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Whirlpool Therapy for Wound Care

What

Precautions

References

- One of the initial treatments used by reconstruction aides in WWII

- Oldest form of wound care but rarely used today

- In 1998, the use of hydrotherapy was included in US Department of Health and Human Services Agency for Health Care Policy and Research pressure Ulcer Treatment Clinical Practice Guideline

- As of 1994, 92% of North American burn centers used hydrotherapy as part of their wound care protocol.

- Can prolong closure of a wound (should only be used short term)- don't leave patient unattended secondary to possible lethargy (patient could faint or drown)

- Clean tank before and after treating patients with infections wounds

- Keep clothing and bandages out of whirlpool

- Don't let whirlpool treatment substitute for a more beneficial treatment

- Temperature Precautions

- Should not exceed local skin temperature (93.2 F) with patients who have PVD

- Should not exceed 100.4 F in patients who have CVD or pulmonary disease

- 89.6 F increases blood flow 2.3 mL/dL of limb volume but will chill the wound and slow clotting

- Extreme temperatures should be avoided in patients with sensory loss

Introduction

Physiological Mechanism/Rationale

Bohannon, Richard W. (1982). Whirlpool versus whirlpool and rinse for removal of bacteria from a venous stasis ulcer. Journal of American Physical Therapy Association. 62: 304-308.

Burke, D., Ho, C., Saucier, M., & Stewart, G. (1998). Effects of Hydrotherapy on Pressure Ulcer Healing. American Journal of Physical Medicine & Rehabilitation, 77(5), 394-398. 

Gogia, Prem P. (1988). Wound management with whirlpool and infrared cold laser treatment: a clinical report. Journal of American Physical Therapy Association. 68: 1239-1242.

Meeker BJ (1998). Whirlpool therapy on postoperative pain and surgical wound healing: an exploration. Patient Education and Counseling. 33: 39-48.

Puliti, B. (2012). Helping them Heal: The Physical Therapist's Role in Wound Care Management. Physical Therapy & Rehab Medicine, 23(2), 24.

Sussman, C., & Bates-Jensen, B. (2007). Whirlpool. In Wound care: a collaborative practice manual for health professionals (3ed ed., pp. 644-661). Philadelphia: Wolters Klewer/Lippincott Williams & Wilkins Health.

Tao, H., Butler, J., & Luttrell, T. (2012). The Role of Whirlpool in Wound Care. Journal of the American College of Clinical Wound Specialists, 4(1), 7-12.

Therapeutic Modalities. (n.d.). http://www.physio-pedia.com/Therapeutic_Modalities Retrieved November 3, 2014.

http://www.apta.org/PTinMotion/News/2014/9/15/ChoosingWiselyRelease/

Contraindications

Parameters

  • Thermal Effects
  • Heat Transfer
  • Thermal Regulation
  • Circulatory Effects
  • Cellular Effects
  • Neuronal Effects
  • Physiologic Effects at Different Temperatures
  • Cellular level = cooling, super hydration, and maceration occur with a noted decrease in antimicrobial peptide levels, macrophage, and neutrophil presence
  • Moderate to severe extremity edema
  • Lethargy prior to getting in
  • Maceration (excessive amounts of fluid remaining in contact with the skin or the surface of a wound for extended periods)
  • Compromised cardiovascular or pulmonary function (DVT, hemorrhagic conditions, circulation
  • Acute injury or inflammation
  • Infection or tuberculosis
  • Malignancy (local)
  • Dry gangrene (needs to be evaluated for ischemia)

Full Body Submersion

  • Incontinence of urine or feces
  • Cross contamination of multiple wounds
  • 1-2 times daily for 10-20 minutes (depending on dressing changes)
  • Temperature should be determined based on condition (98.6 F is considered optimal for epithelial cell migration, mitotic cell division, and leukocytic activity)
  • Monitor vital signs before, during, and after treatments
  • Can be done with or without agitation (jets) and antimicrobial agents

Benefits of Whirlpool Treatments

Disadvantages to Whirlpool Treatments

Clinical Bottom Line

  • Mechanical debridement
  • Removing excess antibacterial creams
  • Increasing blood flow and tissue oxygen
  • Increasing core body temperature
  • Cellular effects (mitosis, leukocytic activity, epidermal cell production, antibodies)
  • Fighting infection by improved oxygenation of tissue and removal of bacteria and debris
  • Reducing pain through mild analgesia
  • Superhydrating and macerating skin
  • Changing of skin pH changes skin surface environment
  • Increasing risk of skin infection and wound infection
  • Changing of mental status and possible dizziness
  • Increasing heart and respiratory rates
  • Increased cardiac output and possible inability to compensate
  • Increasing edema in the dependent position
  • Shifting fluids away from the body may lead to dehydration and nutrient depletion
  • Traumatizing the wound or surrounding tissues by mechanical forces
  • Traumatizing the tissues by overheating (burns) of insensate skin or ischemic tissue
  • Based on the review of four articles, whirlpool therapy is supported for the treatment of surgical wounds, venous ulcers and pressure ulcers. However, these articles are more than 15 years old and whirlpool may not be the most effective treatment for these wounds any longer. According to a statement published by the American Physical Therapy Association in September 2014, whirlpool should no longer be used in the treatment of wounds.
  • However, APTA did not have evidence to support this statement.

CAT Research

Question = In patients ages 25-75 years old, what is the effectiveness of whirlpool therapy in the treatment of wounds?

All research found was at least 15 years old.

Only articles that included "whirlpool OR hydrotherapy AND wounds" were included.

Patient Scenarios

1. Patient with bilateral pressure ulcers on posterior heels with no signs of infection

2. Patient with a chronic venous stasis ulcer contaminated by pathogenic bacteria on the proximal medial malleolus

3. Patient with an open wound secondary to blunt trauma on the left lateral tibial surface

4. Patient with a abdominal surgical incision resulting in a wound

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