CASTING

ROSECHELLE S. ELARCO, RMT, RN, MAN

CAST
 Casts are placed to PROVIDE STABILITY to a fracture,
dislocation, or soft-tissue injury while it heals.
 HELP PREVENT OR DECREASE MUSCLE
CONTRACTIONS and help keep the injured area immobile,
especially after surgery, which can also help DECREASE
PAIN.

❑ IMMOBILIZE
❑ SUPPORT
❑ DEFORM/ DISLOCATE BONE
Indications of applying a CAST

 TO immobilize a body part in a specific position

 TO exert uniform compression to the tissue
 TO provide early mobilization of UNAFFECTED body
part
 TO correct deformities
 TO stabilize and support unstable joints
Casting Materials
 Plaster of Paris - involves mixing  Fiberglass (knitted fiberglass
white powder with water to form a thick bandages impregnated with
paste. (calcined gypsum or roasted
gypsum) polyurethane)
❑ Before applying a plaster cast,  Bandages of thermoplastic.
a stockinette is applied first,
(made out of thin, webbed
material over the injured area)  Lightweight and dries in 20-30
minutes
❑ Several layers of soft cotton
were wrapped around the area  Comes in a variety of colors, patterns
before applying the paste. and designs.
❑ The paste hardens into a
protective case.  Water resistant
 Drying takes 1-3 days
 If dry, it is SHINY, WHITE,
hard and resistant
4
History
Casting and splinting have been applied for thousands of years.
One of the earliest descriptions of casting material was by Hippocrates in 350BC, he wrote about
wrapping injured limbs in bandages soaked in wax and resin.
In 3000 BC, ancient Egyptians used wooden splints made of bark wrapped in linen to support
broken limbs. They also used stiff bandages which is derived from their vast knowledge of
embalming techniques.

Advances in the choice of materials were made during the wars.

Plaster of Paris bandages were first used by Antonius Matthysen, a Dutch military surgeon in 1852.
Plaster of Paris has been commercially available since 1931.
 Types of CAST

SHORT ARM CAST ARM CYLINDER CAST

LONG ARM CAST
Location - below the elbow - Location - upper arm - wrist
Location - upper arm - hand
hand Uses - hold elbow, muscles/
Uses - upper arm, elbow,
Uses - forearm / wrist fractures tendons, dislocation/ and after
forearm fractures
surgery
 Types of CAST

SHOULDER SPICA CAST MINERVA CAST

Location - around the trunk of the body, shoulder, Location - around the neck and trunk of the body
arm and hand Uses - surgery on the neck / upper back area
Uses - shoulder dislocation/ after surgery on
shoulder
 Types of CAST

SHORT LEG CAST LEG CYLINDER CAST LONG LEG CAST

Location - below the knee - foot
Uses - lower leg fractures / severe
ankle (sprain/ strains) fractures
Location- upper thigh - ankle
Uses - knee or lower leg
fractures/ knee
dislocation
Location- middle of the thigh to the base
of the toes
Uses- fracture healing of the knee or a
dislocation, and after surgery of the knee
or leg.
 Types of CAST

ABDUCTION BOOTS CAST SHORT LEG HIP SPICA CAST

Location - upper thighs – feet L - chest – thighs/knees
Uses- treatment of congenital clubfoot U - hold hip muscles/tendons in place
Types of CAST

ONE AND-ONE-HALF HIP SPICA CAST BILATERAL LONG LEG HIP SPICA CAST
UNILATERAL HIP SPICA CAST Location - chest - foot on 1 leg - upper knee Location - chest - feet
Location - chest - foot (1 leg) of other leg Uses - pelvis, hip, thigh fractures
Uses - thigh fractures
 ASSISTING WITH THE APPLICATION OF A
POP CAST
Nursing Interventions
❑Handle a wet cast only with the palm of your hands
❑Cool settings on a hair dryer can be used to dry a plaster cast
(heat cannot be used on a plaster cast because the cast heats up
and may burn the skin)
❑Turn the extremity every once in a while so that all sides of the cast
will dry
❑Examine the cast for possible pressure areas
❑Keep the cast and extremity elevated
❑POP casts need 24 to 48 hrs. to dry
❑Fiberglass casts - 20 to 30 min.
 MONITORING A PATIENT AFTER
CASTING / BRACING

Nursing Interventions
❑monitor the neurovascular status of the affected extremity; notify MD if NV
compromise occurs
❑instruct the client in isometric exercises to prevent muscle atrophy
❑instruct patients not to stick objects inside the cast
❑monitor for warmth / wet spots on the cast
❑monitor for foul odor
❑monitor the client’s temperature
 CLIENTS EDUCATION

❑Instruct the client on the need to help maintain correct alignment and
positioning of the affected body part during the procedure.
❑ Inform the client that when the casting material is placed, it will feel warm as it sets,
then cool for several hours as it dries
❑Instruct the client not to bear weight on the cast while it is drying.
❑Remind the client to communicate any pain during the procedure so pain intervention
can be provided.
❑Provide instruction on cast care after the procedure is completed.
 CAST CARE INSTRUCTIONS:

❑Keep the cast clean and dry.

❑Check for warmth and movement of the exposed extremity and observe for color
❑Elevate the cast above the level of the heart to decrease swelling.
❑Encourage the patient to move his/her fingers or toes to promote circulation.
❑Check for cracks or breaks in the cast.
❑Rough edges can be padded to protect the skin from scratches.
❑Do not scratch the skin under the cast by inserting objects inside the
cast.
❑Can use a hairdryer placed on a cool setting to blow air under the cast and cool
down the hot, itchy skin. Never blow warm or hot air into the cast.
❑Do not put powders or lotion inside the cast.
For Pediatric patients
❑Cover the cast while your child is eating to prevent food spills and
crumbs from entering the cast

❑Prevent small toys or objects from being put inside the cast.

❑Do not use the abduction bar on the cast to lift or carry the child

❑Older children with body casts may need to use a bedpan or urinal in
order to go to the bathroom.
 TIPS TO KEEP BODY C ASTS CLEAN AND DRY
AND PREVENT SKIN IRRITATION
AROUND THE GENITAL AREA

1. Use a diaper or sanitary napkin around the genital area to prevent leakage
or splashing of urine.
2. Place toilet paper inside the bedpan to prevent urine from splashing onto
the cast or bed.
3. Keep the genital area as clean and dry as possible to prevent skin irritation.
 COMMON COMPLICATIONS OF
CASTING:
* Most problems are caused by improper initial application of the cast.

A. Pressure / Plaster sores

- result from skin necrosis caused by localized pressure from the inner
aspect of the cast

B. Skin blistering
- may result from poor oxygenation due to a tight-fitting cast
- may also result from skin infection
C. Compartment Syndrome
D. Cast Syndrome
 EQUIPMENT NEEDED

• Appropriate size cotton (for plaster) or synthetic (for fiberglass) cast padding such as Webril
• Stockinette, cut approximately 6 inches longer than the part to be casted
• Appropriate size plaster or sealed fiberglass rolls
• For plaster casts: Ace wraps, two or three-inch sizes, two to three rolls
• For plaster casts: bucket of warm water
• For plaster casts: roll of three to four inch tape
• Protective clothing for yourself
• Disposable gloves (nonsterile)
• Special supplies: Shoulder immobilizer for arm fractures, crutches for lower limb fractures,
finger traps for arm fractures that need to be reduced
BANDAGES AND BINDERS
 REASONS FOR BANDAGE / BINDER
APPLICATION

•to create pressure over a body part

•to immobilize a body part
•to support a wound
•to reduce or prevent edema
•to secure a splint
•to secure a dressing
 PATIENTS PREPARATION

• Always explain to the patient the purpose of the BorB and the length
of time it should be in place

• Ideally, it should be placed over clean, dry surfaces to prevent the

harboring and growth of microorganisms

• Need not be sterile when there are underlying sterile dressings to

protect the wound

• Should not be rolled over “wrinkled dressings” which can produce

pressure on the wound or skin
• Need to be wrapped tight enough to hold and secure dressings, yet loose
enough to avoid constricting a body part in any way

• 30 minutes after application, check the patient for comfort

• Any BorB that encircles an extremity must be checked more frequently because
of the possibility that the device will compromise circulation

• If too tight - BorB blocks venous return and leads to swelling; at the same time,
the bandage or the swelling itself can block arterial circulation to the extremity
causing neurovascular damage

• It is difficult to judge tightness, therefore check on the patient regularly

• For in-patient setting: one check per shift; if the patient is conscious, it is best to
teach the patient how to monitor for circulation changes
 DOCUMENTATION MUST COVER THE
FOLLOWING:

✓ Time of inspection
✓ Type of BorB applied
✓ Area to which the BorB was applied
✓ Assessment of the neurovascular status
✓ If the BorB is to be removed or changed, check the condition of the skin
 TYPES OF BANDAGES

1. Roller gauze
- this material does not stretch but is soft, strong, and
comfortable
- comes in different sizes / available in sterile and
non-sterile forms
- used to hold dressings in place
2. Stretch gauze
- soft, meshlike, flexible, stretchable
- also used to hold other dressings in place
- when applying a stretchable bandage, keep the
patient’s extremities in a functional position while
they are wrapped
3. Elastic bandage
- used to provide constant pressure over an area or to
support an injured joint
- can be used to facilitate venous return
(lower extremity)
 GENERAL METHODS
OF
APPLYING ROLL BANDAGES
1. Circular
- used to secure a dressing or to cover a confined
area of an extremity
- also used to anchor a bandage and terminate them

Unroll the bandage either toward you or laterally, holding the

loose end until it is secured by the first circle of the bandage.
Two or three turns may be needed to cover an area
adequately.
Hold the bandage with a tape or a clip.
2. Spiral
- applied over a wider area
- used to bandage parts of the body that have uniform
circumference (arm / thigh)

Begin with the spiral method.

After securing with one or two overlaps, place the
bandage to overlap one-half or two-thirds of the
width, and in this manner move up the extremity
to provide even support.
Tape or clip the bandage in place.
3. Reverse-Spiral
- also applied over a wide area like the spiral method
- used to bandage parts of the body that are not uniform in
circumference (forearm / leg)

Begin as you would for the spiral

bandage. When the end is secured
by the first turn, hold your thumb on
the bandage as it approaches the
side nearest you and fold over,
reversing the direction downward.
When the desired area is covered,
end with a circular wrap and secure
the bandage with tape or a clip.
4. Figure-8
- often used to wrap around a joint; allows the joint to maintain its mobility
without dislodging the bandage

Make the first turn over the joint, securing with

the overlap.
Make the next turn higher than, or superior to,
the joint.
Make the following turn lower than, or inferior to,
the joint.
Continue working in this manner, one turn above
and one below.
The spiral method is used above and below the
joint. Secure the bandage with a tape or a clip.
5. Recurrent Fold - used to cover distal parts of the body

Head & Digit

When used on the head, the circular turn is
made, and then turns are made over and
back across the top of the head. Subsequent
turns are folded alternately to the right and left
of the initial center fold. Keep your fingers in
place at the top to secure the bandage until a
A circular turn or two can be made to complete
the bandage.
 5. Recurrent Fold - used to cover distal parts of the body

Stump
- Note: Wrap the stump according to the method preferred by the surgeon.
* Commonly, a recurrent bandage is placed on the stump first, and then a
spiral is started at the distal end of the stump and moved up to the thigh.
Pressure must be properly distributed, with slightly more pressure at the
most distal portion of the stump, both to enhance return circulation and to
produce a smooth, even stump.
* Other surgeons prefer a figure-8 bandage wrapped from the stump up and
around the hip and the waist.
Stretch Net Binders
- not used for support like other binders e.g. abdominal
binder
- generally used to hold dressings in place
 Slings (Arm Sling)

1. With the patient facing you, place one

end of a triangle over the unaffected
shoulder.
2. Bring the long straight border under
the hand on the affected side.
3. Loop upward, positioning the other
end of the triangle over the affected
shoulder.
4. Tie or pin the ends to one side of the
neck. Never secure the a sling at
the back of the neck, where
pressure could be exerted.
5. Fold the corner flat and neatly at the
elbow, and pin.
6. Check the position - the hand should
be supported in the sling.