Re wrapping splints?

[Shellaaay10x]

Hi everybody,

I work for an elementary school as one of the support nurses. today a student came in with her finger splint off wrapped in coband/some sort of elastic wrap tape. We have no documentation/doctor's note whatsoever about her having a splint. Anyways we put the splint back on her finger but I didn't not want to wrap it because of liability, plus I did not even know why or how she got this injury! I called moms work and when she came, she was super upset yelling at me. Stating that she is the "athletic director" at the high school and how she doesn't understand how I can't wrap her daughters poor finger. She also said she wraps athletes frets "all the time" and does treatment. As for as I knew, athletic directors aren't doctors? Anyways, I explained to her how she needed a doctors note, how I can't apply ace bandages or wraps. It's like a prescription. She continued to yell at me stating that "she knows my scope of practice" and what I can and cannot do. Then she continued to yell at me for keeping her daughter there and missing class.

I told her she can talk to my district nurse and she threatened to "email her".

I talked to my district nurse right after the incident and she was right on my side about everything, how she will talk to the parent/"athletic director" about our rules and policies.

Just wondering what you guys would have done.

That ended my day. Lol!

[Madddie0916]

I think you did the right thing. You put to splint back on over the Coban wrap I take it? You say it was wrapped when she walked in? Sounds like Mom was annoyed and didn't want to be bothered. So she doesn't understand your policy but you were right.

[Shellaaay10x]

I think you did the right thing. You put to splint back on over the Coban wrap I take it? You say it was wrapped when she walked in? Sounds like Mom was annoyed and didn't want to be bothered. So she doesn't understand your policy but you were right.

The whole thing was off. The wrap and the splint. I put the splint back on (which stabilized finger already) but I did not want to wrap it, which was previously wrapped in a coband-like bandage. (The mom was calling it "tape"). Elastic bandage is the same thing I feel...but yes I just did not want to wrap it because I wanted somebody knowledgeable of injury to come look at it and plus of the policy we have about wraps, esp if I have no documentation whatsoever on this poor little girls finger. Mom worked at the high school down the street. I really don't understand why she had to talk to me in that manner. Lol

[akulahawkRN, ADN, RN, EMT-P]

The whole thing was off. The wrap and the splint. I put the splint back on (which stabilized finger already) but I did not want to wrap it, which was previously wrapped in a coband-like bandage. (The mom was calling it "tape"). Elastic bandage is the same thing I feel...but yes I just did not want to wrap it because I wanted somebody knowledgeable of injury to come look at it and plus of the policy we have about wraps, esp if I have no documentation whatsoever on this poor little girls finger. Mom worked at the high school down the street. I really don't understand why she had to talk to me in that manner. Lol

There are quite a number of elastic tapes that are used in injury and splint stabilization, many of which nurses just don't use much. Part of the education an AT receives is proper selection of tape when securing various splits and braces. There's a lot of consideration that actually goes into this. It's not like trainers just reach into a drawer or to a shelf and grabs whatever's right there. You have to know anatomy and biomechanics pretty well. You have to understand the purpose of the splint, what activity is going to occur, length of time it's expected to remain in place, etc.

There are times I'll reach for cloth tape. There are times I'll go for elastic tape. There are times I'll pull out self-adherent Coban (or similar elastic tape). There are times I'd want to use an elastic wrap. There are times I'd go with velcro-like strapping...

In your specific shoes, as I have mentioned earlier, I would have dealt with the splint and sent her on her way. Given the prohibition of no "wrapping" of splints, I would probably have used a small amount of relatively narrow plastic tape to loosely affix the splint in place, for the purpose of prevention of further injury and found a way to contact the parent to state that I need some kind of note stating why the splint is in place and an order allowing me to deal with the splint appropriately. There are ways of taping that allow for swelling, should it occur, so the tape doesn't itself contribute to compartment syndrome. Most of this, OP is likely stuff you've never needed to know and I doubt you'll ever have a need to really know this stuff.

In any event, while I did perhaps ramble a bit, my main point is that there are other tape and "wrap" selections you can use that go beyond the typical stuff you'll find in a typical medical setting. Overall, I still think you made the correct call. IMHO if the parent wants some thing "special" done for her kid, she needs to arrange for it herself. You're not an appropriate resource for it.