HOT AND

COLD
APPLICATIO
N

SUPERFICIAL HEAT AND

COLD
Primarily increase or decrease temperature of
skin, superficial subcutaneous tissues

TRANSFER OF ENERGY: HEAT, OR THE LOSS OF HEAT,

OCCURS IN ANY OF THE FOLLOWING WAYS:

Conduction: Contact
Convection: movement
Evaporation: through liquid-gas transfer
Radiation: electromagnetic waves
Conversion: transfer from one energy type to
another

THERAPEUTIC APPLICATION
Heating Agents
Transfer heat to patients body,
between various tissue / fluids
Cooling Agents
Transfer heat away from patients
body

HOT APPLICATION
Hot application is the application of a hot
agent, warmer than skin either in a moist
or dry from on the surface of the body;

To
To
To
To
To
To

relive pain and congestion,

provide warmth,
promote suppuration,
promote healing,
decrease muscle tone and
soften the exudates.

Cold application

Cold application is the application of

a cold agent cooler than skin either
in a moist or dry form, on the
surface of the skin;
To reduce pain and body
temperature,
To anaesthetize an area,
To control hemorrhage,
To control the growth of bacteria,
To prevent gangrene,

CLASSIFICATION OF HOT APPLICATIONS

LOCAL
Dry heat

Hot water
bottles
Chemical
heating
bottles
Infrared rays
Ultraviolet
rays
Short wave
diathermy
Heating
lamps
Electric
cradles
Electric

GENERAL
Moist
Warm
soaks
heat

(Local baths)
Hot
fomentations
(Compresses
)
Poultices
(cataplasm)
Stupes
(medical
fomentations
)
Paraffin
baths
Sitz bath

Dry heat
Sun
bath
Electric
cradles
Blanket
bed

Moist
heat
Steam
baths
Hot
packs
Whirlpoo
l bath
(Full
immersio
n bath)

CLASSIFICATION OF COLD APPLICATIONS

GENERAL

LOCAL

Dry cold
Ice bag
Ice collar
Ice pack
(poultice)
Ice cradle
Chemical
cold
packs

Moist
cold
Ice to
suck
Cold
compress
Evaporati
ng lotion

Dry cold
Hypotherm
ia

Moist
cold
Cold
sponging
Cold
bath
Cold
packs

Local Application of heat

and cold to the body can
be therapeutic, but
before using these
therapies, the nurse
must understand normal
body responses to
application of heat and
cold and how and when

CLASSIFICATION OF TEMPERATURES: FOR

TREATMENT PURPOSES, ARE CLASSIFIED AS
FOLLOWS:

Temperature for hot and cold

applications
Description Temperature

Application

Very cold

Below 15C

Ice bag

Cold

C 15-18

Cold packs

Cool
Tepid
Warm

C 27 18
C 37 27
C 40 37

Cold compresses
Alcohol sponge bath
Warm bath

Hot
Very Hot

C 46 40
Above 46 C

Hot soak, hot compresses

Hot water bag for adult

Bodys Physiologic
Response
to
Heat and Cold

PRIMARY / PHYSIOLOGICAL EFFECTS

HOT APPLICATION

COLD APPLICATION

Peripheral Vasodilatation

Peripheral Vasoconstriction

Increased capillary permeability

Decreased capillary permeability

Increased oxygen consumption

Decreased oxygen consumption

Increased local metabolism

Decreased local metabolism

Decreased blood viscosity

Increased blood viscosity

Decreased muscle tone

Decreased muscle tone

Increased blood flow

Decreased blood flow

Increased lymph flow

Decreased lymph flow

Increased motility of leucocytes

Decreased motility of leucocytes

SECONDARY EFFECT OF HOT AND

COLD APPLICATION
With the local heat application, the maximal
increase in the of circulation & temperature occurs
after 20 to 40 min exposure. After this time, the
heat application must be discontinued & a recovery
time of 1 hour allowed otherwise secondary effect
(vasoconstriction) will take place.
With the cold application, the primary effects may
last only for 30 min to 1 hour. After this time, a
recovery time of one hour must be allowed or
secondary effects (vasodilatation) will take place.

SYSTEMATIC RESPONSE
Heat-loss via sweating and vasodilation
Heat conservation via
vasoconstriction, curl-up
Heat production via
shivering, movement

REBOUND Phenomenon: Heat

Occurs at the time that maximum therapeutic
effect of hot or cold application is achieved
Heat produces maximum vasodilatation in
20-30 minutes.
Continuation beyond 30-45 minutes causes
tissue congestion, the blood vessels
constrict

REBOUND Phenomenon:
Heat
Now the opposite effect is occurring
because of reflex vascular
constriction.
Recovery time of one hour is advised
before reapplication

REBOUND Phenomenon: Cold

Maximum vasoconstriction occurs when
the skin temperature reaches 150 or in
about 30 minutes to one hour.
Vasodilation begins as a protective device
to prevent the body tissue from freezing
Recovery time of one hour is best before
reapplication.

FACTORS AFFECTING HEAT AND

COLD TOLERANCE
Body part: Certain areas of the skin have a
sensitivity to temperature variations. The inner
aspect of the wrist and forearm, the neck, and the
perineal area are temperature-sensitive, while the
back of the hand and the foot are not as sensitive.
Duration of application: Therapeutic benefits of
heat and cold applications are achieved with short
periods of exposure to temperature variations.
Tolerance increases as the length of exposure
increases.

 Area of body exposed: The larger the

area exposed to heat and cold, the
lower the tolerance to temperature
changes.
Damage to body surface area: Injured
skin areas are more sensitive than intact
areas to temperature variations.

 Individual tolerance: Tolerance to

temperature variations is affected by age
and physical condition. The young and the
aged are especially susceptible to heat
and cold. Neurosensory impairments may
interfere with the reception and perception
of stimuli, increasing the risk of injury.
Age: Thinner skin layers in children and
elderly people increase the risk for burns
from the heat and cold applications. Older
adults have a decreased sensitivity to pain.

Scientific principles involved in

hot and cold applications
Water is a good conductor of heat
Air is a poor conductor of heat
The flow of heat is from the hotter area
to the less hot area
Prolonged exposure to moisture
increases the skins susceptibility to
maceration and skin breakdown,
reducing the protection of the intact skin.

 Moisture left on the skin causes rapid

cooling due to evaporation of the moisture
Presence of steam increases the
temperature of the hot application
Oil acts as insulator and delays the
transmission of heat
Woolen materials absorb moisture slowly,
but hold moisture longer and cool off less
quickly than the cotton materials.
The temperature tolerance varies with
individuals and according to the site and
area covered
Friction producess heat.

Hot
APPLICATION

INDICATIONS

THERAPEUTIC USES OF LOCAL

HOT APPLICATIONS

Decreases pain
Decreases muscle tone
Promote healing
Promotes suppuration
Relives deep congestion
Softens the exudates
Provide warmth
Stimulates peristalsis

Contraindications

CONTRAINDICATIONS OF HOT
APPLICATIONS

Malignancies
Impaired kidney, heart & lung functions
Acutely inflamed areas
On clients with paralysis
Open wounds
Edema associated with venous or lymphatic
diseases
Headache
Client with metabolic disorders
Very young & very old client
Client with very high temperature

COMPLICATION
S

COMPLICATIONS OF HOT
APPLICATIONS

Pain
Burns
Maceration (with moist heat)
Redness of the skin
Edema
Pallor (secondary effect)
Hyperthermia

GENERAL INSTRUCTION
Assess the condition of the client prior to,
during & after the application of the heat
& cold application.
Check vital signs.
Maintain correct temp. for the entire
duration of the application.
Never use any equipment unless
understand its operation completely.
There must be a recovery period
between the application.

 Expose the client only to a safe temp.

Dont allow the client to adjust temp. control
of appliances.
Never ignore the complaints of a client
Make sure that the client is in a position to
remove the application if it is causing him
discomfort.
Client must have a calling signal within his
reach.
Never leave client even for short period
Squeeze off water from moist heat
applications to prevent scalding.

 Apply thin layer of petroleum jelly or oil to

skin prior to the application of moist heat
application. It will reduce soaking of the skin
& therefore maceration.
Dont use electrical appliances close to the
open oxygen.
Dont use electrical appliances near water or
other fluid.
If any sign of complication recognized stop
procedure immediately.
After procedure, dry the body area gently by
patting not by rubbing to remove the
moisture.

DRY HEAT

Hot water bag

Fill two-thirds to half full with warm water
and remove air at the top so the bag is
easier to mold over the body part.
Dry the outside of the bag & test for leakage
by holding the bag upside down.
Cover bag with a towel or pillowcase (never
apply directly on the skin surface)
Keep bag in place for 2030 minutes and
then remove.
Do not allow the client to lie on the hot
water bag

Hot Bag

HOT PACKS / CHEMICAL

HEATING PACKS
Commercially prepared, disposable hot packs
supply warm dry heat to an injured area.
Striking or squeezing the pack will release
chemicals that create the heat.
These packs are designed to maintain a
constant temperature between 40.6 C & 46
C for 30 min to 1 hour.

HOT PACKS/ CHEMICAL HEATING

PACKS

AQUATHERMIA PADS
Are useful in treating muscle sprains and for areas
with mild inflammation or edema.
Unit consists of a waterproof plastic or rubber pad
connected by two hoses to an electrical control unit
that has a heating element and a motor. The
reservoir of the unit is filled two-thirds full with
distilled water.
The desired temperature is usually set with a key at
45C for adults.
Cover the pad with a thin cloth or pillowcase prior to
application.
Treatment usually continues for 2030 minutes.
Do not have client lie on pad.

AQUATHERMIA PADS

ELECTRICAL HEATING PADS

Provide constant, even heat, are lightweight, and
can easily be molded to a body part.
Unit composed of electrical coil enclosed within a
waterproof pad covered with cotton or flannel
cloth to absorb the perspiration & to insulate the
pad.
Instruct the client to avoid using high setting, to
prevent burns.
No wet dressing should be applied with pads.
Do not allow the client to lie directly on the pad,
because heat will not dissipate and the client may
be burned.

ELECTRICAL HEATING PADS

INFRARED LAMP
Radiant energy
2 types luminous (infrared)
and non luminous (far
infrared)
Luminous produces some
visible light (as opposed to
non luminous), non
luminous is less penetrating
than luminous

ULTRAVIOLET RAYS / LAMPS

Transmit ultraviolet rays, which are
invisible heat rays.
Observe the skin carefully during
and after the treatment.
Client & therapist must use
protective goggles to shut out
reflected harmful rays.
Duration of treatment is usually 2030 min

DIATHERMY
Highfrequency
wave
achieves
deep heat
penetration
Ultrasound
Shortwave
Microwave

ELECTRIC CRADLES / HEAT

CRADLES
It is used when large body part is to be
treated & covering of skin with gown or
sheets is not possible.
Sheet or blankets can be added over the
cradle to maintain the heat at the desire
levels.
Duration of treatment is usually 20-30
min, after unit is warmed up, or can be
used continuously to provide low temp.

HEATING LAMPS
Used to supply heat to the body parts.
The distance between the exposed part & the lamps
depend upon the wattage of the light bulb & heat
tolerance.
Duration of treatment is usually 20-30 min
Recommended distances are as follows:
WATT BULB

DISTANCE FROM THE BODY PART

25
40
60

35 cm
45 cm
60 to 75 cm

MOIST
HEAT

FOMENTATION
Moist application of heat over an area by
means of double thickness of flannel or
other soft material wring out from hot
water, protected by a waterproof
covering, wool and bandage.
Types: Simple
Medical
Surgical (applied over an open wound)

Purpose
To relieve pain & congestion
To relieve inflammations
To relieve retention of urine
To promote suppuration
To stimulate peristalsis & relieve tympanites
To relieve intestinal & renal colic
To soften the crust & for the easy removal of the
crust
To help in the absorption of the exudates
To relieve muscular spasm
To relieve congestion in the internal organs

TREATMENT PROCEDURE
Have all equipment assembled at bedside
before beginning treatment
Have the person remove clothing and drape
with a sheet.
Explain the procedure, tell them to tell you
when it is too hot & when it isnt hot enough
The duration and frequency in changing the
fomentations depend upon the desired
effect.
Take care not to burn the person with too hot
a fomentation.

 Be sure persons feet are warm (if cold, cover with blanket).
Cover part to be treated with a bath towel.
Apply fomentation. To relieve congestion, have the
fomentation cover a large area. For local effect, make the
fomentation the area size.
Add another towel if the fomentation is too hot.
Remove fomentation every 3-5 minutes and use cold mitten
friction or rub with cold wash cloth for 30 seconds and then
dry the area.
Reapply fomentation (3-6x in total always finish with cold).
Hot fomentation - cold mitten friction and dry area - hot
fomentation - cold mitten friction and dry area - hot
fomentation - cold mitten friction and dry area.
If general perspiration was produced neutral to cool
shower or a sponge bath.
Have person rest 30 minutes.

Contraindications
1. Unconsciousness.
2. Careful not to burn patient
3. Paralyzed parts of the body.
4. Do not use on the legs or feet of a diabetic.
5. Edema and varicose veins and advanced
vascular disease of the legs and feet.
6. Malignancy.
7. Tendency to bleed.
8. Stomach and bowel ulcers.

Important Considerations
Always ask if fomentations are burning the
patient. If they are too hot, put a towel between
skin and hot fomentation.
Have extra dry towels handy to layer in case
fomentation is too hot.
Have the room warm before you begin treatment;
make sure there are no drafts.
Caution with the thin or aged persons and
children.
Parts where bone is close to skin surface are
especially apt to burn.

STUPES (MEDICAL FOMENTATIONS)

Medicine (e.g. turpentine) is applied

locally to augment the effects of the
hot compresses used.
Commonly used to relieve
tympanites by increasing the
peristalsis & relaxing the muscle
spasm.
Drugs used are: turpentine (1 part)
with olive oil (3 parts) for adults. For
children, turpentine (1 part) with

POULTICES (CATAPLASM)
Application of moist heat in the form
of a soft spongy mass that retains
its heat for a varying length of time,
according to the ingredient used.
Starch poultices: starch and sodium
bicarbonate in the proportion of 8:1
Duration of application is 30 to 60
min

MOIST HEAT PACKS

Canvas Pouch with Silica Gel
Pack is kept in a water-filled heating
unit maintained between 160 F -170
F
Pack maintain temperature for 30-45
minutes
Packs transfer heat by conduction
Main benefit is superficial heat to 1cm

MOIST HEAT PACKS

Set-up
Cover pack with terry cloth or towel covering
Place pack on patient in comfortable
manner (patient on pack is contraindicated)
Check patient within 5 to 6 minutes for
comfort
Allow 3-4 hr minimum between treatments
on the same day

MOIST HEAT PACK

Indications:
Precaution:
Subacute or chronic
infected areas
inflammatory conditions
must be covered
Reduction of subacute
with gauze
or chronic pain
Contraindications:
Subacute or chronic
Acute conditions
muscle spasm
Decreased ROM
Peripheral
Hematoma resolution
vascular disease
Reduction of joint
Impaired
contractures
circulation
Infection (discuss)
Poor thermal

WARM COMPRESSES (GAUZE

DRESSING MOISTENED IN A
PRESCRIBED WARMED SOLUTION)
Applied to improve circulation, relieve edema,
and fasten the suppurative process and
healing.
For an open wound, use sterile technique.
Solution to moisten the gauze can be heated
first to 40.5C (105F) or procedure is similar to
application of a wet to dry dressing and the use
of a hot water bag or a heating pad to cover the
dressing.
Remove compress after 2030 minutes and
redress wound.

WARM SOAKS
(LOCAL BATHS)
Immersion of body part in warmed solution
promotes circulation, decreases edema,
increases muscle relaxation, and provides a
means to debride wounds and apply medicated
solution.
Can also be accomplished by wrapping body
part in dressings and saturating them with
warmed solution.
Sterile technique is generally indicated for open
wounds, such as a burn. Check agency
protocol regarding the temperature of the
solution.

 Temp. of warm water is at 105 to 110 F

(40.5 to 43 C)
Duration of treatment is usually 20 min
Temp. of solution should be checked
frequently & additional solution is added
or the solution is replaced in order to
maintain the appropriate temp.

PARAFFIN BATH
A mixture of 15 to 30 ml of mineral oil to 1
pound of paraffin wax
Temperature of 118 F to 126 F for upper
extremity tx.
Temperatures of 113 F to 121 F for lower
extremity (circulation is less efficient)
Paraffin can provide approx. 6x the amount of
heat as water due to low specific heat.

PARAFFIN BATH
Used to deliver heat in uniform amounts to
small irregularly shaped areas (hands,
fingers, wrist and foot) especially for
rheumatoid arthritis.
Wax moistens skin, water tends to dry skin

PARAFFIN BATH SET UP

Pack (Glove) Method
Immersion Bath
Clean extremity
Clean body part
Immerse extremity in bath
Dip part quickly; allow 10
and allow wax to dry - repeat
sec. to dry (turns milky)
7-12 more times
Dip the extremity 6-12 more
After final withdrawal from
times
wax, cover extremity with
Then cover with cellophane
plastic bag, or wax paper.
or towel for duration of tx
Then wrap in towel
(10-15 min)
If indicated elevate body part
DO NOT touch sides or
Following tx remove wax and
bottom of bath (burns)
return to bath
After tx scrape off and
replace in bath

PARAFFIN BATH
Contraindications
Precautions
Open wounds (options?)
Sensation is different
Skin infections
from specific heat
Sensory loss
and thermal capacity
Peripheral vascular
- may cause burns
disease
Indications
Sub acute and chronic
inflammation
limitation on ROM after
immobilization

WHIRLPOOLS / FULL
IMMERSION BATHS

Tx temperature is between 105-112 F

for extremities and 100-108 F for whole
body
Tx times usually last 10-20 minutes;
watch for lethargy with WWP

WARM WHIRLPOOL
Precautions
Must be connected to ground-fault
indicator
Instruct patient not to turn whirlpool motor on
or off while in whirlpool
Patient should be continually monitored
Do not run while turbine is dry
Clean tank pre and post infectious wound tx
Keep clothing and bandages out of whirlpool

WARM WHIRLPOOL
CONTRAINDICATIONS
INDICATIONS
Decreased ROM Acute conditions where
water turbulence would
Subacute or
further irritate injured area
chronic
Fever above 101 F
inflammatory
Comprimised circulation
conditions
Stiffness or
soreness
Irregular shaped
areas

SITZ BATH / HIP BATH

Used for clients who have had rectal surgeries, an
episiotomy during childbirth, painful hemorrhoids, or
vaginal inflammation.
Only the clients pelvic area is immersed in warm fluid;
the client sits in a special tub or chair or in a basin
placed on the toilet seat so that the legs and feet remain
out of the water (immersing the entire body causes
widespread vasodilation, negating the effect of local
heat to the perineum or pelvic area).
Water temperature should be from 43 to 46C (110 to
115F) & Duration of the bath is usually 1530 minutes.
Prevent overexposure and chilling by draping a bath
blanket over the clients shoulders and thighs, and
prevent drafts.
Assess the client during the bath for extensive

 Solutions used: Potassium permanganate solution 1:5000

Boric acid 1 dram to 1pint
Eusol solution

Contraindications
Pregnancy
Menstruation
Renal inflammation
Increased irritability of the genital organs

COUNTERIRRITANTS
Drugs used to augment the desired
effects of the heat application to induce
vasodilatation in the superficial tissues to
affect the circulation or muscle tone in an
underlying area or distant part by reflex
action.
Counterirritants include mustard,
turpentine, capsicum and liniments such
as camphor, and methyl Salicylates.

RUBEFACIENTS
Simple form of counterirritant which
merely reddens the skin by
vasodilatation.
Its effect is immediate and lasts only for
a short period.
E.g. mustard plaster, Tr. iodine,
turpentine

COLD
APPLICATION

INDICATIONS

THERAPEUTIC USES OF LOCAL

COLD APPLICATIONS

Relieves pain
Prevent gangrene
Prevent edema & reduce inflammation
Control hemorrhage
Control the growth of bacteria
Reduces the body temperature
Anaesthetize an area

Contraindications

CONTRAINDICATIONS OF COLD
APPLICATIONS
Client in the state of shock &
collapse
Edema
Diseases associated with impaired
circulation
Muscle spasm
Decreased sensation
Client have shivering or having very

CONTRAINDICATIONS FOR COLD

Cold hypersensitivity or intolerance
Cryoglobulinemia
Uncommon disorder
Aggregation of serum proteins in distal
circulation when distal extremities cooled
Proteins form a gel that can impair circulation,
Causes local ischemia, gangrene
Paroxysmal Cold Hemoglobinuria
Release of hemoglobin into urine from lysed red
blood cells,
In response to local or general exposure to cold

CONTRAINDICATIONS FOR COLD

Raynauds Disease

Paroxysmal digital cyanosis

Sudden pallor followed by redness of skin of digits,
Precipitated by cold or emotional upset
Relieved by warmth
Bilateral and symmetric (women)

Raynauds Phenomenon
Generally only in one extremity
May be associated with thoracic outlet, carpal tunnel
syndrome or trauma

CONTRAINDICATIONS FOR COLD

Regenerating Nerves
Local vasoconstriction or decreased nerve
conduction may delay regeneration

Circulatory compromise or peripheral

vascular disease
Chronic peripheral vascular disease may
have edema
Cold may increase this edema
Indicators for swelling due to Peripheral vascular
disease
Pallor and coolness

COMPLICATION
S

COMPLICATIONS OF COLD
APPLICATIONS

Pain
Blisters and skin breakdown
Maceration (with moist cold)
Grey or bluish discoloration
Thrombus formation
Redness (secondary effect)
Hypothermia

PENETRATION DEPENDS ON MANY

FACTORS:

Cold has a longer wavelength than heat

Local temperature gradient
Treatment surface area covered
Thickness and characteristics of tissue
treated (fat is an insulator, tissues with
high water content have better heat
transfer)

Inflammation Control
Prophylactically after exercise to
decrease DOMS (Delayed Onset Muscle
Soreness)
Due to muscle connective tissue damage
secondary to exercise

Edema Control
Decreases intravascular fluid pressure
via decreasing blood flow, increased
viscosity
Most effective if applied immediately, in
conjunction with elevation and
compression

Cryotherapy ineffective with edema

secondary to immobility and poor
circulation.

Pain Control
10-15 minute application can control
pain for 1 or more hours.

Adverse Effects

Adverse Effects
Tissue Death
Frost Bite
Nerve damage
Unwanted vasodilation due to prolonged vasoconstriction,
ischemia, thromboses in smaller vessels.

Freezing of tissues
damage at 39 degrees F
To avoid, duration limited to under 45 minutes and tissue
temperature above 39 degrees F
When goal is vasoconstriction, treatment limited to 10-15
minutes

Application, General Rules

Application of Cold
Assess patient and establish goals of
treatment
Determine if cryotherapy most
appropriate treatment
No Contraindications
Select appropriate mode of application
based on body part and desired response
Explain procedure, reasons for treatment,
and expected sensations

DRY COLD

Ice bag, ice collar

Fill two-thirds full with crushed ice so

bag is easier to mold over body part.
Cover bag with towel or pillowcase and
apply to affected area for 30 minutes.
Provides cold to localized area (e.g.,
muscle sprain, hematoma) to prevent
edema formation, control bleeding, and
anesthetize body part.

Application of Cold
Ice Bags
Crushed ice best
conforms better

Get all/most air out of bag.

Colder than ice packs
specific heat of ice higher than gels
Either decrease time or provide slight insulation.

COLD PACKS
Commercially prepared single-use ice
packs provide cold for designated period
of time.
When the pack is squeezed or kneaded,
an alcohol-based solution is released,
creating the cold temperature.

COLD PACKS/ ICE PACKS

Commercial
Silica or mix of saline/gel
Stored in freezer at 23 C
Moldable to patients body
Should be cooled at least 30 minutes
between treatments or 2 hrs. prior to initial
use.

COLD PACKS

Ice Bags,
Reusable Cold Pack
Instant Cold Back
Tx time for all are 15-30 minutes
Because of lasting effects application should
be no less than 2 hours apart
For controlled Cold Therapy Units - may be
applied continuously for 24 to 48 hours post
acute injury or surgery

COLD PACKS
Indications
Acute injury (may
use with wet wrap)
Acute or Chronic
Pain
Postsurgical Pain
and Edema
Shape of Body part

Precautions
AC joint and other areas may
not be suitable for wet wrap
Tension of elastic wrap should
be enough to provide
adequate compression without
unwarranted pressure
Ensure Circulation w/wrap
Frostbite - chance for
reoccurrence
over large or superficial nerves

Advantages and
Disadvantages

Advantages of Ice Packs/Cold Packs

Easy to use
Inexpensive
Short use of clinicians time
Low skill level required
Covers moderate to large areas
Can elevate limb simultaneously

Disadvantages

Must remove pack to inspect skin

Patient may not tolerate weight
Difficult to mold to contoured areas
Longer treatment time (than ice cup)

MOIST
COLD

ICE TOWEL
Wet towel is used
Ice towel need to
be replaced after 2-3
min. and total 20
min. of treatment
can be given.
Useful in treating
muscle and allows
movement to be
performed.

Ice Massage or Ice Cup

ICE CUBE MASSAGE

Slow circular motion for 5-10
min. During
This time the patient will feel
cold, burning
And then aching sensation
before the part
Become numb.
Short strokes should be given.

ICE MASSAGE
Duration of tx
Appropriate for
5-15 minutes or until ice
delivering cold tx to
runs out
small evenly shaped
if the purpose is analgesic,
areas.
then stop when numb
Most effective for
muscle spasm,
contusion and other
minor well-localized
areas

ICE MASSAGE
Indications

Precautions

Subacute inflammation or
injury
Muscle strain
Contusion
Acute or chronic pain

Contraindications
All other ice contraindications
When pressure is not
warranted
Suspected Fx

Injuries where
pressure massage
may be
contraindicated

APPLICATION OF ICE MASSAGE

Use towels in surrounding areas to

catch drips.
Use small, overlapping circles
Keep ice moving rapidly
Continue for 5-10 minutes or until
analgesia achieved
Quick Icing used as quick strokes
with ice cup to facilitate motor
response

ADVANTAGES OF ICE MASSAGE

Treatment area can be observed during
treatment
Excellent for small, irregular areas
Short-duration of treatment
Increases compliance

Can elevate limb if desired

DISADVANTAGES OF ICE MASSAGE

Requires clinician throughout treatment,
unless patient independent

Cold soaks
Procedure similar to that for
warm soaks.
Desired temperature for a 20minute soak is 15C (59F).
Take precautions (such as
preventing drafts and draping
shoulders) to prevent client from
chilling.

Intermittent Cold
Compression and Cryocuff

COLD COMPRESSES
Applied to either decrease or prevent bleeding
and to reduce inflammation.
Procedure similar to that for warm
compresses except cold compresses applied
for 20 minutes at a temperature of 15C (59F).
Technique may be clean or sterile.
Observe for signs and symptoms of burning or
numbness, mottling of the skin, redness,
extreme paleness, or a bluish skin
discoloration.

CONTROLLED COLD COMPRESSION

Intermittent Compression/ Cold Pump
Usually used in post-op patients
Allows for intermittent cold and compression
proven more effective than ice alone

COLD/ ICE SPRAYS

Ethyl chloride was originally used
but it is highly inflammable an thus
posses some risks.
Fluorimethane is now used
widely as it is non inflammable.
The liquid is sprayed on to the
area to be cooled in series of
stroke of about 5s each with a few
seconds interval between each.
The nozzle is held at the angle of
45 or right angle from the skin
surface.

VAPOCOOLANT SPRAYS

Ethyl chloride
Fluorimethane sprays
Work by rapid cooling
Desired treatment of trigger points
Applied in parallel strokes along skin of
muscle immediately prior to stretching

COLD WHIRLPOOLS
Duration of Tx
15-20 minutes
Temp 50 - 60 F

Contraindications

Indications
Decrased ROM
Cryokinetics
Subacute to chronic
inflammation
Peripheral nerve injuries
(avoid extremes)

Acute conditions
where water
turbulence would
further irritate area
Gravity
Postural
Skin Conditions
All other ice
contraindications

INTERVENTIONS

GUIDELINES IN APPLICATION
Check the order, check armband
Assess general condition of the patient
Assess the skin area where application going
Check functioning of equipment
Reassess patient and response in 15 minutes
Stop treatment at designated time
Examine the place where the treatment will occur.
Record the patients response

Safety Measures
DOs
Do explain to the patient sensations to be felt during the
procedure
Do instruct the patient to report changes in sensation or
discomfort immediately
Do provide a timer, clock, or watch so that the patient can
help the nurse time the application
Do keep the call light within the patients reach
Do refer to the agencys policy and procedure manual for
safe temperatures

Safety Measures
Do NOTS
Do not allow the patient to adjust the temperature
Do not allow the patient to move an application
Do not place the patient in a position that
prevents movement away from the temperature
source
Do not leave unattended a patient who is unable
to sense temperature changes or move from the
temperature source

THANK YOU