Cast Care & Traction

A patient in a new cast reports a "burning" sensation under the plaster — this isn't normal drying. Missing this cue changes outcomes. Do you know why?

Cast care and traction are immobilization strategies that carry their own nursing-specific complications. For casts, the priority during the first 24–72 hours is proper drying and neurovascular monitoring. A plaster cast takes 24–72 hours to dry fully; fiberglass dries in about 30 minutes. While drying, support the cast on pillows using only the palms — never fingertips, which create pressure points that lead to skin breakdown underneath. Petal rough edges with moleskin or tape to prevent skin irritation. Perform neurovascular checks (the 5 Ps: pain, pulse, pallor, paresthesia, paralysis) every 1–2 hours initially, then every 4–8 hours. A "hot spot" — localized warmth over the cast — signals infection or pressure ulcer formation beneath. Never insert objects under the cast to relieve itching; this breaks skin integrity. For traction, the two types matter: skin traction (Buck's traction, 5–10 lbs max) and skeletal traction (pins through bone, heavier weights). Weights must hang freely and never rest on the bed or floor. Maintain proper body alignment and countertraction — the patient's body weight serves as countertraction, so keep the bed position as prescribed. For skeletal traction, pin site care prevents osteomyelitis: clean per facility protocol, monitor for signs of infection (purulent drainage, erythema, loosening pins).

Key Distinctions

Don't confuse a hot spot on a cast (pressure necrosis or infection underneath) with normal drying warmth (diffuse, early, temporary). Students confuse skin traction weight limits (5–10 lbs, applied to skin via wraps) with skeletal traction (higher weights, applied directly to bone via pins). Removing traction weights to reposition the patient is never appropriate for skeletal traction — only skin traction may be briefly removed per order.

Clinical Pearl

Palms, not fingertips — and weights hang free, never resting. These two rules prevent the two most common cast and traction errors on the NCLEX.