Whirlpool therapy, or hydrotherapy, is one of the oldest adjuvant forms of treatment for wounds still in use today.1,2 It was originally used in the management of pain, but later found a use in wound management, in particular in the management of burns patients. It is now commonly used to facilitate debridement in infected wounds, nondraining wounds, on wounds with thick eschar, and on wounds with loosely adherent necrotic tissue or thick exudate.1 Typically, whirlpool therapy is used in 20–30-minute sessions, three to four times per week. As a rule, this form of therapy is only maintained for a brief period, and is unsuitable for longer-term use.
Benefits of Whirlpool Therapy
As well as facilitating debridement, whirlpool therapy appears to have a number of other benefits. Use of a whirlpool allows dressings to be removed slowly and gently reducing the pain of dressing changes in patients with sensitive wounds such as crush injuries, venous stasis, pyoderma gangranosum, arterial insufficiency, and animal bites, for example. In addition, the warmth of the water promotes increased circulation to the wound surface, and can be soothing for the patient. Finally, large Hubbard-type tanks are able to provide resistance and buoyancy to help patients with physical therapy.
Evidence, Disadvantages, & Contraindications
Despite the popularity and wide use of whirlpool therapy, and the abundance of anecdotal evidence concerning its benefits, there is actually a lack of evidence from prolonged clinical trials demonstrating its efficacy.3 There are also some disadvantages and contraindications to whirlpool therapy which should be taken into account when considering its use. For example, the force generated at the wound surface can be greater than then recommended force, potentially damaging developing granulation tissue, hindering migrating epidermal cells, and causing maceration. In addition, the limb position that is required to use whirlpool therapy on the lower extremities can actually counterproductively increase venous hypertension and vascular congestion. Finally, there is a serious risk of bacterial cross contamination between patients using the same tank, although this can be overcome by the careful use of antibacterial agents.
The opportunity to weigh up the benefits of whirlpool therapy and investigate further the evidence that is currently available for this modality can be provided by undertaking training for a wound care certification. This training allows wound care professionals to explore topics in greater detail and to become expert in many key areas.
Learn More With Our Wound Care Education Options
Interested in learning more about wound care and certification? Browse through our wound care certification courses for information on our comprehensive range of education options to suit healthcare professionals across the full spectrum of qualifications and experience.
References
- Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
- Hess CL, Howard MA, Attinger CE. A review of mechanical adjuncts in wound healing: hydrotherapy, ultrasound, negative pressure therapy, hyperbaric oxygen, and electrostimulation. Ann Plast Surg. 2003 Aug;51(2):210-8.
- Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003861.
when speaking of developing granulation tissue under the surface of the wound, what would you consider to be a scab and what would you consider to be necrotic eschar? In other words, a necrotic eschar in a pressure wound will be determined as a Stage U, unstageable wound. How then will a scab with developing granulation tissue under the surface of the scab be considered when staging? Will this be a stage 2, 3 or will it be a stage U in terms of pressure wounds.
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