Nursing

1. Assist in
Application & Removal
of
Plaster Cast
By:
Abhishek Yadav
M Sc Nursing 1st Year

2. INTRODUCTION OF ASSIST IN
APPLICATION OF CAST/SLAB
• These procedures are being done to immobilize the
injured injured part in the conditions or problems
like soft tissue injury , fracture, weakened bone, etc.
• For this procedure cast/slab can be made from POP
or fiber glass can be used.

3. DEFINITION OF CAST & SLAB
• A plaster cast / fiber glass cast is a rigid
immobilizing device that is moulded to
countour of body to encase an injured part.

4. • A POP slab / fiber glass slab can be applied firstly for
temporary period while waiting for definitive
treatment or it could be definitive treatment in itself.

5. PURPOSE OF CAST / SLAB
FOR SLAB:
• Applied as first treatment to immobilize the bone or
joints.
• Acts as a splint, to apply pressure on bone.
• To correct further complications.
• To observe signs & symptoms after application
(minimum one week after making cast).

6. FOR CAST:
• Applied after slab, means (full observation of injured
part).
• To immobilize the body part in specific position.
• To apply uniform pressure on bone.
• To provide support / stability for weakened joints.
• To prevent micro-movements in joints, bone fracture.

7. INDICATIONS FOR CAST / SLAB
• Bone fracture / dislocation.
• Soft tissue injury.
• Bone weakness.
• Ligaments injury.
• Joint swelling due to disease.
• Nerve, tendon or vessel repair.
• Congenital talipes equinovarus (CTEV) or clubfoot.
• Achilles / calcaneus tendon (its tear, rupture or
inflammation).

8. TYPES OF CAST /SLAB
1. Upper extremity:
1) Long arm cast:
(A/E cast)
It is applied to arm
from the hand to
about lower two
thirds of arm till the
level below arm pit,
leaving fingers &
thumb free.

9. 2) Short arm cast : (wrist
plaster)
It is just below the
elbow.

10. 3) Arm cylinder cast:
It covers upper and
lower arm & elbow,
but leave wrist & hand
free.

11. 2. Lower extremity :
1) Short leg cast :
(B/K cast)
it include the encasing
of foot, ankle and lower
leg ending below knee

12. 2) Long leg cast :
(A/K cast)
it includes the encasing
of foot and leg to the
hip.

13. 2) Leg cylindrical cast :
(used in knee injuries)
It is similar to long leg
cast but in some cases
it may end just above
the ankles.

14. 3. Hip Spica:
It include the
trunk of body
and one or more
legs. It is
extended till
navel (hollow
area) in trunk.
It is of three
types:

15. 4. Shoulder spica:
In this the trunk is
covered from shoulder
of the involved side
(other side is below
arm pit), to ileac crest
and involved limb is
covered till wrist or
hand.

16. 5. Finger or thumb
spica:
It includes long arm
cast and short arm cast
covering thumb or
fingers

17. 6. Body cast / plaster jacket:
(Rarely used)
(In spinal problem)
An encasement or covering for trunk, especially
thorax.
In this cast the anterior thorax and anterior
abdomen area is remained open.

18. 7. Minerva cast /
Minerva jacket:
(Rarely used)
It is applied to trunk
and head , with spaces
cut out for face and
ears.
It extends from
sternum and distal rib
border anteriorly &
across the distal rib
border posteriorly

19. 8. Bivalve cast:
A cast cutted into two
halves
When frequent
inspection is needed.

20. ARTICLES REQUIRED FOR
APPLICATION OF CAST
A TRAY CONTAINING RATIONALE QUANTITY
POP bandages / fiber glass
bandages
To make cast 1 or 2
Stockinet To cover skin before cast 1
Cotton roll (generally used) To cover the body part 1 or 2
Soft cotton roll
(medicated with glycerin)
To cover or to prevent allergy 1 or 2
Cotton bandage To dress the part 1
Scissor To cut the bandage 1
Short trimming knife To remove hairs before cast 1
Mackintosh To protect bed sheet 1 or 2
Plastic apron / gown To protect ourselves 1
Gloves To protect hands from POP 2
Bowel with lupe warm water To rinse the POP bandage 1
Fracture table To support extremity 1
Measuring tape To measure the part 1

21. Gypsum POP

22. POP / Fibreglass
bandage

24. Fracture bad

25. PROCEDURE FOR APPLICATION OF
CAST
• Assess client’s health status (not be diabetic /
malnourished).
• Explain the procedure to client and start IV line as
advised.
• Immobilize the part by applying splint to affected
part and provide position on bed.
• Assess the affected part for rashes , breakdown and
bruising.
• Provide skin care before the cast / slab application (if
it is open/ compound fracture then prepare client for
surgery).

26. • Determine client’s pain status (provide analgesics 20-
30 minutes before as advised).
• Arrange the articles.
• Place the mackintosh.
• Prepare the client by removing splint & positioning
the body part on bed or fracture table as required.
• Wash hands and don gloves.
• Part preparation.
• Apply glycerin to prevent swelling , lactamine lotion
to prevent allergy, apply betadine gauze piece if any
wound , and cover or apply stockinet over the part to
be casted.

27. • Wrap the part to be casted by the cotton roll or by
using soft cotton (anti-allergic),
• In case of Slab, prepare the POP bandage by
measuring the size to be casted (measuring tape),
and then that measured POP bandage is then placed
again and again onto each layer (in S-shape manner)
of POP (15 layers minimum). then dip it into lupe
warm water.
• In case of cast, dip the rolled POP bandage into lupe
warm water.
• Then in both cases (cast or slab) wait till bubbles stop
coming out of bandage (it takes 15- 20 seconds).

28. • Take it out of the warm water and squeeze the POP
bandage gently (don’t apply more pressure).
• Rule of thumb for plaster application blocks a joint
above and below the fracture, to prevent
mobilization.
• Hold the part to be casted by application of force as
required onto opposite side.
• In case of slab apply measured POP bandage onto
affected part posteriorly , then wrap it around by
wet cotton bandages.
• In case of cast apply rolled dipped POP bandage onto
the affected part to be casted , if required then take
another POP bandage to complete the cast.

29. • If fiberglass cast /slab is applied then open the
packing and apply the rolled bandage over the part
to be casted by wrapping it as in POP cast and make
layers and apply in case of slab making.
• Continue apply the force on opposite side of affected
part by pulling it.
• Both ends of stockinet sleeve may be folded back
over the cast padding to give attractive ending to
cast.
• Wait till the time it hardens. (fiberglass takes less
time to fix).
(handle the damped plaster cast with only palm of
hand not the fingers)

30. • If the cast/slab/fiberglass become harden then tell
the assistants to leave the pressure on to cast area.
• Position the casted part by placing a pillow under it
to elevate the part.
• Remove gloves and replace articles.
• The cast /slab should not be to much hard that it can
decrease the blood supply to affected part. So ask
client to move his /her fingers to confirm the
sensation or control.
• Record application of cast and condition of skin &
circulation.
• Record the client’s ability to perform ADL’s.

31. COMPLICATION OF THE CAST/ SLAB
• Impaired blood flow
• Nerve damage
• Tissue necrosis and infection
• Cast syndrome (nausea, vomiting & abd. distension).
• Complications due to immobility including joint
stiffness, foot drop, decubitus ulcers, depression,
insomnia, etc..
• Medical complications including phlebothrombosis,
pulmonary Embolism, wound enfection, etc..

32. DOCUMENTATION OF PROCEDURE

33. INTRODUCTION OF ASSIST IN
REMOVAL OF CAST/SLAB
• Removal of slab is being done after complete
observation of body part for any complication for
minimum 1 week after (1 month or 45 days after).
• Cast is being removed after the joining of the
fractured bone (confirming by X-ray exma.)

34. DEFINITION
• The removal of cast / slab is a procedure that is done
by qualified and experienced medical personnel
involving different methods of cast removal.

35. PURPOSE OF CAST/SLAB REMOVAL
• Slab is removed to apply cast for further treatment.
• Cast is removed when there is sign of full recovery or
completion of time duration as advised by Doctor.
• To prevent or treat any complication the cast is
removed.

36. ARTICLES REQUIRED FOR CAST/SLAB
REMOVAL
NAME OF ARTICLE RATIONALE QUANTITY
Mackintosh To prevent soiling of bed sheet 1
Clean gloves To protect our hands 1
Water in bucket To dissolve cast 1
Plaster cutter scissors To cut the plaster 1
Vibrator To cut plaster by vibrations 1
Dilator To dilate the cutted cast 1
Sand bags To hold body part 2-3
Handle blade To erode or cut the cast 1

37. Plaster cutter scissors

38. Plaster cutting instrument

39. Vibrator

40. Dilators

41. Handle blade

42. Sand bags

43. PROCEDURE FOR CAST/SLAB
REMOVAL
• Assess the patient’s condition.
• Explain the procedure to patient.
• Provide the proper position to patient as required
(sitting or lateral), and place the sandbags as
required.
• Spread the mackintosh over the bed .
• Arrange all articles as needed.
• Don gloves and start the procedure.
• Place the casted part into the water bucket, this
helps in dissolving and softening the POP bandage.

44. • If you are using plaster cutter scissor to cut the POP
cast/slab or fiber glass cast/slab.
– In this one blade is placed inside the cast under the
padding wool and another blade over the cast,
– then start cutting the plaster slowly slowly , the handle
should be in parallel to the skin position.
– After each cut the blade should be realigned before next
cut is made.
– Never try to cut round corners.
– Always remove the blades and cut from opposite side end
of line.

45. • If you are using the vibrator to remove POP or
fiberglass cast/slab:
– first mark the area line by which you have to make cut ,
– then apply vibrator over the marked line and start it ,
– and change the placement of vibrator according to marked
lines.
– After the cut has been made then use dilator to dilate the
cast and easily remove it out.
• Remove the gloves, replace the articles.
• Remove the stockinet and examine the skin condition
(any trauma due to cast removal).

46. • Wash and dry the part , massage with oil or cream to
restore normal elasticity.
• If there is edema then apply crepe bandage as
advised.

47. REFERENCES
• Annamma Jacob, Rekha R, A textbook of Clinical
Nursing Procedures: The art of Nursing practice, 1st
Edition, Published by Jaypee Publication ,2007.
• http://www.boneandspine.com/removal-of-plaster-
• http://www.m.healthkids.org/en/parents/cast-
removal-
• http://en.m.wikipedia.org/wiki/ortho..//-

48. Thankyou