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CHAPTER 32 Skin Integrity & Wound Healing
CLINICAL INSIGHTS
Clinical Insight 32-1 ➤ Applying Local HeatTherapy
Dry Heat: Disposable Hot Packs and Hot Water Bags or Bottles Hot water bags are common in the home use but not in healthcare agencies because of the danger of burns from improper use. ■ Use water that is 115°F to 125°F (46°C to 52°C). ■ Fill the bag about two-thirds full of warm tap water, expel the air from the bag, and close the top. ■ Tip the bag upside down to test for leaking. ■ Wrap the bag in a towel; place it on the patient. ■ Never place a heat source directly on the patient’s skin. Burns can occur. Dry Heat: Electric Heating Pads ■ Be sure that the body part is dry or that the pad has a waterproof cover. ■ Safety Precautions for Electric Heating Pads ■ Do not use pins (e.g., to hold a cover in place) or other sharp objects on the pad. The pin could go through a wire and cause an electric shock. ■ Tell the patient to report any discomfort during the treatment. ■ For home use, warn the patient about the danger of skin injury, especially from microwavable bags. These can get too hot and lead to a burn. ■ Avoid direct contact with the heating device. Cover the heat source with a washcloth, towel, or fitted sleeve. ■ Do not place the heating device (pad, bag) under the patient; place it over the body part. Helps prevent burns. ■ Apply heat intermittently, leaving it on for no more than 15 minutes at a time in an area. This helps prevent tissue injury (e.g., burns, impaired circu- lation). It also makes the therapy more effective by preventing the rebound phenomenon: ■ Check the skin frequently for redness or blistering. ■ Caution patients to place the heating pad or device over the body area and never to lie on it.
Preparation ■ Determine whether there are any contraindications to heat therapy, such as impaired circulation, bleeding, wound complications, or inability to tolerate the treatment. ■ Explain the application and rationale to the patient. Moist Heat (Irrigations, Compresses, Hot Soaks) If skin is intact and heat is being applied for relaxation: ■ Soak a washcloth or towel in warm water (105°F to 115°F [40°C to 46°C]) and wring out the excess before applying to the skin. Reapply and change water frequently to maintain a constant temperature. For open areas, use a sterile gauze compress, a soak, or a bath: ■ To make a compress, soak gauze in the heated solution (105°F to 115°F [40°C to 46°C]) and then apply it to the wound. Usually, you will use sterile gloves, gauze, and solu- tion. Reapply compresses or towels and change the water frequently to maintain a constant temperature. ■ For a soak, you will need to immerse the affected area. Sterilized tubs are often used for this procedure. Soaking helps cleanse a wound and remove encrusted material. ■ A bath is a modification of a soak.The most used bath is a sitz bath (see Fig. 32-17), which soaks the patient’s per- ineal area.A special tub or chair may be used. Because of infection control concerns, disposable sitz baths are pre- ferred. Check that the water temperature is from 105°F to 110°F (40°C to 43°C). Instruct the patient to soak for 15 minutes. Dry Heat (Aquathermia Pads) Aquathermia pads (also called K-pads) are plastic or vinyl pads that circulate water in the interior to create a constant temperature. ■ Connect the pad via tubing to the electric heating unit, which constantly exchanges water that has been heated to the specified temperature. ■ Fill the reservoir about two-thirds full of distilled water. ■ Set the temperature control to 98°F to 105°F (37°F to 40.5°C). ■ Cover the pad with a protective case and apply it to the body part. To prevent tissue injury.
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