ARUN S ANGADI. M.Sc NURSING. CRITICAL CARE NURSING.

1. HOT AND
COLD
THERAPY
PREPARED BY
MR. ARUN.S. ANGADI
M.Sc. MSN. MTIN CHARUSAT.
CHANGA.

2. INDICATIONS
 Safe heat or cold applications will be provided to patients /
residents as part of pain management programs wherever these
applications are appropriate and effective.
 Therapeutic effects of heat can assist in relieving sore, stiff
muscles or joints.
 The application of heat is a non-medically prescribed therapy,
used with therapeutic intent.
Dialysis Unit
 Heat may relieve muscle cramps that can occur in 20 % of haemo-
dialysis treatments, due to rapid fluid shifts.
 Cold application assists with extra-vasation following canulation
of an AV fistula or graft.

3. As a general rule, in the case of injury, heat therapy
should not be used for the first 48 hours as this will
have the opposite effect of cold therapy, instead
apply R.I.C.E.
Heat increases blood flow and relaxes muscles. Its
good for easing tight muscles, but will only increase
the pain and swelling in the first 48 hours after
injury by accelerating metabolism.

4. Heat therapy can also be used before exercise to
increase the flexibility of joints and to increase
blood flow.
You should not use heat therapy after exercise.
Because heat therapy increases circulation and
increases the skin temperature, it should not be used
when there is any swelling or inflammation

5. EQUIPMENT
 Hot/Cold Gel Pack
 Hot/Cold Surgical pack
 A designated microwave for micro waving gel packs
only

6. PATIENT EDUCATION
 A full explanation of the purpose for hot or cold
application must be given to the patient prior to
application.
 In the case of heat application the patient must be
advised, prior to application, that a comfortable and
even sensation of warmth should be experienced.

7. HEAT APPLICATION
When to Use Heat Therapy
 72 hours after an acute injury
 Sore, stiff muscles or joints
 Dialysis Use – relieving cramping

8. WHEN NOT TO USE HEAT APPLICATION
 Acute stage of an injury
 Over open wounds / rash, or areas of suspected
infections
 Over malignant tumors
 Over an area that has moderate or severe swelling
 Over acute inflammation
 Over skin conditions

9. 1. Gel packs used for heat
application will be stored at
room temperature.
 Do not overheat packs.
2. Microwave gel packs
(Surgipack) for 3 minutes.
 As gel packs are re-used between
patients, gel packs are placed in plastic
pocket for infection control purposes.
 Heat therapy should be applied for 20
minutes at a time with a 2 hour interval
between 20 minute applications.
 Frequent checks must be carried out and
documented.
 The core temperature of a reheated pack
may exceed safe temperature limits.
 The patient’s REACTIONS during and
following hot applications must be
recorded in their progress notes.

10. 3. Place in plastic bag and apply to affected area.
Ensure pack does not come into direct contact with the patient’s skin.
Provide additional padding such as towel or clothing as necessary.
4. Observe site and remove after 20 minutes or if any signs of erythema or
blistering. Do not reapply for 2 hours.
5. The heat therapy can be reapplied several times a day. Never use any type
of analgesic rub or lotion when applying heat therapy.
6. Once cooled, clean with Clinell (Hospital Grade Disinfectant) and place in
medication room for re-use.
7. Do not reheat a warmed pack. Allow pack to cool.
8. Heat applications resulting in excessive skin erythema or blistering require
immediate removal, first aid measures applied and the patient’s doctor
notified.

11. What is the difference between dry heat and
moist heat therapy?
 Moist heat is more effective than dry heat in deeper
tissue heating
 Moist heat penetrates more than dry heat at the same
temperature
 Patients often report greater relief of symptoms from
moist heat.
 Moist heat is preferred over dry heat as a treatment or
component of the treatment for the following conditions:
Pain, stiffness and secondary muscle spasm in
chronic arthritis

12.  Acute temporo-mandibular joint closed lock
condition
 Pain and muscle spasm on posterior neck and
back in patients with ankylosing spondolytis
 Moist heat has the additional capacity to change
the tissue temperature rapidly and obtain a more
vigorous response from temperature receptors

13. Cold therapy ( Cryotherapy)
R.I.C.E. stands for
Rest,
Ice,
Compression,
Elevation, the four basic methods of pain relief and
a speedy recovery

14. REST
Rest is important immediately after an injury for two
reasons:
First, rest is vital to protect the injured muscle,
tendon, ligament or other tissue from further injury.
Second, your body needs to rest so it has the energy
it needs to heal itself most effectively.

15. ICE
 Applying cold therapy (Cryotherapy) is the best
method for soft tissue injuries to provide short term
pain relief.
 Cold therapy will help reducing swelling, bleeding,
spasms and pain.
 Apply as soon as possible after an injury has
occurred and continue for 48 to 72 hrs. Most doctors
recommend 20 minutes of cold therapy followed by
20 to 60 minutes off.

16. Compression:
 For a severe injury, immediate compression
(pressure) is important to decrease bleeding and
keep fluids from pooling in the area.
 Compression should be continued throughout the
day and removed at night.

17. Elevation:
If possible, elevating the injured area above the
heart helps reduce internal bleeding and swelling.

18. What conditions can benefit from cold
therapy?
Sprains - Strains -Contusions - Arthritis-
Muscle spasms - Whiplash - Headaches and
Migraines - Insect bites - Dislocation - Hematoma
(acute) - Bursitis - Tendonitis - Post Surgery -
Myofascial disorders - muscle spasm - muscle
tension - muscle soreness

19. MECHANISM
After an injury, blood vessels that deliver oxygen and
nutrients to cells are damaged.
The cells around the injury increase their metabolism in an
effort to consume more oxygen.
When all of the oxygen is used up, the cells die. Also, the
damaged blood vessels cannot remove waste.
Blood cells and fluid seep into spaces around the muscle,
resulting in swelling and bruising.

20. When ice is applied, it lowers the temperature of
the damaged tissue through heat exchange and
constricts local blood vessels.
This slows metabolism and the consumption of
oxygen, therefore reducing the rate of cell
damage and decreasing fluid build-up.
Ice can also numb nerve endings. This stops the
transfer of impulses to the brain that register as
pain.

21.  Cold or ice should never to applied directly to the skin.
The cold therapy wraps act as a barrier between the soft
ice pack and the skin. Ice therapy requires that as much
heat is drawn from the effected area within the first
twenty minutes as possible

22. WHEN NOT TO USE COLD
THERAPY
 Medical conditions that effect
circulation:
Raynaud’s Disease
Systemic Lupus Erythematous
Peripheral Vascular Disease
Scleroderma
Bueger’s Disease
Hypertension
Certain Heart conditions
Areas where there is nerve damage
 Over open wounds or areas of
suspected infections
 Over skin conditions/irritations
 If the patient has one
of these conditions
consult the patient’s
Medical Practitioner.

23. PROCEDURE: KEYPOINTS:
1. Gel packs (Surgipack)
may be stored in the
freezer so it is always
ready to use.
2. Apply cold pack to
affected area for 15 – 20
minutes and review.
 A minimum of two hours is needed to freeze the
packs.
 Do NOT use directly on skin straight from the freezer,
place over clothing or wrap in a towel or pillowcase.
 Skin responses should be checked regularly for at least
the first five minutes of application. Allow the cold
application to be off for approximately 2 hours.
Exceeding the 15-20minute time frame will cause
decreased circulation to the area.
 The cold therapy can be reapplied several times a day,
may be reapplied once the normal skin erythema
response has completely disappeared. This is to keep
the swelling to a minimum, which will assist with the
body’s ability to heal itself.

24. 3. Cold applications resulting in
excessive skin erythema or
blistering require immediate
removal, first aid measures
applied and the patient’s doctor
notified.
 The patient’s REACTIONS
during and following hot
applications must be
recorded in their progress
notes.

25. THANK YOU ……..