Effective Techniques For Removing Hospital Casts

Cast removal can be a daunting process, especially for children. However, it is a quick and simple procedure. Casts are usually removed using a vibrating cast saw, which cuts through the plaster or fibreglass cast but does not cut or injure the skin. The patient's skin may be cleaned, and the cast technician will demonstrate how the saw works and that it will not cut the skin. The cast is cut along its long axis, and the underlying padding is also cut through. The cast is then spread apart and lifted off. Cast removal should only be performed by trained healthcare providers.

Cast removal process: The healthcare provider cuts the cast in several places, usually along both sides, and uses scissors to cut through the protective padding

Cast removal can be a stressful experience, especially for children. Before the procedure, it is important to familiarise the patient with the equipment and how it works. The healthcare provider should demonstrate how the saw will not cut the skin. This can be done by pressing the blade of the running cast saw against their hand. Patients may also benefit from using noise-cancelling devices, as cast saws can be noisy, and the noise is often more upsetting than the feeling of the saw.

The cast removal process begins with the healthcare provider cutting the cast in several places, usually along both sides. They will then spread and open the cast, lifting it off. To do this, they will use scissors to cut through the protective padding and stockinette layers. The patient should be positioned to provide the operator with optimal access to the extremity with the cast.

The healthcare provider will first score the cast along its long axis. They will then continue cutting the cast in the channel created by scoring until the underlying padding is reached. Next, they will cut the padding and stockinette with scissors. Finally, they will insert a cast spreader between the cut cast edges.

After cast removal, the patient will need to undergo a period of physical therapy to regain full use of the limb. This may include appropriate physical therapy for joint stiffness, for example.

Cast saw safety: Cast saws vibrate back and forth, cutting through the cast but not the skin. They are safe but should only be used by trained personnel

Cast saws are medical devices used to cut through the plaster or fibreglass of orthopedic casts. They have sharp, small-toothed blades that oscillate rapidly back and forth, cutting through rigid materials. Cast saws are designed to slice through these hard substances but not cut soft tissues like skin. Skin is flexible and can move with the vibrations of the blade, preventing injury.

Cast saws are very safe, but they are not without risk. In rare cases, improper use of a cast saw or the use of a worn blade can cause skin lacerations or burns. Skin burns are the most common problem that can occur when removing a cast with a cast saw. Because of the vibration of the cast saw blade, high temperatures can result from the friction of the blade against the cast material. If the blade heats up and contacts the skin, a burn can occur. Using less pressure on the saw to prevent blade heating and allowing a warm blade to cool can help prevent burns.

To further minimise the risk of skin lacerations, ample padding should be placed under the cast material. Padding helps protect the skin from the sharpness of the blade and also provides cushioning so that the blade does not cut through the skin. Cast saws should only be operated by trained professionals.

To alleviate patient anxiety, the healthcare provider or technician may press the blade of the running cast saw against their hand to demonstrate that it is safe. The patient may also wear headphones or earmuffs as the noise from the cast saw can be upsetting.

Complications: The most common complications during cast removal are worn-out blades, insufficient padding, and improper training. Skin burns are also possible due to blade friction

Cast removal is generally a safe and painless procedure. However, there are some potential complications that can arise during the process. One of the most common issues is the use of worn-out blades. If the blade of the cast saw is dull or worn, it can increase the risk of skin lacerations and burns. Sharp, well-maintained blades are essential to ensure a smooth and safe cast removal.

Another complication that can occur is insufficient padding underneath the cast. Adequate padding is crucial to protect the skin from the vibrating blade of the cast saw. Insufficient padding can lead to inadvertent cuts, scrapes, or burns during the removal process. Therefore, healthcare providers should ensure that the cast has ample padding before beginning the removal process.

Improper training and experience of the healthcare provider or technician can also lead to complications. It is important that the person removing the cast is properly trained in the use of the cast saw and understands how to avoid potential problems. Demonstrating to the patient that the saw will not cut their skin can help alleviate fears and ensure a safe procedure.

Skin burns are a potential complication that can occur during cast removal due to blade friction. The vibrating blade of the cast saw creates friction against the cast material, generating high temperatures. If the blade heats up and comes into contact with the skin, it can cause a burn. To prevent this, technicians should use less pressure on the saw to reduce blade heating and allow the blade to cool between cuts.

Waterproof casts: These require complete submersion in water daily to maintain their lining. They must be removed by experienced clinicians or technicians

Waterproof casts

Waterproof casts are typically made of a special liner that doesn't absorb water, unlike the cotton lining of ordinary casts. This liner sits under a normal-looking fiberglass outer layer.

The waterproof liner means that the cast can get wet without falling apart. This makes bathing and swimming easier, and also means that the cast is less likely to smell bad or grow bacteria.

Submerging the cast in water

Waterproof casts require complete submersion in water daily to maintain their lining. This is because the lining that makes the cast waterproof can withstand complete submersion, and it needs to be washed to remove dirt, microbes, and other possible irritants.

Removing the cast

Waterproof casts must be removed by experienced clinicians or technicians who understand the specific demands of waterproof casts. This is because the removal process can be scary for children, and there is a small risk of complications during cast removal, including skin burns and minor cuts.

To remove a cast, a trained healthcare provider will cut the cast in several places, usually along both sides. They will then spread and open the cast and lift it off, cutting through the protective padding and stockinette layers with scissors.

Risks of waterproof casts

Waterproof casts cannot be used after surgery or when pins are used because of the risk of infection. They are also more expensive and less likely to be covered by insurance.

Pre-removal considerations: Before removing a cast, a doctor may get an X-ray and check the area. Patients should be shown the equipment and how it works to alleviate fear

Pre-removal considerations

Before removing a cast, there are several important steps to take to ensure the patient is comfortable and the procedure is safe. Firstly, it is crucial to assess the area and ensure the bone has healed adequately. An X-ray may be requested to confirm this.

Secondly, addressing the patient's fears and anxieties is vital. Cast removal can provoke anxiety, especially in younger patients. Healthcare providers should take the time to explain the procedure, including the equipment used and each step involved. Demonstrating how the cast saw oscillates and showing that it does not cut skin can alleviate fears of lacerations. The patient should be encouraged to communicate any discomfort or concerns during the process.

Additionally, the noise from the cast saw can be distressing, so providing noise-canceling devices or headphones with music can help distract and relax the patient. Ensuring the patient is positioned comfortably with the affected area easily accessible is also important.

Finally, it is essential to have the necessary equipment ready, including a cast saw with a sharp, well-maintained blade, eye and respiratory protection for the operator, and a sheet or drape to collect dust.

Frequently asked questions