prac heat

Question 1

WAX

Answer 1

• Paraffin wax melts at around 54°C but this point is lowered by the addition of mineral oil
• Wax with mineral oil or paraffin
• Thermostatically controlled bath 42‐52°C
• Maintains wax in molten state

Question 2

WAX INDICATIONS

Answer 2

• Hands/ feet
• Rheumatoid arthritis
• Dupuytrens contracture
• Post surgery/ fracture/ immobilisation

Question 3

WAX METHOD

Answer 3

• Check for contra‐indications and temperature of wax
• Test patients sensation (thermal)
• Explanation/ warning
• Wash part (wipes), remove jewellery
• Check for open wounds and contra‐indications
• Immerse part to be treated
• Repeat 6‐8 times
• Wrap in greaseproof paper/ towel for 15‐20 mins

Question 4

WAX SAFETY

Answer 4

• Wax is highly flammable
• Fire blanket and Carbon Dioxide fire extinguisher
• Slippery! Protective floor covering, be careful to avoid dropping bits of wax on the floor

Question 5

HOT PACKS (hydrocollator pads)

Answer 5

• Silicate gel (e.g. bentonite) in canvas cover
• The gel absorbs large quantities of hot water which provides a considerable
store of heat energy
• Different sizes
• Heated tank of water to 70‐80°C by a thermostatically controlled electric heater

Question 6

HOT PACL APPLICATION

Answer 6

• Wrapped so 1‐2 cm (6‐8 layers) of towelling between the pack and skin
• This provides thermal insulation so that although the pack is about 75°C,
the skin temperature does not rise above 42°C or so
• Takes 8 mins for skin temp to reach maximum
• Pack temp falls but skin and superficial tissue temp rising as towelling and pack prevent the skin surface from losing heat
• CHECK patients response and skin colour about 10 mins after placing it
• Left on for 15‐20 mins

Question 7

HOT PACK INDICATIONS

Answer 7

• Pain
• Muscle spasm
• Superficial inflammation • Chronic oedema
• Superficial adhesions

Question 8

HOT PACK SAFETY

Answer 8

• Care if lying a body part on a hot pack, better to apply on top
• Never use a hot pack with another machine
• Do not use water from the hydrocollator for skin testing! Too hot • Check skin at regular intervals
• Extreme care on elderly, frail pts

Question 9

CONTRA-INDICATIONS OF HOT PACKS

Answer 9

• Circulatory insufficiency
• Identified using testing and/or clinical findings including presenting symptoms, past
history and skin discolouration • Risk of dissemination
• Conditions with known or accepted risks including acute infections, tumours (benign or malignant), TB osteomyelitis
• Exacerbation of existing conditions
• Acute infective or inflammatory conditions, skin disorders such as eczema or dermatitis, regions treated within 3‐6 months by radiotherapy, haemorrhagic conditions, severe organs states such as cardiac failure
• To eyes or testes
• Open wound/if skin is broken

Question 10

HOTPACK PRECAUTIONS

Answer 10

• Patient unable to communicate • Sensory loss
• Avoid BURNS
• Care with using other modalities in conjunction
• Extra care if lying a patient on a hot pack (Cervical spine)

Question 11

RECORDING

Answer 11

With all electrotherapy the following must be recorded:
• Results of consent, sensation test and warnings given and understood
(IC√√ S√√ W√√)
• Details of Rx including dosage, details of electrode or hot pack position
• Immediate result of treatment (e.g. abnormal reaction,  P)
• Effect of treatment on both subjective and objective measures