Having Patience With Our Patients: A Key Technique in Cast Saw Burn Prevention

Abstract

Introduction: Although regarded as conservative treatment, casting is not without risk. Injuries may be sustained during application, during cast valving, through the immobilization process, or during cast removal. We developed an experimental model to investigate safe parameters for the appropriate length of time between fiberglass cast application and bivalving for cast saw use. Methods: A hospital sheet was rolled into a mock "arm" on which short-arm fiberglass casts were formed. An appropriate cast saw technique was used with complete withdrawal of the saw blade from the cast material between cuts. A total of 10 casts were made for control/no vacuum (N = 5) and study/vacuum (N = 5) groups. The temperature of the saw blade was measured at 1-minute increments beginning at 3 minutes after fiberglass submersion in water. A mixed factor analysis of variance assessed differences in temperature change over time between groups with a statistical threshold of P , 0.05. Results: Casts that set for 7 minutes were associated with lower blade temperatures compared with casts that set for 3, 4, 5, and 6 minutes. The average temperature increases for the 3-to 7-minute set times without the use of vacuum were 10.08 (6 1.42), 9.38 (61.31), 9.32 (61.85), 8.54 (62.10), and 5.62°F (62.42), respectively, and with the use of vacuum, they were 9. 40 (61.14), 8.36 (61.64), 7.84 (62.05), 7.30 (63.14), and 4.82°F (62.59), respectively. Independent of vacuum use, the change in temperature was significantly different from the maximum temperature (3 minutes) beginning at 7 minutes (all P , 0.043). Discussion: A minimum of 7 minutes of set time for a fiberglass cast before attempting to bivalve using segmented cuts is associated with the smallest increase in temperature of the saw blade. Blade temperature was not affected with the vacuum enabled. Clinicians can demonstrate best practices to minimize the risk of cast saw injuries.

Coated Cast Saw Blades Decrease Blade Temperature During Cast Removal

“…While our study supports the use of coated over stainless-steel blades for most combinations of blade wear and cast material, our mean maximum temperatures were higher than similar studies 9,11 . Our observed operating temperatures greater than 70°C during fiberglass cast removal, regardless of blade material or blade wear, is high enough to cause significant injury 14,15 It should be noted that the temperature of the blade and the actual temperature felt on the skin may differ due to cast padding.…”

“…While our study supports the use of coated over stainless-steel blades for most combinations of blade wear and cast material, our mean maximum temperatures were higher than similar studies. 9,11 Our observed operating temperatures greater than 70°C during fiberglass cast removal, regardless of blade material or blade wear, is high enough to cause significant injury 14,15 It should be noted that the temperature of the blade and the actual temperature felt on the skin may differ due to cast padding. This highlights the importance of adhering to safe techniques described in prior studies, including an in-out technique with pauses to check the blade temperature, cooling the blade with a cold solution, and avoiding bony prominences and concavities.…”

“…Tangible Lack of vacuum [6][7][8] Fiberglass cast material 5,6,9 Thinner padding 8,9 Thicker cast material 8 Shorter cure/set time 10,11 Worn blade 1,5,8 Intangible Technique: cutting over bony prominences, 1 continuous, 9 cutting into concavity 8 Environment: emergency department, nightshift 2 Provider inexperience 2,3,12,13 Sedated or uncooperative patient 2…”

“…[1][2][3][4] Injuries range from superficial abrasions to full-thickness burns and can result in significant patient harm and medicolegal costs. 1,3,5 To prevent harm, multiple studies [1][2][3][5][6][7][8][9][10][11][12][13] report risk factors associated with cast saw-related injury that can be categorized into tangible and intangible factors (Table 1). In general, lower blade temperatures and minimal blade-to-skin contact improve the safety of cast removal.…”