HEAT AND COLD APPLICATION

Objectives:
The students will be able to
• Identify the physiologic effect of Heat and Cold Applications
• Enumerate the indications and Contraindications of Heat and Cold Therapy
• Identify the different methods of heat and cold therapy

Introduction
• In our life we encounter different injuries caused by accidents one of which is suffering from sprain or strain.
The hot and cold applications are essential to manage these ailments. Hence, it is important to identify the
indications and contraindication of these applications to promote comfort to our clients.

Concept of Cold and Heat Therapy

• It is a method that utilizes substances, the temperature of which are lower or higher than the skin surface
temperature, acting on the skin, to attain local and systemic treating effects.

Local Effect of Heat

• Old remedies of aches and pain
• Causes Vasodilation and increases blood flow to the affected area
• Promotes soft tissue healing and increases suppuration.
• Disadvantage: It increases capillary permeability, which allows extracellular fluid and substances that may
result in edema or an increase in preexisting edema
• Heat can be applied in two ways:
1. Heat dry: applied locally for conduction means bottle water, electric pad, aquathermia pad or disposable
heat pack
2. Heat moist: can be provided through conduction by compress, hot pack, soak or sitz bath

Local effect of Cold

• Lowers the temperature of the skin and underlying tissues and causes Vasoconstriction
• Prolonged exposure to cold results in impaired circulation, cell deprivation, and subsequent damage to the
tissues from lack of oxygen and nourishment
• Cold is most often used for sports injuries to limit post injury swelling and bleeding.

Physiologic Effect of heat and cold

HEAT COLD
Vasodilation Vasoconstriction
Increase capillary permeability Decrease capillary permeability
Increases cellular metabolism Decrease cellular metabolism
Relaxes muscles Relaxes muscle by decrease contractility
Increases inflammation Slow bacterial growth, decreases
inflammation
Decrease pain by relaxing muscles Decrease pain by numbing the area, slowing
the flow of pain impulses and by increasing
threshold
Sedatives effect Local anesthetic effect
Reduces joint stiffness by decreasing viscosity Decrease bleeding
of synovial fluids

Systemic effect
• HEAT
- Heat may cause excessive peripheral vasodilation, which produces a drop in blood pressure. A significant
drop in blood pressure can cause fainting.
• COLD
- Extensive cold applications and vasoconstriction, a client’s blood pressure can increase.
- Shivering, a generalized effect of prolonged cold
Thermal Tolerance
Conditions that necessitate precautions in the use of heat and cold:
• Neurosensory impairment
• Impaired mental status
• Impaired circulation
• Immediately after injury and surgery
• Open wound

Variables affecting physiologic Tolerance to Heat and Cold

• Body Parts
• Site of the exposed body parts
• Individual tolerance
• Length of exposure
• Intactness of skin

Adaptation of thermal receptor

• When they are subjected to an abrupt change in temperature, the receptors are strongly stimulated initially
• This strong stimulation declines rapidly during the first few seconds and then more slowly during the next half
hour or more as the receptors adapt to the new temperature

Rebound Phenomenon
• Occurs at the time the maximum therapeutic effect of the hot or cold application is achieved and the opposite
effect begins. (20-30mins- 30-45mins) or cold application (15 C) is achieved and the opposite effect begins
• Safety Alert: An understanding of the rebound phenomenon is essential for the nurse and client. Thermal
applications must be halted before the rebound phenomenon begins.

Applying Heat and Cold

Heat can be applied to the body in both dry and moist forms.
• Dry heat is applied locally by means of a hot water bottle, aquathermia pad, disposable heat pack, or electric
pad. Moist heat can be provided by compress, hot pack, soak, or sitz bath.
• Dry cold is generally applied locally by means of a cold pack, ice bag, ice glove, or ice collar. In addition,
continuous cold therapy (cryotherapy) following joint surgery or injury can be delivered by a cooling unit
 similar to the aquathermia pad (Su et al., 2012). Moist cold can be provided by compress or a cooling sponge
bath.

Contraindications to the Use of Heat and Cold

Determine the presence of any conditions indicating the need for special precautions during heat and cold therapy
• Neurosensory impairment
• Impaired mental status
• Impaired circulation

Cold applications
• Open wounds
• Impaired circulation
• Allergy or hypersensitivity to cold

Heat Applications
Conditions contraindicating the use of heat:
• The first 24 hours after traumatic injury. Heat increases bleeding and swelling.
- Active hemorrhage
- Noninflammatory edema
- Skin disorder that causes redness or blisters

GUIDELINES IN APPLYING HEAT AND COLD

1. Determine the client’s ability to tolerate the therapy
2. Identify conditions that might contraindicate treatment
3. Explain the application to the client
4. Assess the skin area to which the heat or cold will be applied
5. Ask the client to report any discomfort
6. Return to the client 15 minutes after starting the heat or cold therapy, and observe the local skin area for any
untoward signs (e.g., redness). Stop the application if any problems occur.
7. Remove the equipment at the designated time, and dispose of it appropriately.
8. Examine the area to which the heat or cold was applied, and record the client’s response

Methods of Heat Application

• Dry heat
- hot-water bag
- heating lamp
- Chemical heating bags
• Moist heat
- moist hot compress
- sitz bath
- hot soaks

HOT WATER BAG OR BOTTLE

• Common source of dry heat used in the home.
• It is convenient and relatively inexpensive.
• The following temperatures of the water used to fill the bag are considered safe in most situations and provide
the desired effect:
- normal adult and child over 2 years, 46°C to 52°C (115°F to 125°F);
- debilitated or unconscious adult, or child under 2 years, 40.5°C to 46°C (105°F to 115°F).

Procedures:
1. Place the hot water bag flat, Fill the bag with hot water about a half to two thirds full
2. Place the hot water bag flat gradually and expel the remaining air
3. Turn the stopper until it is tight
4. Dry the bag and hold it upside down to check for its leaks
 5. Wrap the bag in a cloth cover and tighten its ties
6. Place the bag on the body site of the client as appropriate

AQUATHERMIA PAD
• Also referred to as a K-pad
• It is constructed with tubes containing water. The pad is attached by tubing to an electrically powered control
unit that has an opening for water and a temperature gauge.
• Some aquathermia pads have an absorbent surface through which moist heat can be applied. The other
surface of the pad is waterproof. These pads are disposable.

Procedure:
1. Fill the reservoir of the unit two-thirds full of water
2. Set the desired temperature. Check the manufacturer’s instructions. Most units are set at 40°C (104°F) for
adults.
3. Cover the pad and plug in the unit. Check for any leaks or malfunctions of the pad before use.
4. Apply the pad to the body part
5. Use tape or gauze ties to hold the pad in place. Never use safety pins.
6. If unusual redness or pain occurs, discontinue the treatment, and report the client’s reaction.

Key points:
• For unconscious clients, elders, infants, and clients who haven't regain consciousness after anaesthesia, the
safe water temperature should be 50℃ in order to avoid burns.
• For the client with impaired sensation, a large towel should be put over the bag with a cloth cover or a blanket
is used to wrap the bag.
• Remove the bag no more than 30 minutes after application if the purpose is to give treatment.

HOT LAMPS
• to reduce inflammation
• to relieve spasm and pain
• to promote scar and granulation tissue formation

Procedures and key points

• The distance is usually 30 to 50cm
• Eyes should be covered
• The duration of this application is 20~30minutes.
• Observe the local exposed skin closely during treatment

HOT MOIST COMPRESS

• to reduce inflammation and edema
• to relieve spasm and pain

Equipment:
• tray • small rubber drawsheet
• sterile dressing transfer forceps • sterile drape
• dressings • cotton mat
• sterile petrolatum • electrical stove
• sterile cotton swab • thermometer
• sterile gauze • boiler (hot water (50～60℃)
• plastic sheet • hot water bag (if necessary)

Procedures
1. Spread light coat of sterile petrolatum over skin surface to be treated.
2. Cover a sterile gauze on it.
3. Put dressings into the hot water (50~60℃)
4. Then cover it with a plastic sheet and cotton mat.
 5. Take out dressings with sterile transfer forceps and wring excess water. Apply the dressing onto the area to
be treated.

Key points:
• Change dressings every 3 to 5 minutes and observe skin condition.
• If continuous compresses are ordered, it can be applied 15 to 20 minutes.

HOT SITZ BATH

• To reduce swelling in rectum and organs in pelvic cavity
• to relieve inflammation and pain in the area of anus and perineum
• to clean the local area and provide comfort.

Equipment
• sterile sitz bath tub • sterile gauzes
• sitz bath chair • thermometer
• hot water bottle • large bath blanket
• sitz bath solution
Procedures
1. Place the sitz bath tub in a special chair. Pour the hot water (40~45℃) into the tub until a half full. Then make
prescribed solution.
2. Allow the client to have sitz bath for 15 to 20 minutes and maintain a constant temperature by adding warm
water.
3. Observe the client for pulse, respiration and facial color. (light-headed or nauseated)
4. After the sitz bath, assist the client out of the tub.

Key points:
• The bath tub and medication fluid should be sterile if there is wound.
• It' s not preferred for the female client:
- during mens
- in the latter period of pregnancy / less than 2 weeks after delivery
- having vaginal bleeding having acute inflammation in pelvic cavity

HOT SOAKS
• 43～46℃
• 30min

Methods of Cold Application

• Dry cold
- ice bag, ice cap or ice collar
- chemical cold pack
• Moist cold
- cold compress
- cold soaks
- cooling sponge bath
o alcohol sponge bath tepid sponge bath

Preparation
• Assessment
- the client's physical condition
- The client's level of sensation
• Equipment
• Explanation
- The client understands the purpose of the therapy and precautions taken during treatment.
USE OF ICE BAGS
• to reduce body temperature.
• to reduce hemorrhage, swelling and pain after sprains, head injuries and dental surgeries

Equipment
• ice bag
• cloth cover
• towel
• basin

Procedures and key points

• Fill the ice bag one half to two thirds full of crushed ice.

USE OF ICE CAPS

• to lower head temperature and prevent brain edema for unconscious clients.

Equipment
• ice cap • Sponges
• drawsheet • rectal thermometer
• bucket • ice
• sterile drape • basin
• small pillow

Procedures and key points

• Take away the pillow, spread the drawsheets under the client's head, place a sterile drape inside the ice cap
• Place the ice cap around the client’s head, apply spongy pad beneath auricles, occiput and neck, and the small
pillow under client's shoulders. The drainage tube is down into the bucket.
• Take anus temperature, maintain it around 33℃.
• Below 30℃ will go to ventricular fibrillation

COLD MOIST COMPRESS

• The moist compress is a moist gauze dressing applied to the body part.
• The compresses are usually immersed into the ice water and then applied to the body part.
• Replace compresses are necessary to maintain coolness. (3～5min)
• If a sterile compress is ordered, the nurse should follow the sterile principles.

CHEMICAL COLD PACKS

• a prefilled plastic package with two separate compartments.
• strikes, kneads or squeezes the pack to mix one chemical compound with the other and provide a controlled
temperature.

HYPOTHERMIA BLANKETS
• This appliance is made based on the principle of semiconductor refrigeration. There is a circulating exchange
between the cooled distilled water in the water tank and that in the hypothermia blanket via main machine.
This process facilitates the heat loss of the skin in contact with the blanket, and then the body temperature is
lowered.
• tepid water sponge bath 32～34℃
• alcohol sponge bath 25～35% ; 30℃