# Plaster Cast Removal

## Overview

This module describes how to remove plaster casts.

## Indications

1. Immobilisation period has ended

2. Cast wetness or damage

3. Foreign object under a cast

4. Numbness, pain, tingling, or other signs that a cast is too tight

5. Concern about infection under a cast

## Contraindications

1. None

## Patient information & consent

### How do I explain this procedure?

“I’m going to use a vibrating saw, cutters, and a cast opener to cut through the cast and then crack it open.”

### What can my patient expect?

“The saw may look scary, but the blade does not rotate, it just vibrates, so it doesn’t cut skin, only cast.”

### What is my patient’s role?

“Let me know if anything feels uncomfortable or painful while I am cutting off the cast.”

## Preparation

### Documentation

1. Patient notes

### Equipment

1. Alcohol-based hand rub

2. A vibrating cast saw or Stille plaster shear

3. Blunt-tipped shears

4. Cast spreaders

5. Linen saver

## Site & Positioning

Position the patient with the cast in easy reach.

## Procedure

Follow medical asepsis without gloves.

1. Perform hand hygiene.

2. Put the linen saver under the cast to collect dust from the procedure.

3. Use the cast saw to cut all the way along the long axis of the cast until you reach the underlying padding. Select a line to cut away from bony prominences.

4. Cut padding with the shears.

5. Insert the cast spreader and crack the cast open a few times along its length.

6. If necessary, cut a second channel on the other side of the cast.

7. Remove the cast.

8. Dispose of medical waste safely.

9. Record completion of the procedure in patient notes.

## Troubleshooting

My patient is terrified of the cast saw.

It is helpful to demonstrate its safety, firstly by pressing it against your own palm, then the patient’s palm, to show that it is not spinning but simply oscillating.

I’m struggling to make progress with the saw.

Press the cast saw all the way through the depth/thickness of the cast at one site at a time, don’t push it along.

## Risks

1. Friction burns or abrasions to the skin from the cast saw

2. Cutting the skin with shears (more likely if not using blunt-tipped shears)

## References

1. McCue JY. How to Remove a Cast. MSD Manual. 2021. Available from: https://www.msdmanuals.com/professional/injuries-poisoning/how-to-do-casting-procedures/how-to-remove-a-cast