
“cut” technique through web space
Continues rolling around hand/wrist complex (4-5 layers) 3 2 1 0
Maintains fiberglass roll against arm in circular turns to 3-4 finger breadths below crease 3 2 1 0
Returns roll in spiral fashion towards wrist; ½ coverage 3 2 1 0
Starts new roll fiberglass – maintain flexed elbow 90 3 2 1 0
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Creates curved “cove” between forearm/humerus at antecubital crease 3 2 1 0
Continues casting proximally along upper humerus (overlapping) 3 2 1 0
Casts above belly of biceps or higher (anatomy dependent/MD preference) 3 2 1 0
Pulls/cinches cast tape along belly of biceps (around the soft tissue structures) 3 2 1 0
Continues final layer (overlapping ½ distance) returning to the base of thumb 3 2 1 0
Cast maintained 90 elbow flexion 3 2 1 0
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Lamination and Molding Techniques
Adequately sprays cast with water and properly laminated fiberglass 3 2 1 0
Performs “Lateral” mold technique [shaped by thumb and fingers palm] 3 2 1 0
Performs “Medial” mold technique [flat opposing hand applies counterforce to lateral mold] 3 2 1 0
Performs lateral/medial molds simultaneously from behind patient 3 2 1 0
Support and Neatness
Application control wrist flexion, extension, ulnar/radial deviation 3 2 1 0
Allows for full thumb & finger ROM 3 2 1 0
Minimizes extremity “pistoning” within cast (forearm/humerus) 3 2 1 0
Medial mold flattening cast to the inner bicep shape against chest wall 3 2 1 0
Lateral mold following deltoid insertion to prevent humeral rotation 3 2 1 0
No fiberglass in contact with skin / ½ or so padding outline at cast ends 3 2 1 0
Maintains good circulation to the fingers/thumb – post application neurovascular status 3 2 1 0
Removal / Extrication Principles
Uses marker to indicate lines for removal 3 2 1 0
Maintains control of cast saw with one finger on cast at all times 3 2 1 0
Incorporates left and right hand into removal technique 3 2 1 0
Uses up/down motion straight into cast (no blade dragging) 3 2 1 0
Cuts through ulnar and radial aspects / medal and lateral humeral borders) 3 2 1 0
Utilizes cast spreader as necessary 3 2 1 0
Opens cast and slides fiberglass application away from patient 3 2 1 0
Checks for skin damage and cleans extremity 3 2 1 0
SKILL POINTS: _______ / 150_

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