Page 116 - ASOP Orthopedic Casting Manual

2.6.1 Thumb Spica Cast - Removal

Thumb Spic a Cast Removal
Removing a thumb spic a fiberglass c ast requires c areful handling to prevent injur y to the p atient. Here's a step-
by-step guide on how to remove the c ast using a c ast saw, scissors, and a c ast spre ader, along with skin
considerations after the c ast is removed:

Explain the process: Infor m the p atient about the c ast removal process, emphasizing that the c ast saw
will make noise and may feel war m but will not cut their skin.

Position the p atient: Have the p atient sit or lie down in a comfor table position, ensur ing their ar m,
wr ist, and thumb are well-suppor ted throughout the process.

Cast saw safet y: Put on protective eyewe ar and ensure the c ast saw is in good wor king condition
before using it. Double-check that the blade is shar p and proper l y attached.

Cutting the c ast: Begin by cutting the c ast longitudinall y along the sides of the thumb, hand, wr ist, and
fore ar m. Take c are to avoid direct contact with the p atient's skin. Appl y gentle pressure and use a
ste ad y, b ack-and-for th motion. Do not force the blade or attempt to cut through the p adding in one
p ass. The c ast saw is designed to cut through the r igid outer layer without cutting the p adding
under ne ath.

Scissor inser tion: Once the c ast is cut on both sides, gentl y inser t the blunt-nosed c ast scissors or a
spre ader bet ween the p adding and the p atient's skin, keeping the blade p arallel to the skin. This will
protect the p atient's skin while you cut through the p adding.

Cut the p adding: Carefull y cut the p adding along the same lines you cut the outer layer of the c ast. Be
c autious not to nick or cut the p atient's skin.

Cast spre ading: Using a c ast spre ader, gentl y pr y ap ar t the t wo hal ves of the c ast. If necessar y, use
additional cutting or spre ading to ensure the c ast c an be removed without c ausing discomfor t to the
p atient.

Remove the c ast: Carefull y lift the t wo hal ves of the c ast away from the p atient's ar m, taking c are not
to c ause any sudden movements or excessive pressure on the he aling injur y.

Remove the p adding and stockinet: Gentl y peel b ack the p adding and stockinet, being c autious of any
sensitive or tender are as on the p atient's skin.

Skin inspection: Examine the p atient's skin for any signs of infection, pressure sores, or other issues
that may require medic al attention. Look for redness, swelling, discharge, or foul odor. Additionall y,
assess the p atient's range of motion and strength in their ar m, wr ist, and f ingers.

Cle an the are a: Gentl y cle anse the p atient's skin with war m water and mild so ap, and p at dr y. Appl y
moistur izing lotion if the skin is dr y or ir r itated.

Follow-up c are: Based on the p atient's recover y progress and physician's instructions, provide
appropr iate follow-up c are, such as range of motion exercises, physic al therapy, or the applic ation of
a new c ast or brace.