INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure

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1 INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure TITLE: Section: Source: Distribution: POLICY Use of Hot Packs, Hot Water Bottles, Magic Bags and Heating Pads Safety & Risk Management Rehabilitation Holders of Interdisciplinary Clinical Manual NUMBER: CC Date Issued: Date To Be Reviewed: Issuing Authority: August, 2008 August, 2011 Jill Robbins Director of Rehab Services 1. Therapy may be provided by nurses (RN s and LPN s), physiotherapists as well as unlicensed staff who have received additional training. 2. An authorized prescriber s order is required for nurses to apply therapy. 2.1 Physiotherapists do not require an authorized prescriber s order to apply therapy. 3. Hot packs are to be used for moist heat therapy to aid in muscle relaxation and mobilization of joints. 4. The use of hot water bottles, magic bags and electric heating pads are not permitted within the CDHA. 5. Hot packs are not be used on patients on strict isolation, contact measures, and enteric precautions. 6. Microwaves (commercial or public) are to not be used to warm any product as it provides uneven heat and unpredictable therapy. 7. Magic bags are not to be used as they are a fire hazard. 8. Electric heating blankets and pads are not to be used as they can interfere with medical equipment and electrical injury. 9. Precaution is to be taken in individuals with diminished or impaired sensation, poor circulation and over open wounds. Use of Hot Packs, Hot Water Bottles, CC Page 1 of 5

Therapy may be provided by nurses (RN s and LPN s), physiotherapists as well as unlicensed staff who have received additional training. 2.

2 GUIDING PRINCIPLES 1. Hot packs are the recommended form of heat application. 2. Hot packs and Hydrocollators cannot be dedicated to an isolation room. 3. Contraindications for therapy include: 3.1 Acute injury or inflammation 3.2 Recent or potential hemorrhage 3.3 Thrombophlebitis 3.4 Impaired mentaion 3.5 Malignancy EQUIPMENT Hot pack of appropriate size and shape for the specified area. New commercial covers are equivalent to two-three layers of terry cloth. If the covers are older they should be considered as one or two layers. If commercial covers are used they are counted in the overall layers provided. Minimum of layers of terry cloth should be applied to the pack (consider more terry cloth layers if sensation is lacking). PROCEDURE 1. Assess and inspect the skin surface where the Hydrocollator pack will be applied. Avoid areas with abrasions, cuts scars, edema or lack of sensation. 2. Provide patient education regarding treatment. 3. Position the patient and remove all jewelry from the area to be treated. 4. Remove hydrocollator pack from hydrocollator using tongs. 5. Fold towel and or wrap towel to provide a minimum of 10 layers of terry cloth on all areas of the hot pack. 5.1 If the patient s body part is lying on top of the pack or has diminished sensation, add more terry cloth layers. 6. Ensure hot pack tabs are also covered by the terry cloth. 7. Position hot pack on affected area. 8. Assess skin q 5-10 minutes in patients with sensation. Use of Hot Packs, Hot Water Bottles, CC Page 2 of 5

New commercial covers are equivalent to two-three layers of terry cloth. If the covers are older they should be considered as one or two layers.

3 9. Assess skin q 1-2 minutes for the first 5 minutes and q5 minutes for the remainder of the therapy in patients with impaired or diminished sensation. 10. Ensure patient has call bell in reach. 11. Remove hot pack after 20 minutes. 12. Inspect skin after hydrocollator pack is removed for residual effects such as redness, blistering or other signs of burning. 13. Return the pack immediately to the heating unit. 14. Document area treated, size and number of terry towel layers required and patient response to therapy. Figure 1- Position of terry cloth for wrapping of hot pack CARE OF HYDROCOLATOR AND HYDROCOLATOR PACK 1. Hydrocollator 1.1 Set the thermometer for the Hydrocollator machine at 70 degrees to 75 degrees Celsius ( degrees Fahrenheit). 1.2 Add tap water daily to maintain the water level. 1.3 Empty and clean the Hydrocollator on a bi-monthly basis if the water is clouded or if a pack bursts open releasing sediment into the Hydrocollator unit. 1.4 Clean the interior of the Hydrocollator with a detergent or mild disinfectant. Use of Hot Packs, Hot Water Bottles, CC Page 3 of 5

Return the pack immediately to the heating unit. 14. Document area treated, size and number of terry towel layers required and patient response to therapy.

4 2. Hydrocollator Packs 2.1 Do not leave the Hydrocollator packs out of the Hydrocollators for extended periods of time as they will become mildewed. 2.2 Maintain the water slightly over the top of the Hydrocollator pack If the water level is allowed to drop the elements will burn out and scorching of the Hydrocollator packs will occur. 2.3 Allow one-half hour of reheating prior to reusing the pack. 2.4 Replace the Hydrocollators packs once the pack begins to wear Signs of wearing include: sections of the pack appearing loose and empty fabric fraying filler oozes or leaks through the fabric the pack is not able to retain its heat property RELATED CAPITAL HEALTH DOCUMENTS Position Statement from Risk Management CDHA REFERENCES: Cameron, Michelle H. (2003) Physical Agents in Rehabilitation: From Research to Practice. W.B Saunders Companypage p Cameron, Michelle H. (1999) Physical Agents in Rehabilitation: From Research to Practice. W.B Saunders Companypage p Hayes, KW. (2000) Manual for Physical Agents 5 th Ed. Prentice Hall Health, NJ. p9-12. Perry, A. & Potter, P.(2006). Clinical Nursing Skills & Techniques 6 th Ed. St Louis, Missouri: Elsevier Mosby, pp Manufacturers Manual for M-2 Hydrocollator: Instructions for Use and Operation. Chatanooga, Pharmaceutical Company. Use of Hot Packs, Hot Water Bottles, CC Page 4 of 5

2.4.1 Signs of wearing include: sections of the pack appearing loose and empty fabric fraying filler oozes or leaks through the fabric the pack is not able to retain its heat property RELATED CAPITAL

5 Electrophysical Agents in Physiotherapy: Therapeutic and Diagnostic Use. 2 nd Ed. Science Press 1983, Hikery Wadsworth. APP Chanmugam. HISTORICAL NEW Use of Hot Packs, Hot Water Bottles, CC Page 5 of 5

Chapter 4 Physiological Therapeutics. 2 Superficial Heat

Chapter 4 Physiological Therapeutics 2 Superficial Heat Date revised 8/27/03 Superficial Heat PHYSIOLOGICAL EFFECTS OF HEAT APPLICATION 1. Increases blood flow 5. Promotes abnormal ossification 2. Increases