Splinting is a common first-line intervention in orthopedic care, utilized by nurses to manage acute musculoskeletal injuries. It involves applying an external support device to stabilize an injured body part, limiting movement to prevent further harm. This procedure is performed in various settings, including emergency departments, clinics, and inpatient units, to provide immediate comfort and protection. The nurse’s role extends beyond mere application, encompassing thorough patient assessment and education to ensure the best possible outcome.
Defining Stabilization and Immobilization
Splinting serves two primary purposes: stabilization and immobilization of an injured limb or joint. Stabilization refers to holding the injured area in a safe and neutral position to reduce uncontrolled movement. Immobilization prevents damage to soft tissues, nerves, and blood vessels that could be compromised by bone fragments or joint instability.
A splint is often preferred over a full cast in the acute phase of an injury because it is non-circumferential, meaning it does not fully encircle the limb. This design allows the underlying soft tissues to swell without causing dangerous pressure build-up, which is particularly relevant immediately following trauma. By restricting motion, splinting helps alleviate muscle spasms and reduces the patient’s perception of pain. It acts as a temporary measure, preparing the injury for definitive treatment, such as surgery or the later application of a full cast once swelling has subsided.
Categories of Splinting Devices
Splinting devices vary widely in material and design, categorized mainly by their function and construction. Prefabricated splints, often called off-the-shelf devices, are ready-made supports like wrist braces or finger splints. These are frequently used for less severe injuries or for long-term support following initial trauma.
Custom splints are constructed specifically for the patient using moldable materials such as plaster or fiberglass strips, often referred to as half-casts. These strips are layered and secured to one side of the limb with an elastic bandage, allowing for a precise fit while retaining the non-circumferential advantage. Specialized devices like air or vacuum splints are utilized in pre-hospital emergency settings to provide rapid, temporary stabilization. Splints can be classified as static, holding the joint in a fixed position, or dynamic, which incorporate springs to allow for controlled, limited movement during rehabilitation.
Nursing Assessment and Application Technique
A thorough pre-application assessment is a necessary initial step before placing any splint. This involves a neurovascular check to establish a baseline for circulation, sensation, and movement (CSM) distal to the injury site. The nurse must ensure adequate pain management is achieved before application, as muscle relaxation is helpful for proper positioning and reduction of the injury.
The application technique requires careful attention to protect the patient’s skin and ensure the splint functions correctly. A stockinette, a soft, knitted material, is applied first, followed by cotton padding to cushion the limb. Bony prominences, such as the elbow or heel, require extra padding to prevent pressure injuries. The splint material is measured to extend across the joints immediately above and below the injury to fully immobilize the affected bone or joint. Once the splint is molded and secured with a wrap, the nurse repeats the neurovascular assessment and documents the findings.
Post-Application Monitoring and Patient Education
Monitoring the patient after splint application is an ongoing responsibility that focuses on preventing serious complications like compartment syndrome. Nurses use the detailed neurovascular assessment, commonly known by the mnemonic of the “5 Ps,” which includes assessing for disproportionate pain, pallor (paleness), pulselessness, paresthesia (numbness or tingling), and paralysis. Pain that increases significantly, especially with passive movement, and is unrelieved by medication, is often the earliest and most concerning sign of neurovascular compromise.
Patient education is an important nursing responsibility to ensure safety outside the hospital setting. The patient must be instructed to keep the splint clean and dry, as wet padding can soften the skin, increasing the risk of infection and irritation. Patients should be taught to elevate the injured extremity above the level of the heart for the first few days to minimize swelling. Instructions must clearly outline signs that require immediate medical attention, such as swelling that extends beyond the edges of the splint or a change in the color or temperature of the fingers or toes.