Think back to a time when you were really hot and you started sweating and your fingers were swollen. Now think about a time when you were really cold and you started to shiver and maybe your lips turned a little blue. What you experienced are the effects of heat and cold. Heat and cold have opposite effects on body functions. Heat increases blood flow by vasodilating blood vessels. When heat is applied to an area, the blood vessels in that area will dilate to increase blood flow (Fig. 1). However, when cold blood flow is slowed by vasoconstricting blood vessels to conserve body heat (Fig. 1). Applying a cold pack to an area will constrict blood flow in that area to reduce swelling.
An aquathermia pad is a pad with tubes inside. The pad is attached to a cooling/heating unit with two hoses. The cooling/heating unit is filled with distilled water to bring to desired temperature. The water flows through one of the hoses and into the tubes in the pad. Then the water flows through the other hose and back into the cooling/heating unit to maintain the desired water temperature before flowing back into the pad.
A cold pack is a type of dry cold application. It is a pack filled with cold fluid. Cold packs may be cooled by keeping them in the freezer, by striking or squeezing them to activate chemicals, or placing ice into bag or glove . The aquathermia pad can also be used as a cold pack. Cold packs are applied to the area of the body being treated. They may be reusable or disposable ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ) .
A cold compress is a cloth or pad that is soaked in cold water. It is then applied to the area of the body being treated. A cold compress warms quickly so it must be resoaked and reapplied. Compresses such as 4 X 4 gauze or Telfa pads, are used to apply moist cold to a small area. These compresses are easily made of washcloths or towels. Compresses and cold packs are usually not sterile. However, if there is a break in the client’s skin, sterile dressings may be used (Acello & Hegner, 2021; Sorrentino, et al., 2019).
Hot packs can be hot water bags, heating pads, and hot aquamatic pads. Some hot packs are filled with hot fluid. Hot packs may be heated by heating them in the microwave or in hot water or by striking or squeezing them to activate chemicals. Hot packs are applied to the area of the body being treated. They may be reusable or disposable. The water temperature of a hot pack should not exceed 110°F, or 43°C. A hot pack such as an electric heating pad or an aquathermia pad, which produces dry heat, is used to treat muscle sprains and mild inflammations and for pain relief. K-pads use Temperature-controlled, distilled water that flows through the waterproof pad. The water temperature of a hot aquamatic pad is typically 95° to 105°F, or 35° to 41°C ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ) .
Description automatically generated Compresses such as 4 X 4 gauze or Telfa pads, are used to apply moist heat to a small area. Large warm, moist packs of cotton or terry cloth are used to apply heat over a larger area. Commercially prepared warm packs are also available and may be used to apply either dry or moist heat. Covering any hot pack with heavy, dry material helps it retain heat longer. Application of an Aqua-K pad over a pack enables the pack to remain heated almost indefinitely. The water temperature of a hot compress is typically 100° to 105°F, or 38° to 41°C. Compresses and hot packs are usually not sterile. However, if there is a break in the client’s skin, sterile dressings may be used ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ) .
A hot soak is a type of moist heat application that consists of immersing the client’s affected body part in warm water or medicated solution for a prescribed time. The area of the body being treated is placed in a basin filled with hot water. The water temperature of a hot soak is typically 105° to 120°F, or 41° to 49°C ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ) .
A sitz bath is a type of moist heat application. The pelvic, perineal, and rectal areas of the body are placed in hot water. The water temperature of a sitz bath is typically 105°F, or 41°C. Disposable sitz basins are often used or a regular bathtub with enough water to cover the client’s hips and perineum ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ) .
Follow the Agency Guidelines for all Hot and Cold Applications
Table 13.2.1 Approximate Range of Temperatures for Hot and Cold Applications
Heat relieves pain, relaxes muscles, promotes healing, reduces tissue swelling, and decreases joint stiffness. When heat is applied to the skin blood vessels in the area dilate. Blood flow increases bringing more oxygen and nutrients to the surrounding tissue for healing. The vasodilation allows for excess fluid to be removed from the area faster. On observation, the skin will be red and warm to the touch ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ) . Heat applications are also comforting. And the sensation of heat may decrease the transmission of pain signals to the brain which can relieve pain and discomfort. In addition, heat applications relax muscles and joints which can decrease stiffness. Heat applications are used for chronic, or ongoing, conditions. These include back pain and arthritis. Heat applications may also be used only after the first two to three days following an acute, or sudden, injury (Acello & Hegner, 2021).
There are two types of heat applications: Dry and moist. Dry heat applications are dry against the skin and no water touches the skin. Dry heat applications include hot packs, hot water bags, heating pads, and hot aquathermia pads. A dry application stays at the desired temperature longer. Moist heat applications are moist against the skin where the moisture or water touches the skin. Moist heat applications include hot compresses, hot soaks, and sitz baths. Moist heat applications Moist heat has greater and faster effects and are more penetrating than dry heat applications ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ) .
High temperature can cause burns (See Table 13.2.1). When heat is applied too long, blood vessels will start to constrict. Persons at risk for complications include older adults, fair-skinned persons, those with decreased sensation to heat and pain. Persons with dementia and those who have metal implants are also at risk for injury. Others at risk for complications include:
Cold applications are used for acute or sudden injuries such as treat sprains, fractures, or fevers and are therefore useful right after an injury. Cold applications have numbing effect so relieves or reduces pain. When the blood vessels vasoconstrict blood flow to the area and as a result, less blood is able to come to the area. This in turn, decreases bleeding and reduces swelling. Cold is applied during the first two to three days following an injury.
There are two types of cold applications: Dry and moist. Dry cold applications are dry against the skin and no water touches the skin. Dry cold applications include cold packs, ice bags, and cold aquathermia pads. Moist heat applications are moist against the skin where the moisture or water touches the skin. Moist cold applications include cold compresses and cold soaks. Moist cold applications are more penetrating than dry cold applications ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ) .
Cold temperature can cause burns, pain, blisters, and poor circulation (See Table 13.2.1 above). When cold is applied for a long time, blood vessels dilate; this occurs as the body tries to warm the body temperature. Persons at risk for complications include older adults, fair-skinned persons, those with decreased sensation to heat and pain. Persons with dementia and those who have metal implants are also at risk for injury. Others at risk for complications include:
Loss of consciousness
Hypothermia is when the core body temperature drops below 35°C. While hyperthermia is when the core body temperature is excessively higher than normal. Under normal circumstances, the body is able to maintain its core body temperature within 1°C of 37°C. These excessively high or low body temperatures are managed and treated in acute care facilities. Hypothermia-hyperthermia blankets (Aquathermia blankets) are placed over and under the clients to maintain temperature regardless of changes in the client’s body temperature. The healthcare team monitors the client’s temperature through a rectal, skin, or esophageal probe with the goa to maintain body temperature (Acello & Hegner, 2021).
Role of an assistant Health Care Assistants and Cold and Heat Applications
When performing cold and heat applications, HCAs must follow the client’s care plan. Specifically, HCAs need the following information:
In some health authorities and agencies, only physicians, therapists, and nurses may perform cold and heat applications. Health care assistants should only perform cold and heat applications if their agency permit them to do so. While performing a cold or heat application, HCAs must immediately report any problems to their supervisor. After performing a cold or heat application, HCAs must report and document all of the actions taken, including any observations and if the application resulted in pain relief, decreased stiffness, or reduced swelling.
Guidelines for cold and heat applications
Any client receiving a heat or cold application should be frequently checked for any signs of problems related to their use. Inspect the skin beneath the application frequently, according to the care plan. It is advisable to check the skin every 5 minutes for the first two checks, and at least every 15 minutes after that (Sorrentino et al., 2013)). Because not every client may report having any discomfort, you should be particularly aware of signs such as restlessness, agitation, or other changes in behaviour and w hen performing cold and heat applications, HCAs must follow these guidelines ( Acello & Hegner , 2021; Sorrentino, et al., 2019 ):
Because heat and cold applications produce different effects, HCAs must thoroughly understand the purposes, effects, and complications of these applications. There are risks involved, some employers allow only nurses to do the heat and cold applications. You, as the HCA, must be certain that this is within your scope of practice for the agency you work for.
Before you undertake the application of hot or cold therapies, it is your responsibility to make sure of the following (Sorrentino et al., 2013) :
Situation: Mrs. Rosatti is 83 years old. This morning she twisted her ankle going to the bathroom. The nurse instructs you to apply an ice pack to the area.
Hot and cold application have many benefits but if not performed correctly can cause injury. As a result, cold and heat applications must be performed correctly and physicians must order cold and heat applications for patients. Health care assistants may be able to support the health care team with such applications. However, the HCA must ensure that such tasks are within their scope of practice and they have received the appropriate training and support from the RN.
Figure 13.2.1: Tchristianson, Artery Changes, CC BY
Figure 13.2.2: Nurcan, C., & Karadağ, M. (2015). Superficial Heat and Cold Applications in the Treatment of Knee Osteoarthritis. Attribution 3.0 Unported (CC BY 3.0) Superficial Heat and Cold Applications in the Treatment of Knee Osteoarthritis | IntechOpen
Figure 13.2.3: mage Dhenning2005, aka Dave Henning, Public domain, via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Ice_pack.jpg
Figure 13.2.5: Mamun2a, CC BY-SA 4.0 , via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Cold_Hot_Pack.jpg
Figure 13.2.8 Kolobetsoo, CC BY-SA 4.0 , via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Foot_Soaking_at_a_spa.jpg
Figure 13.2.9 Sitz Bath loonyhiker NonCommercial-NoDerivs 2.0 Generic (CC BY-NC ND 2.0) https://www.flickr.com/photos/loonyhiker/5115026425
ReferencesAcello, B., & Hegner, B. (2021). Nursing Assistant: A Nursing Process Approach, 12th ed. Cengage.
Sorrentino, S., Remmert, L., & Wilks, M. (2019). Mosby’s Canadian Textbook for the Support Worker (4th ed.).
definitionto become enlarged, widened to open up blood flow
× Close definitionto narrow the diameter of a blood vessel
× Close definitionaquathermia pad is a pad with tubes inside where water flow in and out of a heating/cooling unit.
× Close definitionA type of dry cold application. It is a pack filled with cold fluid. Cold packs may be cooled by keeping them in the freezer, by striking or squeezing them to activate chemicals, or placing ice into bag or glove
× Close definitiona cloth or pad that is soaked in cold water. It is then applied to the area of the body being treated
× Close definitionCan be hot water bags/bottles, heating pads, and hot aquamatic pads.
× Close definitionA type of moist heat application. The pelvic, perineal, and rectal areas of the body are placed in hot water.
× Close definitionwhen the core body temperature drops below 35°C.
× Close definitionwhen the core body temperature is excessively higher than normal.
× Close definitionPersonal Care Skills for Health Care Assistants Copyright © 2023 by Tracy Christianson and Kimberly Morris, Thompson Rivers University. is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.
