6.4 Splints, Elastic Bandages, Orthotic & Prosthetic Devices

Splints, Elastic Bandages, Orthotic & Prosthetic Devices

Two NCCT tasks cover these devices: assist with immobility support and splint applications (for example, elastic bandage, wrist splint) and assist patients with orthotic or prosthetic devices (for example, hearing aids, dentures, AFO). Orthoses support, align, or protect a body part (braces, splints, AFOs). Prostheses replace a missing body part (artificial limbs, eyes, dentures). Both help patients function, and both can injure skin and nerves if they are applied wrong. Denture care is covered in Section 4.1 and eyeglasses in Section 4.2.

Circulation Checks Come First

Check the body part before applying any device, right after, and then routinely as ordered or per policy. Compare with the other side.

Rapidly increasing pain, especially with pain on stretching the fingers or toes, numbness, and a tight, swollen limb, can signal compartment syndrome and is reported immediately.

Elastic (ACE) Bandages

1. Start with the limb elevated and the skin clean and dry. Choose a width that fits the body part.
2. Wrap from distal to proximal (for example, from the foot toward the knee) to support venous return.
3. Anchor with one or two circular turns, then use a spiral wrap, overlapping each turn by about half the bandage width, or a figure-eight pattern over joints such as the ankle, knee, or elbow.
4. Keep the tension even and snug, not tight, with no wrinkles or gaps.
5. Leave fingertips or toes exposed for circulation checks.
6. Secure the end with the provided fasteners or tape. Avoid metal clips on fragile skin, where they can cause pressure spots.
7. Rewrap when it loosens or bunches, or as ordered; remove it to check and wash the skin per the care plan.

Splints, Slings, and Immobilizers

• Resting hand and wrist splints keep joints in a functional position and prevent contractures after stroke or injury. Follow the OT's wearing schedule, pad bony areas, and fasten straps snugly but not tightly.
• Knee immobilizers and other braces are applied exactly as fitted. Label left and right devices.
• Slings: support the forearm with the elbow at about 90 degrees and the hand slightly higher than the elbow to reduce swelling. Pad the strap at the back of the neck and tie any knot to the side of the neck, not over the spine.
• After removing any splint, inspect the skin. Redness that fades within about 30 minutes is expected; redness that does not fade, blisters, or open areas are reported as possible device-related pressure injuries.
• Clean devices as the manufacturer directs, and never modify the fit yourself.

Orthoses: AFOs and Back Braces

• An ankle-foot orthosis (AFO) is a plastic brace that holds the ankle and foot in position, often for foot drop after stroke or nerve injury. Put a clean sock on first, seat the heel fully back into the heel cup, fasten the straps, and then put on the shoe (often a half size larger).
• Check the skin at the heel, ankle bones, and the top of the foot after each removal.
• Spinal braces (such as a thoracolumbosacral orthosis, or TLSO) are applied exactly as ordered, often with the patient log-rolled and supine, over a thin T-shirt to protect the skin.

Prostheses and Residual-Limb Care

• Residual limb: wash it daily with mild soap and water, dry it completely, and inspect it for redness, blisters, or open areas, which the patient may not feel. Report any breakdown, because a sore can keep the patient from wearing the prosthesis.
• Limb socks and liners: put on clean ones daily and add or remove sock layers as taught when the limb's size changes.
• Donning and doffing: follow the patient's training; many patients do this themselves. Store the prosthesis upright and out of walkways.
• Phantom limb pain (pain felt in the missing limb) is real pain; report it so it can be treated.
• Report a prosthesis that rubs, slips, or makes a new noise, and never let a patient walk on a prosthesis they have not been cleared to use.

Hearing Aids

• Check the battery and turn the aid on or close the battery door. Many aids are color-coded red for the right ear and blue for the left.
• Insert it gently into the ear canal until it sits snugly. Whistling (feedback) usually means the aid is not seated correctly, is blocked by earwax, or is turned up too loud.
• Remove it before bathing, showering, shampooing, or using a hair dryer, and at night. Open the battery door and store it in a labeled case, never loose on a meal tray or bed where it can be lost.
• Clean it with a soft, dry cloth. Never use water or alcohol, and report an aid that stops working.

Artificial Eyes

Follow the care plan and the patient's routine. To remove an artificial eye, wash your hands, put on gloves, pull down the lower lid, and gently press so the eye slides out into your hand. Clean it with saline or water as directed, store it in a labeled container, and clean the eye socket as ordered. Report redness, drainage, or odor from the socket.

Clinical Trap: The Snug Wrap

A PCT rewraps a patient's lower leg with an elastic bandage, starting just below the knee and working down to the ankle, pulling each turn tight. An hour later the toes are pale, cool, and tingling. Wrapping proximal to distal pushes blood toward the foot and traps it there, and excess tension compresses the vessels. The bandage should be removed per policy and rewrapped from the toes upward with even tension, and the finding reported to the nurse.