g. Observe the extremity encased in plaster for circulatory impairment by
comparing fingers or toes of the casted extremity with the uninvolved extremity. The
primary concern following new cast application is to prevent complications. Circulation
should be checked hourly during the first 24 to 48 hours, then every 4 hours.
(1) Check the skin temperature of the injured extremity. It should not be
colder than the unaffected limb.
Check and compare the pulses. They should be equal.
(3) Check for complaints of numbness, tingling, burning, swelling, pain,
pressure, or inability to move the fingers or toes.
(4) Report presence of the above signs and symptoms IMMEDIATELY to
avoid possible tissue necrosis; these findings indicate possible ischemia.
h. Perform the blanching (capillary refill) test. The nail beds of the fingers or
toes are compressed lightly and released to check how quickly the color returns.
(1) With pressure applied, the nail bed should turn pale (blanch). When
pressure is released, the color should return within the time it takes to say "capillary
refill," indicating return of capillary action.
(2) Failure to blanch, or a blue tinge, indicates impaired venous circulation
and congestion of tissues.
(3) Failure of color to return, or cold, pale fingers or toes suggests impaired
(4) In either case, report findings IMMEDIATELY. Do not wait. Permanent
damage can result from impaired circulation caused by cast pressure.
1-18. FINISHING THE DRY CAST
Cast edges may have been trimmed and finished with a smooth edge at the time
of application or edges may be finished after the cast is dry.
a. When a cast is lined with stockinette, it may be pulled out from within the cast
and folded back over the edges of the cast and taped in place. See figure 1-12.
b. Adhesive tape or moleskin may be used to cover rough edges of the cast by
applying overlapping pieces in a "petal" fashion. See figure 1-12.