1-19
1-19. CAST CUTTING
Casts may be cut for different reasons--to allow for wound dressings, to examine a painful area, or to relieve pressure. Nursing personnel may be required to assist with cast cutting at the bedside as an emergency measure.
a. Bivalving the Cast. Bivalving is the recommended method for emergency cutting to relieve pressure. In bivalving, the cast must be cut along its entire length on two sides (medial and lateral) and the base lining or padding cut completely down to the skin. If the cast or the lining is split only part way, the congestion will be increased and additional tissue damage will occur. To cut the cast, use a knife, a hand cutter, or an electric cast cutter. Use bandage scissors to cut the base material. To use a knife for emergency cast cutting, follow these steps.
(1) Make a shallow groove to indicate the cutting lines on both sides of the cast.
(2) Apply water or peroxide along the cutting lines to soften the plaster. Use a syringe to apply.
(3) With the knife, cut through the layers of plaster along the cutting line. Do not attempt to slice through all layers at once and do not use the knife to cut through the base material.
(4) With the bandage scissors, cut through the base material down to the skin. Cut every thread of the lining material completely through since the lining is sometimes the source of the trouble.
(5) Use tape or an elastic bandage to loosely hold the bivalve cast together in order to maintain support of the casted part until further instructions are obtained.
b. Windowing the Cast. This procedure is done on specific order of the physician. It is a potentially dangerous procedure because the underlying tissue may bulge through the window opening, causing "window edema." If a window is cut, the piece of plaster removed should be saved.
(1) The physician indicates the area to be windowed.
(2) The physician or orthopedic technician cuts the window, usually a square or rectangular area, out of the cast. Once the plaster has been cut out, the lining material is carefully cut away from the skin.
(3) After the physician examines and treats the underlying area, a dressing may be applied over the exposed skin area and the cutout piece of plaster bound in place again. Replacing the cutout plaster section will prevent window edema.
