Pams-_Whirlpoos

A whirlpool is a very versatile physical agent modality. The use of a whirlpool can include cold therapy, heat therapy, contrast baths, and wound care. The use of a whirlpool can increase circulation, reduce stress, calm agitation, decrease inflammation, and treat a larger area for the client. A whirlpool is a tank filled with water that is set to a specific temperature, either cold or hot. This temperature is determined by the specific effect, and desired use of the therapy. The tank is also fitted with a pump or jet that creates currents in the water. The movement of the water is used as a massaging agent, and helps to keep the desired temperature on the clients’ skin. The tank can also be fitted with a sling chair so that the client can be immersed as completely as the prescription allows. The size of most tanks will allow for other types of seating depending on the requirements of the client. Patients can use a whirlpool modality either as a precursor to treatment or post-treatment. When using a whirlpool for cold therapy, the patient is able to receive cold treatment to a larger area of the body, than they would be able to using an ice pack. When using a cold whirlpool the client can experience vasoconstriction, superficial anesthesia, decreased local metabolism, and decreased connective tissue elasticity (Prentice, 1999). The therapeutic effects include a decrease or prevention of swelling, decreased pain, decreased inflammation, and decreased secondary tissue damage (Prentice, 1999). The use of a cold whirlpool is more of a post-treatment option. Most practitioners would use cold whirlpool as a preventative measure after a stressful treatment. When researching whirlpool use, it was hard to find an example of cold whirlpool use as applied to occupational therapy. In most cases, cold whirlpool treatments would be used in an acute, or sub-acute setting. For clients with cold intolerance or vascular repairs the use of cold therapy is contraindicated (Early, 1998). Anytime that the client is in a whirlpool, he or she should never be left alone (Audet, 1995). It is also important to keep track of the time spent in the cold whirlpool. It is possible to cause damage to soft tissue using cold therapy. The use of a warm whirlpool is more likely to be applied for occupational therapy. When using a warm whirlpool the client will experience vasodilation, decreased pain perception, increased local metabolism, increased connective tissue plasticity, and decreased isometric strength (Prentice, 1999). The therapeutic effects include decreased pain, increased soft tissue extensibility, and a sedative effect (Prentice, 1999). The warm whirlpool provides a uniform warming over a large area of the body. The water is heated to 96 to 105 degrees. The client can be seated in the warm water up to their chin if it is deemed necessary. The use of the jet allows the client to remain at a constant temperature, and helps to reduce cooling of the water around the clients body (Prentice, 1999). While in the whirlpool, the client can engage in therapeutic exercises, the warmth makes stiff joints, muscles and other soft tissues more pliable and readily moveable. Again, when using a whirlpool the client should never be left alone. It should also be understood that a warm whirlpool is like taking a warm bath, it relaxes the client with an almost sedative affect. The client may feel lethargic after a session in a warm whirlpool, especially if the client is fully submerged and not just an extremity. Another use of the whirlpool is the contrast bath. During a contrast bath, the client alternates between a cold whirlpool and a warm whirlpool. The theory behind a contrast bath is that the alternating vasoconstriction and vasodilation will help to increase the movement of lymphatic debris out of the affected area being treated (Early, 1998). This modality is used only in the sub-acute or chronic stage of recovery (Prentice, 1999). There isn’t a lot of supporting research behind the contrast bath. Wound care is the last of the common uses for the whirlpool. The use of a warm whirlpool has been shown to increase circulation, soften and loosen necrotic tissue, mechanical debridement, wound cleansing, and exudate removal (Sussman, 1998). The addition of a disinfectant or antiseptic to the water will allow the entire wound to be treated while immersed. Special care should be taken when using a whirlpool for wound care, especially to cleaning and maintaining a clean tank, and all equipment used during a whirlpool session. Some wounds should not be treated with whirlpool therapy including: • clean granulating wounds - clean granulating wounds are easily traumatized by the force of even a mild agitation • epithelializing wounds • migrating epidermal cells may be damaged by even minimal force • new skin grafts - skin grafts will not tolerate the high shearing forces and turbulence • new tissue flaps - tissue flaps are very sensitive to shearing forces and vasoconstriction which may occur if the water or air temperature cause chilling • venous ulcers - it is undesirable to increase blood volume to an area where blood volume is already a problem - will complicate the problem; in addition, a dependent position will produce more dependent edema and stasis; the hard necrotic fibrin found in a venous ulcer are not effectively debrided by hydrotherapy. • non-necrotic diabetic ulcers - callus will be softened leading to maceration, macerated tissue will not tolerate pressure and wound will be enlarged (Sussman, 1998) There are some disagreements about the use of antiseptics in a whirlpool for wound care, and the debate has not been settled. It is important to follow procedure when using a whirlpool. The whirlpool is equipped with an electrically powered jet or pump to circulate the water. Anytime that water and electricity are together it is important to follow certain safety procedures. The whirlpool must be grounded, and the cord plug must be secure (Audet, 1995). This will help to ensure that the client and the practitioner are safe. The tank should be filled, and the pump checked to make sure that it is working properly. The equipment to be used during the session should also be gathered and placed accordingly. This will include water for client consumption, seating, towels, padding, and any other equipment that might be used (Audet, 1995). Before treatment begins, the client should use the restroom. The procedure should be explained to the client, including the temperature of the water, the action of the jet pump, and safety procedures (Audet, 1995). The client should have all wound dressings removed (Audet, 1995) prior to submergence in the whirlpool, as these can and will come loose in the water and can damage the pump. Clothing on the area to be treated should also be removed (Audet, 1995), in the case of larger parts of the body being submerged, the client should be provided with some type of water appropriate clothing. The water temperature should be checked prior to treatment, then the client should be positioned correctly for treatment. Re-checking of the seating and client comfort should take place before the pump is turned on, this includes adding padding to any parts that may be uncomfortable due to pressure from the tank or the seat (Audet, 1995). Once the pump is turned on, it should be adjusted to facilitate the goals of the modality. The client should be watched carefully for signs of distress such as overheating, dizziness, nausea (Audet, 1995). If any of these things should happen treatment should be terminated immediately and proper action taken to care for the client. Careful observation of time should be taken to ensure the client is not left in the whirlpool to long. Again, the client should never be left alone (Audet, 1995). Once the treatment is over, the pump should be turned off, and moved out of the way (Audet, 1995). The client should be helped out of the whirlpool, and all wet parts dried thoroughly, and then the skin should be inspected (Audet, 1995). During wound treatment it is important to watch for patches of skin that can slough off, because these can cause damage to the pump (Audet, 1995) After treatment, the whirlpool must be cleaned. It is important to thoroughly clean and disinfect all equipment used during treatment. The spread of infectious disease can only be stopped by the vigilant use of precautions. There are many factors that must be taken in to account when deciding on whether to use a whirlpool as a physical agent modality. It is important to understand the needs, strengths and weaknesses of your client, and your clients’ diagnosis. Bibliography Audet, L. (1995). Whirlpool Procedure. Standard Policy/Procedures Eastern New Mexico medical Center, 70-72. Early, M. B. (1998). Physical Dysfunction for the Occupational Therapy Assistant. St Louis: Mosby Elsevier. Prentice, W. E. (1999). Therapeutic Modalities in Sports Medicine. Boston: McGraw Hill. Sussman, C. (1998). Wound Care Collaborative Practice Manual for Physical Therapists and Nurses. Torrance: Aspen Publishers.