1. Pullen, Richard L. Jr., RN, EdD

Article Content

A CAST CAN IMMOBILIZE a fracture while it heals, correct a deformity, apply uniform pressure to underlying soft tissue, or support and stabilize weakened joints. Casts are usually made of lightweight and durable fiberglass, which is also stronger and faster drying than plaster.




* Perform hand hygiene and explain the procedure.


* Support the body part to be casted, then position it as the health care provider indicates.


* Wash and dry the part, then if you're not using cast liner, apply knitted stockinette material smoothly without causing constriction.


[latin sharp s]Wrap soft, nonwoven roll padding or cast liner (illustrated) smoothly and evenly around the part, using extra padding around bony prominences and pressure points.


* Choose an appropriate-width bandage, then apply the casting material evenly, overlapping each preceding turn by half the width of the bandage. Use a continuous motion and maintain constant contact with the body part. To strengthen the cast, use additional casting material at joints and at points of anticipated stress.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

* Smooth the cast edges. Trim and reshape them with a cast knife or cutter. Remove particles of casting material from the patient's skin.


* Support the cast on a firm, smooth, soft surface as it hardens. Avoid putting pressure on it. Handle a damp cast with only the palms of your hands. A fiberglass cast dries within minutes to a few hours. A plaster cast takes 24 to 72 hours to dry completely, depending on its thickness and the environment.


* To help the cast dry, leave it uncovered and exposed to the air. You can also use a fan. Turn the patient every 2 hours, supporting his major joints.



[latin sharp s] Frequently assess the neurovascular status of the casted limb and immediately report any abnormalities to the health care provider.


* Frequently observe the skin around the cast edges, keeping the skin dry.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

* Teach the patient how to care for the cast. Tell him to report unrelieved pain, numbness, tingling, coldness, or discoloration of his casted limb.


* Document his response to cast application and your patient teaching.





* Don't rest a damp cast on a hard surface or anything with sharp edges.


* Don't use a hair dryer to dry it.


* Don't let the patient use anything to scratch under the cast. Scratching may compromise skin integrity and increase infection risk.




Altizer L. Casting for immobilization. Orthopaedic Nursing. 23(2):136-141, March-April 2004.


Kozier BJ, et al. (eds). Kozier & Erb's Techniques in Clinical Nursing: Basic to Intermediate Skills, 5th edition. Prentice Hall, 2004.


3M Scotchcast Wet or Dry Cast Padding: Clinical Information. 3M Medical, 2006.


Procel Cast Liner: Application Guide. W.L. Gore and Associates, 2000.


Smeltzer SC, et al. (eds). Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 11th edition. Lippincott Williams & Wilkins, 2007.