Cast Care (Of Resident With Plaster Cast) 

Purpose: 

To provide proper care for residents in a plaster cast to prevent infection and irritation and to ensure continuous immobilization. 

Equipment: 

• Adhesive tape to “petal” rough edges of the cast if necessary 

• Pillows for positioning 

• Traction device if ordered 

• Trapeze bar if ordered 

• Immobilizing device(s) if necessary 

Procedure: 

6. Initial Assessment and Preparation: 

• Check circulation and any areas of irritation above and below the cast. 

• Ask the resident to move all joints above and below the cast, unless contraindicated. 

7. Managing Rough Edges: 

• If the cast edges are rough and irritating, cut two to three-inch strips of one-inch adhesive tape. 

• “Petal” the edges of the cast by overlapping strips of tape. Ensure the tape is secured and not adhering to the resident’s skin. 

8. Positioning: 

• Place pillows under the cast to elevate the affected part above the level of the heart to prevent edema. 

• Do not position pillows under the heel; instead, position pillows under the ankle with the heel free of pressure. 

• Check all cast edges to ensure no pressure is being exerted on the skin. 

• Do not pad the cast with any material such as cotton, 4x4s, or abdominal pads as this may cause pressure. 

9. Drying the Cast: 

• Allow the cast to dry thoroughly by exposing it to air for 24 hours. A cast dryer or fan may be used for large casts. 

• Handle the cast as little as possible until it is thoroughly dry. 

10. Ongoing Monitoring: 

• After the cast is applied, check the extremity for circulation by documenting color, temperature, edema, and CMS (circulation, motion, sensation) every shift. 

• Turn the resident as necessary. Consult with the physician for proper positioning of the resident and support the cast well during and after turning. 

• If any edema, irritation, signs and symptoms of infection, or pain occur, notify the physician immediately. 

11. Additional Precautions: 

• Cover the cast with plastic when bathing to keep it dry. 

• Prevent small objects from falling into the cast. 

• Inform the resident of permitted activities and activities to be avoided until the cast is removed. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the cast care procedure, including the resident’s response, in their medical record. 

• Note any observations related to circulation, irritation, and overall skin condition. 

• Regularly review and update techniques for cast care according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper cast care procedures to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.