We have completed our series on wound dressings. We hope you found them enjoyable and informative. We will now be turning our attention to adjunctive therapies in wound care, covering topics as diverse as laser therapy, ultrasound, negative-pressure wound therapy and this week’s topic, whirlpool therapy.
Whirlpool therapy is thought to affect the inflammatory phase of healing, and can be used on a variety of wounds. Whirlpool tanks can be installed (permanent) or portable, and may be used for full-body immersion or for a single extremity. Settings can be adjusted, depending on the direction of turbulence and force of agitation deemed necessary. Different settings of temperature can also be used to differentiate the whirlpool’s effect on circulation.
Indications
- Wounds with moderate to heavy exudate
- Wounds with debris
- Necrotic wounds
- Ischemic wounds
- Wounds with tissue able to withstand increased circulation to the wound
Contraindications
- Clean granulating wounds can be traumatized by even gentle water agitation
- Epithelializing wounds
- Wounds with skin grafts, which may be damaged by agitation of water
- Venous ulcers because, by their very nature, they already suffer problems with circulation
- Diabetic ulcers which are non-necrotic, because the callous formation will be disrupted, and tissue maceration will lead to a wound that may enlarge
- Edema to an extremity
- Upper extremity infection
- Presence of dry gangrene
- In addition, patients who have renal failure, circulatory or pulmonary disease, acute phlebitis, are febrile, lethargic or unresponsive, or who are incontinent of urine or feces should not use whirlpool therapy
- Spinal cord-injured patients and those with peripheral neuropathy are at risk for thermal injury or hypothermia when whirlpool therapy is used
Advantages
- Softens necrotic tissue, facilitating its removal (mechanical debridement)
Increases blood flow to the wound (improves circulation, which brings an influx of oxygen and nutrients to the tissues) - Cleanses the wound(s)
- Helps to remove exudate, which decreases risk of infection
- Analgesia is induced by the effects of the warm water on the wound
Disadvantages
- Sensitive patients may develop allergies to the chemical agents used in whirlpool therapy
- Improper cleansing of the whirlpool may lead to wound infection
- Obese persons may not be candidates for whirlpool therapy because of their inability to disperse heat effectively
- Whirlpool therapy is time-consuming (treatments often given for 20 minutes twice a day, after which wounds should be dressed)
- Treatment can be expensive in terms of supplies, dressings, and labour
The temperature of the water used in whirlpool therapy should be based on wound and client condition. Water temperature should not exceed 1 degree above skin temperature in clients with peripheral vascular disease (PVD) and should not exceed 38 degrees Celsius in patients with heart or lung disease. When the water temperature must be lower, take care to ensure the client does not become chilled by keeping the therapy room warm and free of drafts. Where possible, immerse a single limb rather than the entire body.
Join us weekly as we explore the many different treatment modalities available for managing wounds. If you are interested in becoming certified in wound management, please visit www.woundeducators.com.
Sources:
Bates-Jensen & Sussman, C. (1998) Wound Care Collaborative Manual for Physical Therapists and Nurses, Aspen Publishers.
