Unit IV: Wound Care and Application of P.O.

Outline:

 Dressing of wound
 Removal of sutures
 Care of drainage tube
 Bandaging
 Application of splints, Plaster of Paris (POP) and stockinet
Objective

The students should be able to carry out wound care correctly.

The students should be able to apply bandage on body parts.

WOUND DRESSING AND TYPES OF DRESSING

Definition
A wound is a break in the continuity of soft parts of the body –
skin, mucus membranes, muscle, tendons e. t. c. it may either be
superficial or deep. It can be accidental or intentional.
Complete asepsis must be observed in caring for all types of wounds by
employing a NON-TOUCH ASEPTIC TECHNIQUE, viz using sterile
instruments and dressings.

TYPES OF WOUND
1. Incised wound: This type of wound occurs when the skin is
broken by sharp instrument such as a knife or a piece of glass.
The wound usually bleeds freely but heals quickly.
2. Punctured wound: In this type of wound, the depth is greater
than the length and there is danger of deep organs being
damaged. These type of wound is caused by a pointed instrument
 such as a spike , a needle, a bayonet or by gunshot. There is
danger of internal organs being damaged.
3. Lacerated Wound: In this type of wound the skin and tissues are
torn rather than clean cut and the wound are irregular. There is
commonly “crushing” of the skin and muscle. These type of
occur when a limb is caught up in machinery or after a road
accident
4. Contused Wound: In this type of wound there may be relatively
little damage to the skin but underlying tissues may be severely
damaged with bleeding from blood vessels under the skin. This
release of blood causes ”bruising”. Contused wounds are caused
by violence from a blunt instrument. For example by hitting the
finger with a hammer

Purposes of Wound Dressing:

• To prevent contamination from wound
• To help approximate edges of wound
• To protect wound from injury
• To apply medicine locally
• To apply pressure
• To absorb drainage from wound
• To remove clips, sutures and drains
• Prevent infection
• Control bleeding
• Prevent further injury
Large or deep wounds should always be cleaned and treated.

A dressing is a sterile wound covering while a bandage holds a dressing

in place.

Dressings should be
 – Sterile (microorganism- and spore-free)
– Aseptic (bacteria-free)

– Held in place with a bandage firmly enough to control

bleeding, but not stop circulation (i.e., not too tight)
– Larger than the wound
– Soft, thick, and compressible
– Most are porous, allowing air to circulate
– Ideally, layered, lint-free, gauzy, and somewhat bulky
– Always placed against the wound and held by bandage;
the bandage should never directly touch the wound.
Types of Dressings
Occlusive: have an airtight and waterproof seal; used for specific types
of chest wounds
Compress: thick, bulky, usually sterile, intended to stop bleeding
Trauma: larger area, thick, sterile, absorbent; used for more serious or
widespread injury
Adhesive strips: combination of sterile dressing and bandage,
individually packaged; used for small wounds.
Adhesive tape: commonly unsterile, comes in varying-width rolls, not
applied directly to wounds; holds dressings in place.

Gauze pads: used in various dressings, may have coating to prevent

sticking; the portion applied to a wound should be sterile.
Special pads: commonly used for larger-area trauma; also called multi
trauma pads.
Bandage compresses: special dressing used to cover wounds and help
control heavy bleeding

Principle of wound dressing

 Order of doing dressings:
a. Clean wounds should be done first.
b. Potentially infected wounds, e.g. wounds in known
contaminated area; where there is any type of drainage;
burns; ulcers.
c. Infected wounds.
 Wound dressing should be carried out in a treatment room or on
patient’s bed and no other activities should take place while the
dressings are in progress.
 When dressings are done in a ward, they should not be done
immediately after bed making or ward cleaning.
 Where possible these are done by two people.
 A dresser does the actual dressing and an assistant.
 Explain procedure to and reassure the patient.
 Ensure privacy.
 Both Nurses wash hands
 Masked
 Prepare trolley

(A) Preparation of Trolley

1. Clean trolley first with soap and water, then mop with hibitane in
spirit starting from the bottom shelf.
2. Put on a mask
3. Set bottom shelf first.
(B) Requirements
Top Shelf:-
A sterile wound cleaning or dressing kit containing
 3 pairs of sterile dressing forceps:
 1 pair of sterile dissecting forceps;
 1 pair of sterile surgical scissors if necessary.
 A sterile dressing mackintosh and towel PRN.
 3 gallipots, 2 for lotions and 1 for resting instruments
Additional Requirement when necessary; all must be sterile
Top Shelf:
 Extra Gallipot (s) for dressing lotion.
 Ribbon gauge for incised wounds.
 Stitch scissors, clip remover.
 Sinus forceps.
 Probe.
 Toothed dissecting forceps.
 Dressing lotions.

Bottom Shelf
A large clean tray containing:
 Bottles of lotions
 Bandages of various sizes
 Receiver for soiled dressing swabs and gauzes.
 A receiver for soiled bandages and binders.
 A jar of antiseptic lotion containing a cheatle forceps.
 Pack of sterile gauze and swab
(C) Procedure
– Wheel trolley to the bedside.
– If necessary, place dressing mackintosh in position.
– Place kidney dish near the wound to receive dirty swabs
and old dressing.
This should be placed as conveniently as possible but
never near patient’s mouth, face or too far for easy reach.
– Wash hands and dry with towel by the sink or bowl.
– Open bowls, receivers and pour out lotion into gallipot.
– Remove bandages or strapping.
– Wash hands and dry with one side of sterile dressing
towel.
– Care must be taken not to contaminate hands or top of
trolley.
– Use the other half of the towel to protect patient’s limb
resting on the mackintosh.
– Care must be taken not to contaminate hand while this is
being placed in position.
– When necessary the nurse can call for help or assistance
to lift patient’s limb.
– Use the first dressing forceps to removed old, dirty
dressings.
– Discard into the kidney dish placed to receive the same, at
the bottom shelf of the trolley.
– Keeping the dissecting forceps between the bowls of
swabs and gallipot of lotion and dressing forceps only, do
not allow it to come in contact with patient thus getting
contaminated.
– Using each swab only once, clean the surrounding of the
wound first, the wound, taking care not to hurt the patient.
– Use as many swabs as will keep the wound clean.
– Discard the dressing forceps used for cleaning.
– Pick up the last pair and this is now used to apply new
dressing.
– Cover wound with clean dressings.
– Forceps could be rested in kidney dish or discarded.
– Bandage the wound or apply adhesive strapping.
– Remove dressing mackintosh and dressing towel.
– Make patient comfortable.
– Remove screen.
– Take trolley to the sterilizing room and discard.
REMOVAL OF SUTURES

Definition of Suture

A suture is a medical device used to hold body

tissues together after an injury or surgery or to repair
damaged tissues for therapeutic purpose. Most commonly, a
thread attached to the appropriate needle size is used for
suturing, alternative wound closures are tapes (Sterile
strips), staples, tissue adhesives or barbed sutures. However,
 they all aim at holding body tissues together for a particular
period of time for therapeutic purposes.

Purpose / Rationale

 To prevent wound.
 To close dead space.
 To prevent spread of infections.
 To hasten healing.
 To promote neatness and aesthetic view of wound.
 To minimize tension that causes wound separation.

Types of Suture Materials

A. Based on material/quality.

i. Absorbable Sutures: These types of sutures do not require

removal. This is because they are digestible by the enzymes
found in the tissues of the body. They are used in place that
require minimal support and heals rapidly. E.g. oral cavity,
mucosal layer, lower layers of skin, stitches of fascia tissue
etc. examples of absorbable sutures include gut, polyglactin
(vicryl), Poliglecaprone (monocryl), Polydioxanone (PDS).

ii. Non-absorbable Sutures: These types of sutures are not

absorbable hence, needs to be removed. These sutures are
used in soft tissue repair, including cardiovascular and
neurological procedures. Examples of non-absorbable are:
nylon, silk, prolene, polyester etc.
 Although, absorbable sutures are less stressful
because there is no need of its removal after suturing, it can
be dangerous. Sometimes, the body might react with the
suture used due to its constituents which could lead to
infection, inflammation, redness and other complications.

B. Based on Origin.

i. Natural Sutures: The source of this suture is purely natural

e.g organics, animal product, raw materials, etc.

ii. Artificial/Synthetic Sutures: The source of this suture is

artificial. It is usually industrially processed.

C. Based on actual structure of the material.

i. Monofilament Sutures: This consists of a single thread.

This suture easily passes through tissues.

ii. Braided Sutures: This consists of several small threads

braided together, although better security, but increased
potential for infection.

Sutures vs Stitches

There has been a controversy between the two terms.

Sutures use a thread or strand of material to perform wound
closure. Stitches are the term used to refer to a surgical
procedure or process of closing a wound with sutures.
Suture Techniques

Just as there are many different types of sutures, there

are many different suture techniques. Surgical technique
used to close a given wound depends on:
  the force and direction of tensions on the wound,
 the thickness of the tissues to be opposed
 anatomic considerations.
i. Continuous Sutures: This technique involves a series of
stitches that use a single strand of sutures materials. This
type of suture can be placed rapidly and is also strong, since
tension is distributed evenly throughout the continuous
suture strand. Usually, the stitch run is usually tied only at
the beginning and end of the stitch/run.

ii. Interrupted Sutures: This suture technique uses several

strands of suture material to close the wound. After a stitch
is made, the material is cut and tied off. This technique leads
to a securely closed wound. If one of the stitches breaks, the
remainder of the stitches will still hold the wound together.

iii. Deep Sutures/Retention Sutures: This type of suture is

placed under the layers of tissues below (deep) to the skin.
They may be either continuous on interrupted. This stitch is
often used to close fascia layer.

iv. Buried Sutures: This type of suture is applied so that the

suture knot is found inside (that is, under or within the area
that is to be closed off). It is typically not removed and is
useful when large sutures are used deeper in the body.

v. Purse-string Sutures: This type of continuous suture is

placed around an area and tightened much like the
drawstring on a bag. For example, this type of suture could
 be used in the intestines to secure an intestinal stapling
device.

vi. Subcutaneous Sutures: These are placed in the dermis, the

layer of tissue that lies below the upper layer of the skin. Short
stitches are placed in a line that is parallel to the wound. The
stitches are then anchored at either end of the wound

Removal of Sutures

Procedure for removing sutures.

Sutures should be removed at the earliest possible time to prevent

minimize suture reaction and suture marks but they should remain
in place long enough to prevent wound dehiscence and scar spread.

When sutures are removed depend on where they are on body.

 Scalp: 7-10 days.

 Face: 3-5 days.
 Chest or trunk: 10-14 days.
 Arms: 7-10 days.
 Legs: 10-14 days.
 Hands or Feet: 10-14 days.
 Palm of Hands or Sole of Feet: 14-21 days.

Procedure for removing sutures is as follows:

 Greet patient and introduce yourself.

 Confirm patient identity.
 Explain procedure to patient. Inform the patient that the
suture removal may produce slight discomfort, such as a
stinging sensation, but should not be painful.
 Seek consent.
 Bring tray to patient’s bedside.
 Provide privacy.
 Perform hand hygiene.
 Don gloves.
 Remove dressing and inspect the wound using non sterile
gloves. Visually assess the wound for uniform closure of the
wound edges, absence of drainage, redness and swelling.
 Clean incision areas with antimicrobial solution before and
after suture removal.
 After assessing the wound, decide if the wound is
sufficiently healed to have the sutures removal. If there are
concerns, question the order and seek advice from the
appropriate health care provider. Remove gloves and
perform hand hygiene again, don gloves again.
 Clean incision site with a wet swab.
 Grasp the suture at the knot with a pair of forceps in
dominant hand and hold scissors in dominant hand. This
allows for dexterity with suture removal.
 Place the curved tip of the suture, scissors under the suture
as close as possible, either opposite the knot or under the
knot.
 Cut the suture. If using a blade to cut the suture, point the
blade away from you and the patient.
 If it is a continuous suture, with the forceps or hemostat, pull
the suture out in one piece gently. But if it is an interrupted
suture, cut the knots of each and drag gently the suture out.

NB: When removing simple interrupted sutures, do not cut the

suture thread that is, the closet to the skin near the suture knot.
This would help reduce infection from the longest thread which
is exposed to the environment.

 Inspect to ensure that all suture materials are removed

because if left on the skin, they act as a foreign body causing
inflammation.
 After removal, we discard the suture into a piece of sterile
gauge or into the moisture proof bag.
 Continue to remove alternative sutures.
 If dehiscence occurs, report the situation to the nurse-in-
charge and stop removal of suture, but if it does not,
continue with the procedure.
 If sterile strips are ordered by primary care providers, then it
must be applied to enhance the healing of the wound. Also,
 it helps maintain sterility, support wound tension across
wound and help to eliminate scarring.
 Dressing should be reapplied if indicated.
 Document findings such as suture removal, appearance of
incision, application of dressing, steri strips, etc.

a. For Interrupted Sutures

An end of the suture is grasped with forceps and gently pulled
away from the skin. The tip of the scissors (or stitch cutter) is passed
under the drawn up portion and the sutures snipped and gently pulled out
with forceps.
Alternate sutures should be removed first. When this is done, it can be
noted if there is good union between the skin edges. If the union is good,
the remainder of the sutures may be removed unless otherwise
instructed.
b. For Continuous Sutures
These are of various types and require different techniques of removal.
One type of completely pulled through the wound after cutting it from its
anchorage at either end of the wound.
Another type is removed by cutting at the skin edge of each loop and
removing as for an interrupted suture.
Subcuticular suture dissolves spontaneously with time and only exposed
portions are removed if necessary.

Removal of Clips
A clip is removed by passing the curved portion of the remover
under the centre of the clip then bringing the two blades together. This
frees the clip edges and it can now be lifted off gently with forceps.

Application of jelonet, Etc.

After swabbing, a piece of jelonet of the appropriate size is removed
from its container, using non-touch technique-and applied to the wound
so that it is completely covered.
Ensure that the lid is replaced immediately after the jelonet has been
removed and if possible tin is re-sterilised.

Application of Powders
These may be dusted or insufflated on the wound.

Application of Sprays from Aerosols

Hold aerosol approximately 12" from wound and liberally spray. If it is
to be applied to head or face, cover patient’s eyes.

CARE OF DRAINAGE TUBE

Shortening of a Drain
Examples of Types of Drains:
a. Circular rubber/ plastic
b. Corrugated rubber
c. Paul’s tubing (fine rubber)
d. Catheter e.g. intrapleural
e. Closed – suction of an open wound
Care of a), b), c), Overleaf
1. First, gently rotate to break any adhesions.
2. Withdraw 1 inch (or break any adhesions.
3. Insert fresh sterile pin a little below the point where the
drain is to be cut
4. Cut off portion that has to be removed.
5. Swab area, surround with gauze dressings and secure.

Removal of Drain:
May be situated in main wound or through a separate stab incision.
 Gently loose pack from wound edges.
 Remove slowly with forceps.
 Ensure that all packs are removed.

Probing a Wound
This may be necessary when the superficial layers are healing too
quickly and allowing pocketing of exudates to occur. To prevent this, a
probe or sinus forceps may be inserted to open the tract to allow drainage
to continue.

Suction drainage:
This is a form of closed drainage used to drain areas where a cavity has
been left, e.g. after mastectomy.

BANDAGING

DEFINITION OF BANDAGE

A bandage is a strip of cloth used to wrap sore part of the body.

Bandages are available in various widths most commonly 1.5cm- 7.5cm
(0.5- 3 inch). They are usually supplied in rolls for easy application to a
body part.

Before applying a bandage, as a nurse, one needs to know its purpose

and to assess the area requiring support. When bandages are used to
secure dressings, the nurse wears gloves to prevent contact with body
fluid.

DEFINITION OF BANDAGING

Bandaging is the process of covering a wound or an injured part.

USES

1. To prevent contamination of wound by holding dressings in position.

2. To provide support to the part that is injured, sprained or dislocated.
3. To provide rest to the part that is injured.
4. To prevent and control hemorrhage.
5. To correct deformities.
6. For applying pressure to bleeding wounds.
TYPES OF BANDAGES

1. Roller bandages.
2. Tubular bandages.
3. Triangular bandages.
1. ROLLER BANDAGE
They are the most common types of bandages. They are normally made
from a single continuous strip of lightweight and breathable cotton
gauze, used primarily for holding dressings against wounds. They can
also be used to control light to moderate bleeding when used together
with a pad or dressing, which makes them very useful in emergency
situations. They typically look like a wrapped cylinder of white cotton
gauze.

2. TRIANGULAR BANDAGE
They are amongst the most versatile types of bandaging usually find in a
first aid kit. They are essentially a single sheet of thick cotton or calico
designed for constructing slings that;

a. Support soft tissue injuries

b. Immobilize broken bones.
triangular bandages can be used to create a makeshift tourniquet in
emergency situations. If no roller bandages are available, it can also be
wrapped around a pad or dressing to apply pressure.

3. TUBULAR BANDAGES.
They are perhaps the least versatile of the three conventional bandages.
These are elasticated tubes of thick gauze designed for use with a single
body part, dictated by the width of the bandage itself. They provide
compression, can be used to immobilize or support knee and elbow joints
and, in some cases, hold a dressing limb. They look like a long ring of
bandage within a first aid kit, or potentially like a roll of elasticated,
circular bandage that is designed to be cut to fit the required area.

A roller bandage
A triangular bandage

A tubular bandage

MATERIALS COMMONLY USED FOR BANDAGES

1. Flannel
2. Cotton
3. Cotton gauze
4. Jute
5. Wool
6. Special materials like crape bandages, elastic bandages and
domestic materials.

SIZES OF BANDAGES
 Parts of bandage Width(cm) Length(cm)
Head 5 4-6
Trunk 10-15 6-8
Leg 6-8 4
Arm 5-6 3-4
Fingers 2.5 2
Hand 5 3

ASSESSMENT BEFORE APPLYING BANDAGES

1. For the presence of and status of wounds (open wound will require a
dressing before a bandage is applied).
2. Note the presence of drainage (amount, colour, odour, viscosity).
3. Inspect and palpate for adequacy of circulation (skin temperature,
colour and sensation).
4. Ask the client about any pain experienced (location, intensity, onset,
quality).
5. Inspect and palpate area for swelling.
6. Inspect assess the ability of the patient to reapply the bandage when
needed.
7. Assess the capabilities of the client regarding activities of daily
living e.g to eat, dress, comb hair, bathe and assess the assistance
required during the convalescence period.

GENERAL PRINCIPLES

1. Select a bandage of proper size and suitable material.

2. Put the patient in comfortable position.
3. Support the injured area while bandaging.
4. If a joint is involved, flex it slightly.
5. Face the patient while applying the bandage except when applying it
to the head.
6. Pad bony prominences.
7. Hold the roll of the bandage in the right hand when applying
bandage on the left side, hold the bandage with the roll uppermost
and apply the outer surface to the skin, unrolling a few cm of the
bandage at a time.
8. Put some cotton wool on the part to be bandaged so that the bandage
does not slip or cutting into the skin underneath.
9. Bandage from below upward and from within outward.
10. Hold the end of the bandage over the outer aspect of the injured area
and wind the bandage around the part twice to fix it.
11. When bandaging a limb, start with an oblique turn to keep the
bandage in position, as an alternative method.
12. Cover2/3 of the bandage by the next one; while covering a large
area by winding the roller bandage around the part, keep the edge
parallel.
13. Keep even and not too tight pressure while applying bandage, too
tight bandage may interfere with circulation.
14. Finish with a straight thumb and fix the end with a safety pin,
sticking plaster or by dividing the terminal portion of the bandage
longitudinally and tying the two ends around the bandaged part.
15. If possible, leave fingers and toes exposed to check circulation.
16. Do not bandage the part too tightly or too loosely.
17. Observe the extremities carefully for any sign of swelling and
blueness due to interference with circulation by a bandage that is too
tight.
18. When removing a bandage pass it from one hand to the other so that
it is collected in a concertina fashion.
19. Cover dressings with bandages at least 5cm (2 inches) beyond the
edges of the dressings to prevent the dressing and wound from
becoming contaminated.

BASIC TURNS FOR ROLLER BANDAGES

Applying bandages to various parts of the body involve one or more five
basic bandaging turns.

1. Circular Turn: used to anchor bandages and terminate them.

Circular turns are not usually applied directly over a wound
because of the discomfort the bandage would cause.
2. Spiral Turn: used to bandage part of the body that are fairly
uniform in circumference e.g the upper arm or upper leg.
3. Spiral Reverse Turn: used to bandage cylindrical part of the body
that are not uniform in circumference e.g leg, fore arm.
4. Recurrent Turn: used to cover distal part of the body e.g the end
of a finger, the skull of stump of an amputation.
5. Figure-eight Turn: used to bandage an elbow, knee or ankle
because they permit after application.
6. Special Bandages: this bandage is usually used for abdominal
wounds and chest injuries. It is prepared from a number of strips
or tails of flannel or cutting material. It is 4-6 inches wide and has
sufficient length to cover the affected part.
APPLICATION OF SPLINTS, PLASTER OF PARIS (POP) AND
STOCKINET.
A splint is defined as "a rigid or flexible device that maintain in
position a displaced or movable part; also used to keep in place and
protect an injured part” or as “ a rigid or flexible material used to
protect, immobilize or restrict motion in a part.

APPLICATION OF SPLINT

1. Gather your splinting material

 Scissors
 A bucket or large pot of cool water
 A roll of soft cast padding
 A stockinette
 A roll of elastic bandage
 Medical tape or clips to secure bandage
 Sheets to protect the patient's clothing
 Crutches, optionally.
2. Apply the stockinette: stockinette is applied as the first layer of a
splint to protect the patient's skin from direct contact with splinting
material.

3. Ensure the limb is in the appropriate position

4. Wrap padding around the limb over the stockinette .

5. Measure your splinting material: The splint should end up being

slightly shorter than the padding.

6. Decide in the splint thickness: A splint generally ranges from 8–15

layers of dry splinting material.

On average, use 6-10 layers for upper extremities , 12-15 layers for
lower extremities
The necessary thickness depends on which body part needs splinting, the
patient 's size and how strong the splint needs to be.

7. Soak the splint material in water: Place your dry splint in a deep
bucket of cool water. Try to lay it flat into the water, if possible to avoid
wrinkling or creasing the material.

8. Squeeze the splint material so it's moist and flat- Take out the wet
splint material and squeeze it gently to remove excess water.

9. Apply the splinting material

10. Fold back the edges of the stockinette and padding: Once your splint
is applied, fold back the extra length of padding and stockinette over the
edge of the splint

11. Let the splint dry and apply an elastic wrap: Apply an elastic wrap
around the splinted limb, further from the body to the closer body.

12. Provide other necessary equipment to patients:- provide crutches for

any lower extremity injuries that require non-weight bearing. Ice pack
can help reduce pain and swelling.

DEFINITION OF PLASTER OF PARIS

It is a white powdery slightly hydrated calcium surface made by calcium

gypsum used chiefly for cast and mold in a form of a quick setting paste
with water. Cast are solid dressings applied to a climb or other body
parts
 POP

TYPES OF POP CASTS

i. SHORT ARM CAST: Extend from below the elbow to proximal

palmer crease
ii. LONG ARM CASTS: Extend from the auxiliary fold to the
proximal palmer crease
iii. SHORT LEG CASTS: Extend from below the knee to the base
of a toes
iv. LONG LEG CASTS: Extend from the upper third of the thigh in
the base of the toes
v. SPICA CASTS: Extend from the mid trunk to cover one or both
extremities
vi. BODY CASTS: Encase the trunk of body
vii. SPLINTS : Are bivalue casts that provide immobilization and
allow for edema

Purpose

Casts are applied to:

 Immobilize a body part in a specific position

  Exert uniform compression to soft tissue

 Provide for early mobilization of unaffected body parts

 Correct or prevent deformities

 Stabilize and support unstable joints

Plaster of Paris Cast Application

Application of POP

stokinnette
 First of all, stockinette is applied over the area to be plastered and
covered by the soft cotton padding of the required width firmly
over the area.

 For securing, each turn is overlapped by one third in order to

secure layers.

 The patient is settled in a comfortable position with clothing

protected. The equipment is readied [water in bowl bandages]

 The affected part should be covered with suitable padding and the
desired position secured and held correctly.

 Bandages of the correct size are immersed in water, one at a time,

and held there until bubbling stops.

 The bandage is removed by holding it at the ends. The ends are

gently squeezed towards the centre then pulled back to shape.

 The bandage is unrolled around the limb in an even manner.

Minimum tension should be exercised and this should be directed
towards the centre of the bandage not at the edges.

 Molding of the bandages to the contours of the limb should be

done by constant smoothing with the palms of the wet hands.

 When the required thickness has been obtained, the extremities of

the plaster of Paris cast may require trimming to ensure that a
free range of movement is possible at joints which are not
immobilized.

 The completed wet cast is handled carefully and supported

correctly to protect it from damage.
  The cast does not fully dry out until 36 to 72 hours after
application.

 When a dry plaster of Paris cast is tapped with the knuckles, it

gives a crisp, clear sound, but the damp cast gives a dull sound.

 When the required thickness has been obtained, the extremities of

the plaster of Paris cast may require trimming to ensure that a
free range of movement is possible at joints which are not
immobilized.

 The completed wet cast is handled carefully and supported

correctly to protect it from damage.

 The cast does not fully dry out until 36 to 72 hours after
application.

 When a dry plaster of Paris cast is tapped with the knuckles, it

gives a crisp, clear sound, but the damp cast gives a dull sound.

Care of plaster of Paris

i. The patient should be instructed not to wet, cut, heat or interfere

with the place.
ii. Report any discomfort, bluishness, swelling & numbness of the
digits.
iii. Report any pain, high grade of fever.
iv. Report if the plaster cracks, becomes loose or uncomfortable.
v. Elevate the affected part to allow venous return.
vi. Apply ice-pack to reduce swelling.

Stockinette
Stockinette: soft elastic usually cotton fabric used especially for
bandages.

Application

a. Measure the length of stockinette needed. It should extend 3 – 4

cm beyond the area to be casted at each end.
b. Using your own palm length as a guide determine where the
thumb hole is to be cut.
c. At this location, cut a slit in the stockinette large enough to give
the base of the thumb lots of space.
d. Roll the stockinette over the area tso be casted and smooth it out.
Never apply to skin or stockinette alone.