injuries poisoning
How To Apply a Cast
Step by Step Description of Procedure
Choose stockinette of the appropriate width; it should be form fitting but not so tight that it compromises circulation. Apply stockinette to cover the area (eg, about 5 to 10 cm) proximal and distal to the anticipated extent of casting material. Place several layers of padding (typically, 4). Wrap the padding circumferentially, from distal to proximal, over the area to which the cast will be applied. Overlap the underlying layer by half the width of the padding. Apply the padding firmly against the skin without gaps but not so tightly that it compromises circulation. Extend the padding slightly (about 3 to 5 cm) past the anticipated extent of the plaster or fiberglass. Smooth the padding as necessary to avoid protrusions and lumps. Tear away some of the padding in areas of wrinkling to smooth the padding. Add separate, non-circumferential pieces of padding over and around bony prominences. Immerse the casting material in lukewarm water. Gently squeeze excess water from the casting material.Do not wring out plaster. Apply the casting material circumferentially from distal to proximal, overlapping the underlying layer by half the width of the casting material. Use 4 to 6 layers of plaster (typically) or 2 to 4 layers of fiberglass to ensure adequate strength of the cast. Smooth out casting material to fill in the interstices in the plaster, bond the layers together, and conform to the contour of the extremity. Use your palms rather than your fingertips to prevent the development of indentations that will predispose the patient to pressure ulcers. Fold back the stockinette before adding the last layer of casting material. Roll back the extra stockinette and cotton padding at the outer margins of the cast to cover the raw edges of the splinting material and create a smooth edge; secure the stockinette under the casting material. Hold the body part in the desired position until the cast material hardens sufficiently, typically 10 to 15 minutes. Check for distal neurovascular status (eg, capillary refill and distal sensation) and motor function. 