Hip spica cast care
After orthopedic surgery to correct a fracture or deformity, a child may need a hip spica cast to immobilize both legs. Occasionally, the doctor may apply a hip spica cast to treat an orthopedic deformity that does not require surgery. Infants usually adapt more easily to the cast than do older children but need encouragement, support, and diversionary activity during their prolonged immobilization.
Waterproof adhesive tape 
moleskin or plastic petals cast cutter or saw scissors nonabrasive cleaner hair dryer optional: disposable diaper or perineal pad.
- Identify the patient using two patient identifiers per facility policy.
- Before the physician applies the cast, describe the procedure to the child and his parents.
- When the physician constructs the cast, keep it uncovered, draping a small cover over the perineal opening. Turn the child every 1 to 2 hours toward his unaffected side using your palms. Do not use the stabilizer bar between his legs for leverage.
Soften the edges
- After the cast dries, cut several petal-shaped pieces of moleskin and place them around the open edges of the cast. Use waterproof adhesive tape around the perineal area.
- Give the child a sponge bath to remove any cast fragments from his skin.
- Assess the child's legs for coldness, swelling, cyanosis, or mottling. Also assess pulse strength, toe movement, sensation (numbness, tingling, or burning), and capillary refill. Perform these circulatory assessments every 1 to 2 hours while the cast is wet and every 2 to 4 hours after the cast dries.
- Check the child's exposed skin for redness or irritation, and observe the child for pain or discomfort caused by hot spots (pressure-sensitive areas under the cast). Also, be alert for a foul odor.
Salon-style care
- To relieve itching, blow cool air from a handheld hair dryer under the cast. Warn the child and his parents not to insert any object into the cast to relieve itching by scratching.
- Encourage the child's family to visit and participate in his care and recreation and be sure to teach them home care techniques. (See Hip spica cast care.)
- Tuck a folded disposable diaper or perineal pad around the perineal edges of the cast to protect from soiling. Then apply a second diaper to the child, over the top of the cast, to hold the first diaper in place. Plastic petals can be tucked into the cast to channel urine and feces into a bedpan. If the cast still becomes soiled, wipe it with a nonabrasive cleaner and a damp sponge or cloth. Then air-dry it with a hair dryer set on “cool.”
- Keep a cast cutter or saw available at all times.
- During mealtimes, position older children on their abdomens to promote safer eating and swallowing. (See Documenting hip spica cast care.)
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