CARING FOR A CAST
CAST
• Rigid external immobilizing
device that encases a body part
• Rigid dressing used to
immobilize a fractured bone or
soft tissue injury.
• Generally allows the patient
mobility while restricting
movement of the affected body
part.
TYPES
• 1. Plaster: white in color
2. Fiberglass
- comes in a variety of colors, patterns, and designs.
FUNCTIONS:
• To immobilize a body part in a specific position
• To prevent or correct deformity
• To support, maintain and protect realigned bone
• To promote healing and early weight bearing
Cast Application
• Apply the stockinette.
Apply the wadding sheet.
Casting Material Fiber glass or the
plaster cast
Contraindications:
PROCEDURE
OBJECTIVE: The cast remains intact and the patient does
not experience neurovascular compromise
1. Review the medical record and nursing plan of care to
determine the need for cast care and care for the
affected body part.
To validate the correct patient and correct procedure.
2. Identify the patient. Explain the procedure to the patient.
Proper identification validates the correct patient and
correct procedure. Discussion and explanation help
allay anxiety and prepare the patient for what to expect
3. Perform hand hygiene and put on gloves if necessary.
To prevent spread of microorganism. Gloves protect the
nurse from residual casting materials collecting on
hands.
4. Close the room door or curtains. Place the bed at an
appropriate and comfortable working height, if
necessary.
Proper handling of plaster cast prevent dents in the cast
which may create pressure areas on the inside of the
cast.
5. If a plaster cast was applied, handle the casted extremity
or body area with the palms of your hands for the first
24-36 hours, until the cast is fully dry.
Proper handling of plaster cast prevent dents in the cast
which may create pressure areas on the inside of the
cast.
Pressure Sore
6. If the cast is on an extremity, elevate the affected area
on pillows covered with waterproof pads. Maintain the
normal curvatures and angles of the cast.
Elevation helps reduce edema and enhances venous
return. Use of a waterproof pad prevents soiling of
linens. Maintaining curvatures and angles maintain
proper joint alignment, helps prevent flattened areas on
the cast as it dries and prevent pressure areas.
7. Keep cast (plaster) uncovered until fully dry.
To allow heat and moisture to sipate and air to circulate
to speed drying.
8. Wash excess antiseptic or antimicrobial agents such as
Povidone-iodine (Betadine), or residual casting material
from the exposed skin. Dry thoroughly.
Washing the area permits a clear area for inspection and
reduces the risk for irritation and breakdown from the
agent.
9. Assess the condition of the cast. Be alert for cracks,
dents, or presence of drainage from the cast. Perform
skin and neurovascular assessment according to facility
policy as often as every 1-2 hours. Check for pain,
edema, inability to move body parts distal to the cast,
pallor, pulses, and abnormal sensations. If the cast is on
an extremity, compare it to the uncasted extremity.
Assessment helps detect abnormal neurovascular
function or infection and allows for prompt intervention.
Assessing the neurovascular status determines the
circulation and oxygenation of tissues. Pressure within a
cast may increase with edema and lead to compartment
syndrome.
Compartment Syndrome
10. If breakthrough bleeding or drainage is noted on the
cast, mark the area on the cast. Indicate the date and
time next to the area. Follow physician order or facility
policy regarding the amount of drainage that needs to be
reported to the physician.
Marking the area provides a baseline for monitoring the
amount of bleeding or drainage.
11. Assess for signs of infection. Monitor the patient’s
temperature. Assess for foul odor from the cast,
increased pain, or extreme warmth over an area of the
cast.
Infection deters healing. Assessment allows for early
detection and prompt intervention.
12. Reposition the patient every 2 hours. Provide back and
skin care frequently. Encourage range of motion for
unaffected joints. Encourage the patient to cough and
deep breath.
Repositioning promoted even drying of the cast and
reduces the risk for the development of pressure areas
under the cast. Frequent skin and back care prevents
patient discomfort and skin breakdown. Range of motion
maintains joint function of unaffected areas. Coughing
and deep breathing reduce the risk of respiratory
complications associated with immobility.
13. Instruct the patient to report pain, odor, drainage,
changes in sensation, abnormal sensation, or the
inability to move fingers or toes of affected extremity.
Pressure within a cast may increase with edema and
lead to compartment syndrome. Patient understanding of
signs and symptoms allows for early detection and
prompt intervention.
14. Remove gloves and dispose them appropriately; place
the bed in the lowest position, if necessary.
Proper glove removal and disposal reduce the risk for
transmission of organisms; bed repositioning promotes
safety.
15. Perform hand hygiene.
To prevent the spread of microorganisms.
General Considerations
• Explain that itching under the cast is normal but
the patient should not stick objects down in the
cast to scratch.
• Begin patient teaching immediately after the cast
is applied and continue until the patient or a
significant other can provide care.
• If a cast is applied after surgery or trauma,
monitor vital signs
• Synthetic casts are light weight, easy to clean
and somewhat water resistant.
Infant and Child consideration
• Do not allow the child to put anything inside the cast.
• Remove toys, hazardous floor rugs, pets or other
items that might cause the child to stumble
• Keep in mind that synthetic casts come in different
colors and with designs, such as cartoons and stripes.
• Cover a synthetic cast with a plastic bag for bathing
• Instruct the parents/guardians of a child with a cast not
to alter standard car seats to accommodate a cast.
Specially designed car seats and restraints are
available for travel in a car.
Older Adult Considerations
• Obtain baseline information for
comparison after the cast is applied.
• Use more than one neurovascular
assessment to assess circulation
• Compare extremities or sides of the body
for symmetry.
Contact the doctor's office for the following signs:
• Increased pain and the feeling that the splint or cast
is too tight.
• Numbness and tingling in your hand or foot.
• Burning and stinging.
• Excessive swelling below the cast.
• Loss of active movement of toes or fingers.
COMPLICATIONS:
1. Compartment syndrome
the most serious complication of casting or splinting
a condition of increased pressure within a closed space
that compromises blood flow and tissue perfusion and
causes ischemia and potentially irreversible damage to
the soft tissues within that space
2. Skin breakdown
3. Infections
4. Joint stiffness
