Cast Application
A cast is a hard mold that encases a body part, usually an extremity, to provide immobilization of bones and surrounding tissue. It can be used to treat injuries (including fractures), correct orthopedic conditions (such as deformities), or promote healing after general or plastic surgery, amputation, or nerve and vascular repair. (See Types of cylindrical casts, page 130.)
Casts may be constructed of cotton-polyester, plaster, fiberglass, or other synthetic materials. Typically a doctor applies a cast and a nurse prepares the patient and the equipment and assists during the procedure. With special preparation, a nurse or other practitioners may apply or change a standard cast, but an orthopedist must reduce and set the fracture.
Contraindications for casting may include the presence of skin disease, peripheral vascular disease, diabetes mellitus, open or draining wounds, extreme edema, and susceptibility to skin breakdown. These aren’t strict contraindications; the doctor must weigh the potential risks and benefits for each patient.
Equipment
Tubular stockinette ▪ casting material ▪ plaster splint, if needed ▪ bucket of water ▪ sink equipped with a plaster trap ▪ linen-saver pads ▪ sheet wadding ▪ sponge or felt padding, as needed ▪ rubber gloves ▪ gloves ▪ pain medication ▪ Optional: cast stand, pillows, sterile marker.
Preparation of Equipment
Gather the tubular stockinette and cast material. Tubular stockinettes range from 2″ to 12″ wide. Wear rubber gloves.
For A Cotton-Polyester or Fiberglass Cast
Gently squeeze the packaged casting material to make sure the envelopes don’t have any air leaks. Humid air penetrating the packaging can cause the casting material to fail. To prepare the casting material, follow the manufacturer’s directions for the appropriate water temperature to use. Place the equipment so that it’s easily accessible during the procedure.
For A Plaster Cast
Gently squeeze the packaged casting material to make sure envelopes don’t have any air leaks. Humid air leaking into the envelope can cause the plaster to become stale, which could make it set too quickly, form lumps, fail to bond with lower layers, or set as a soft, friable mass. (Baking a stale plaster roll at a medium temperature for 1 hour can make it usable.)
Follow the manufacturer’s instructions for water temperature when preparing plaster. It’s advisable to use water that’s room temperature or slightly warmer because it allows the cast to set in about 7 minutes without excessive exothermia. (Cold water retards the rate at which setting occurs and may be used to facilitate molding of difficult casts. Warm water speeds the rate of cast setting and raises the temperature of the skin under the cast.) Place equipment so that it’s easily accessible.
Implementation
Verify the doctor’s order.
Make sure the doctor has obtained an informed consent and that it’s documented in the medical record.1
Gather the equipment, and check the casting packages for air leaks.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.2
Explain the procedure to allay the patient’s fears.
Mark the procedure site if indicated.6
Cover the appropriate parts of the patient’s bedding with a linen-saver pad.
Remove any jewelry on the limb to be casted. Jewelry may interfere with the circulation to the limb.
Assess the condition of the skin of the affected limb, and note any areas of abnormal color, ecchymosis, open wounds, rashes, or irritation. This will make it easier to evaluate any patient complaints after the cast is applied.
Assess the patient’s baseline neurovascular status. Palpate the pulses and assess the temperature, color, capillary refill, motion, sensation, and pain in the affected and unaffected limb.
Assess the patient’s vital signs.
Assess the patient for pain and muscle spasms and provide medication as ordered, using safe medication administration practices. Perform a follow-up pain assessment and notify the doctor if pain isn’t adequately controlled.7
If the patient has an open wound, assist the doctor with administering a local anesthetic, closing the wound, and applying dressings, as needed.
Participate in a preprocedure time-out.8
Help the doctor position the limb, as ordered. (Commonly, the limb is immobilized in the neutral position.)
Support the limb in the prescribed position while the doctor applies the tubular stockinette and sheet wadding. The stockinette should extend beyond the ends of the cast to pad the edges. (If the patient has an open wound or a severe contusion, the doctor may not use the stockinette.) The limb is then wrapped in sheet wadding, beginning distally, and extra wadding is added to the proximal and distal ends of the cast
area as well as to any points of prominence. Smooth any wrinkles as the sheet wadding is applied.
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