Assisting With Cast Application

Goal: The cast is applied without interfering with neurovascular function; and patient demonstrates signs of healing.

1. Review the medical record and medical orders to determine the need for the cast.

2. Perform hand hygiene. Put on gloves and/or other PPE, as indicated.

3. Identify the patient. Explain the procedure to the patient and verify area to be casted.

4. Perform a pain assessment and assess for muscle spasm. Administer prescribed medications in sufficient time to allow for the full effect of the analgesic and/or muscle relaxant.

5. Close curtains around bed and close the door to the room, if possible. Place the bed at an appropriate and comfortable working height, if necessary.

6. Position the patient as needed, depending on the type of cast being applied and the location of the injury. Support the extremity or body part to be casted.

7. Drape the patient with the waterproof pads.

8. Cleanse and dry the affected body part.

9. Position and maintain the affected body part in the position indicated by the physician as the stockinette, sheet wadding, and padding is applied. The stockinette should extend beyond the ends of the cast. As the wadding is applied, check for wrinkles.

10. Continue to position and maintain the affected body part in the position indicated by the physician or advanced practice professional as the casting material is applied. Assist with finishing by folding the stockinette or other padding down over the outer edge of the cast.

11. Support the cast during hardening. Handle hardening plaster casts with the palms of hands, not fingers. Support the cast on a firm, smooth surface. Do not rest it on a hard surface or sharp edges. Avoid placing pressure on the cast.

12. Elevate the injured limb above heart level with pillow or bath blankets, as ordered, making sure pressure is evenly distributed under the cast.

13. Place the bed in the lowest position, with the side rails up. Make sure the call bell and other necessary items are within easy reach.

14. Remove gloves and any other PPE, if used. Perform hand hygiene.

15. Obtain x-rays, as ordered.

16. Instruct the patient to report pain, odor, drainage, changes in sensation, abnormal sensation, or the inability to move fingers or toes of the affected extremity.

17. Leave the cast uncovered and exposed to the air. Reposition the patient every 2 hours. Depending on facility policy, a fan may be used to dry the cast.