Applications of

Heat and Cold

1. Therapeutic 2. Comfort 3. Rehabilitation
 Factors to Consider in Safe
Application of Heat and Cold

1. Patient’s Condition
▪ Age
▪ Circulatory or neurologic
deficiencies
▪ Level of consciousness
▪ Amount of body fats
▪ Condition of the skin in the
area being treated
▪ Patient’s diagnosis
2. Adaptation of thermal receptors
3. Thermal application must be stopped before
“rebound phenomenon” begins
Rebound phenomenon
▪ occurs at the time the maximum therapeutic effects of
hot or cold application is achieved and the opposite
effects begin.
▪ negates the therapeutic effect of heat and cold
application.

* 20- 30 minutes – maximum vasodilatation heat produces

* 60 F / 15 C – temperature of the skin when maximum
vasoconstriction occurs
• Continuation of heat application beyond 30 – 45 mins.
May result to tissue congestion, vasoconstriction and
client’s at risk of burn

• Continuation of cold application below 15°C

May result to vasodilatation begins w/c is protective &
prevents freezing of body tissues

• Prolonged cold application

May result to impaired circulation, cell deprivation &
subsequent tissue damage due to lack of oxygen &
nourishment
 SIGNS OF TISSUE DAMAGE
a. bluish & mottled skin appearance
b. numbness
c. stiffness
d. pallor
e. sometimes blister & pain

4. Moisture conducts heat better than air

5. Length of exposure and the area to be
exposed
6. Condition of the equipment
• The length of time the body is exposed as well as
the size of the skin area being treated affects the
body to tolerate the treatment:
– Smaller area – shorter exposure = better tolerance
– Larger area of exposure = lower tolerance

• Feel hot and cold applications most while the skin

temperature is changing and after a period of time
tolerance increases.
 LOCAL EFFECTS OF HEAT AND COLD

Physiologic Response to HEAT

• Vasodilation of peripheral blood vessels

• Increase blood flow (to injured body part)
• Increase supply of oxygen
• Decrease blood viscosity
• Increase tissue metabolism
• Improve circulation
 Physiologic Response to COLD

• Vasoconstriction of peripheral blood

vessels
• Decrease blood circulation
• Decrease capillary permeability
• Delayed re-absorption of fluid
• Increase coagulation of blood
 Systemic Effects
• Heat – CO & PR, sweating, BP

• Cold - BP, shivering, goose bumps

• Heat and cold in one body part is found in

another area of the body
Hypothalamus
– Responds to signals from the thermal receptors
– Controls body temperature
– Thermoregulatory centre in the brain.

• Anterior hypothalamus – dissipate heat

• Posterior hypothalamus – conserve heat
TEMPERATURE FOR HEAT AND COLD
APPLICATION
Description Temperature Application
Range
Very cold Below 59 F (< 15 Ice bags
C)
Cold 59 – 65 F (15 – 18 Cold pack
C)
Cool 65 – 80 F (18 – 27 Cold compress
C)
Tepid 80 – 98 F (27 – 37 Sponge bath
C)
Warm 98 – 105 F (37-41 Aquathermia pad
C)
Hot 105 – 115 F (41- Hot soak
46 C)
Very Hot Above 115 F (46 Hot water bottle
C)
 Indications for
HEAT Application
1. Promotes wound healing
2. Relieves pain
3. Relieves muscle tension and joint stiffness
4. Warms part of the body
5. Reduces edema / swelling
6. Eliminates toxic products
 Contraindications for
HEAT Application

1. The first 24 hours after injury

2. Active hemorrhage
3. Non inflammatory edema
4. Localized malignant tumor
5. Skin disorder that causes redness
or blister
 Indications for
COLD application
1. Relieves pain
2. Limit inflammation & suppuration
3. Control bleeding
 Contraindications for
COLD application
1. open wound
2. impaired circulation
3. allergy or hypersensitivity to cold
Devices used for HEAT Application
1. DRY Heat
• Hot water bags or bottles
• Electric heating pad
• Aquathermia pad
• Heat Lamp
• Heat Cradle
• Hot packs
• Gel filled hot packs
• Thermal blanket (heating)
• Diathermy
Hot water bottle/ bags
Aquathermia pad

• It is a rubber pad of
tubular construction that
can be filled with distilled
water, an electrical unit
heats the water and keeps
it at an even temperature
 Aquathermia pad

• Steps in applying Aquathermia pad

(K pad)
1. Fill reservoir of unit 2/3 full
distilled water
2. set desired temperature = 40.5 C
(105 F) adults
3. cover and plug unit
4. apply to body part (continue for
30 minutes.)
Electric Heating Pad
▪ This provides constant and
even heat.
▪ It has wires that provide
heat should be covered by
rubber or plastic to ensure
safety
▪ Should never use in the
presence of moisture
because of the danger of
electric shock
Heat Lamp

• It is a gooseneck
lamp containing a
60-watt bulb, applied
18-24 inches from
the body
Heat Cradle

• A metal cradle in which

several electric sockets
are installed for 25-watt
luminous bulb, applied
18 inches away from
the patient
Hot Packs

• commercially prepared and

disposable
• instructions depending on
the manufacturer
Gel-filled Hot Packs

• Gel-filled hot
packs are available
commercially and
are reusable
• Be certain to read
manufacturer’s
instructions
Thermal Blanket

• Similar to the water-

flow heating pad
except that it is of
blanket size
Diathermy
 Diathermy
• Deep heat treatment
• Electrical energy is changed to heat similar to the
principle underlying the microwave
HOT WATER BAG
APPLICATION
Definition: A common form of dry heat used at
home
 Equipment
• Pitcher with hot water
• Hot water bag
• Towel
• Bath thermometer for hot water (optional)
• Dropper or a stick
 HOT WATER BAG Application
1. Check the order & specify
2. Identify the patient
3. Assess the general condition of the patient
4. Explain the procedure
5. Prepare equipment & supplies.
6. Wash hands.
7. Provide privacy and comfort, exposing only the
area to be treated.
8. Check temperature of water using bath
thermometer or test on inner wrist. (Make sure
heat will be within the acceptable range for
individual). Rinse bag with water, empty, then fill
to warm the rubber.
9. Fill the hot water bag half to 2/3 full.
 HOT WATER BAG Application
10. Expel remaining air from bag in one of two ways:
place the bag on a flat surface, permit water to come
to the opening and then close the bag or hold the bag
up, twist the portion to remove the air and then close
the bag. Fasten up securely. Check for leaks.
***Air reduces pliability of the bag. Securing the
top prevents leakage of water and discomfort for
the patient.

11. Cover the bag with towel or other protector & apply to
prescribed area.
***Covering the device protects the skin from direct
contact with rubber. Heat travels by conduction from
one object to another.

12. Remove hot water bag after 15- 20 minutes (or as

ordered by the physician).
 HOT WATER BAG Application
13. Evaluate the following: 1) signs and symptoms of both
desirable and undesirable response to treatment and 2)
patient’s comfort

14. Document the treatment, including the length, time,

and patient’s response.

15. Perform hand hygiene

Note:
Adult and child over 2 yrs – 46 C to 52 C (115 F – 125 F)
Deliberated/unconscious adult or child under 2 yrs. – 40.5
C to 46 C (105 - 115 F
2. MOIST Heat
• Warm moist compress
• Sitz baths
• Warm soaks
Warm Moist Compress
Sitz bath
 Sitz bath
• Means of applying tepid or hot water to the pelvic
or rectal area, clients are placed in a tub filled
water with sufficient water to reach the umbilicus

• Temperature = 40 C to 43 C (105 – 110 F)

• Duration 15 – 20 min.
Warm Soaks

• Immersion of a body area

into warm water or a
medicated solution
• Soften and remove
encrusted secretions and
dead tissue
WARM COMPRESS
APPLICATION
Definition: A form of local moist heat application
done with compress cloth.
 Equipment
• Basin
• Hot water
• Towel or any cloth, size depending on the
area affected.
 WARM COMPRESS Application
1. Check the order & specify
2. Identify the patient
3. Assess the general condition of the patient
4. Explain the procedure
5. Prepare equipment & supplies.
6. Wash hands.
7. Provide privacy & comfort.
8. Prepare compress. Pour warm water into the
basin & place the towel on it. Check temperature
of warm water with inner wrist.
 WARM COMPRESS Application
9. Apply the heated towel.
10. After 20-30 minutes, remove warm compress.
11. Evaluate the following: 1) signs and symptoms
of both desirable and undesirable response to
treatment and 2) patient’s comfort
12. Document the treatment, including the length,
time, and patient’s response.
13. Perform hand hygiene.
Devices used for COLD Application

1. DRY Cold
• Ice bags / ice collar
• Cold packs / ice packs
• Gel filled cold packs
• Thermal blanket (cooling)
Ice Bags/Ice Collars
 Ice Bags/Ice Collars
• commercially prepared ice bags
• these bags cannot be reused
Gel-filled Cold packs

• available
commercially and
reusable
Thermal Blanket (Cooling)

• commonly referred as
hypothermia blanket
• the blanket cools the
patient to the desired
body temperature and
maintains that level
2.MOIST Cold
• Cold compress
• Cold sponge
bath
Cold Compress
Cold Sponge Bath

• Used to lower temperature

• Heat dissipates both by heat
conduction and evaporation
• Alcohol is not added
anymore due to the harmful
effect of its fumes and its
extreme drying effect
ICE BAG
APPLICATION
Definition: Ice bags, like their counterpart hot
water bottles or bags, are relatively easy and
inexpensive method for applying cold to the area
affected.
 Equipment
• Ice bag or collar
• Ice chips
• Bath towel or absorbent pad
• Towel or pillow case
 ICE BAGS Application
1. Check the order & specify
2. Identify the patient
3. Assess the general condition of
the patient
4. Explain the procedure
5. Prepare equipment &
supplies.
6. Wash hands.
7. Provide privacy & comfort
8. Place towel or absorbent pad
under area to be treated.
9. Prepare ice bag or collar:
a. Fill bag with water, secure cap & invert.
b. Empty water & then fill bag 2/3 full with
small ice chips.
c. Release excess air from bag by
squeezing its sides before securing cap.
d. Wipe bag dry.
e. Apply snugly over area.
10. Check condition of the skin every 5 minutes
11. After 15- 20 minutes (or as ordered by the
physician), remove cold application & gently dry
off any moisture.
*** Drying prevents maceration of the skin.
Prolonged application of cold can result in
diminished blood flow and tissue ischemia
or compensatory vasodilatation to provide
warmth to area being treated.
12. Assist client to comfortable position.
13. Evaluate the following: 1) signs and symptoms of
both desirable and undesirable response to
treatment and 2) patient’s comfort
14. Document the treatment, including the length,
time, and patient’s response.
15. Perform hand hygiene.
COLD COMPRESS
APPLICATION
Definition: a form of local, moist cold application
done with compress cloth.
 Equipment
• Basin filled with cold water and ice
• Towel, size depends on the part that needs
application
 COLD COMPRESS Application
1. Check the order & specify
2. Identify the patient
3. Assess the general condition of
the patient
4. Explain the procedure
5. Prepare equipment &
supplies.
6. Wash hands.
7. Provide privacy & comfort
8. Place towel or absorbent pad
under area to be treated
9. Place ice chips or cold water in
the basin. Wrung out excess
moisture.
10. Apply compress to affected area, molding it
gently over site.
11. Check condition of the skin every 5 minutes.
12. After 15-20 minutes (or as ordered by the
physician), remove compress & gently dry
off any moisture.
***Drying prevents maceration of the skin.
Prolonged application of cold can result in
diminished blood flow and tissue ischemia or
compensatory vasodilatation to provide
warmth to area being treated.
13. Assist client to comfortable position.
14. Empty basin, dry and store. Dispose off
soiled linen and gloves.
15. Evaluate
16. Document
17. Perform hand hygiene.
15. Evaluate the following: 1) signs and
symptoms of both desirable and undesirable
response to treatment and 2) patient’s
comfort
16. Document the treatment, including the
length, time, and patient’s response.
17. Perform hand hygiene.
THE END