Cast Application Protocol: Best Practices for Orthopedic Care

Pre-Application Assessment

Patient Evaluation

• Assess injury type and location
• Review radiographic findings
• Check neurovascular status
• Document skin condition and swelling

Material Selection

• Plaster vs. Fiberglass considerations
• Cast padding requirements
• Appropriate width selection
• Water temperature for plaster

Application Procedure

1. Preparation

• Position patient appropriately
• Protect patient's clothing and surrounding area
• Gather all necessary materials
• Don personal protective equipment

2. Stockinette Application

• Apply appropriate size stockinette
• Extend 5-7.5 cm beyond intended cast edges
• Ensure smooth application without wrinkles

3. Padding Application

• Apply uniform layers of padding
• Double-pad bony prominences
• Avoid wrinkles and excessive compression
• Pay special attention to:
  • Olecranon
  • Malleoli
  • Heel
  • Other pressure points

4. Cast Material Application

• Immerse plaster/prepare fiberglass
• Apply with 50% overlap between layers
• Maintain proper tension
• Smooth surface during application

5. Molding and Positioning

• Position extremity in functional position
• Mold appropriately for injury type
• Maintain position until initial set

Post-Application Care

Immediate Assessment

• Check neurovascular status
• Ensure appropriate fit
• Verify joint positions

Patient Education

• Cast care instructions
• Warning signs and symptoms
• Follow-up schedule
• Activity restrictions

Documentation Requirements

• Type of cast applied
• Materials used
• Injury details
• Pre/post neurovascular status
• Patient education provided

Quality Assurance

• Regular assessment during drying
• Verify proper trim lines
• Confirm patient comfort
• Schedule follow-up care