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Surgical Asepsis Lab Recording Notes

Chapters and Sections Covered:
Chp. 31: Asepsis - starting with Sterile Technique - pgs. 700 - 713
Chp. 36: Skin Integrity & Wound Care - starting with the RYB Color
Code (skipping pg. 938) - pgs. 937 - 957
Chp. 37: Perioperative Nursing - starting with Wound Care - pgs. 987
- 996
There are two different types of asepsis:
Medical Asepsis
reduces the number of pathogens
we use medical asepsis for basic hygiene purposes
Surgical Asepsis
makes an area or all objects free of all microorganisms
some of the principles for surgical asepsis:
first of all, you need a sterile field
a sterile field is just a barrier between your table and
your supplies but it would be a sterile barrier
a sterile field is considered sterile if it comes in a
sterile package that would have to be opened
sterile field border: depending on the size of the
equipment you are using, its a 1 to 2 inch border
the edges of the sterile field are not considered sterile
sterile field should not be hanging off the table
all supplies put on the sterile field must also be sterile
you cannot put clean supplies on the sterile field
ex: if you took an open 4 X 4 and opened it and it is now
unpackaged, you cannot put it back in the package
if you are opening a sterile package, you have to open it sterile
to sterile
you cannot reach over another sterile item if you want to
maintain sterility - you have to go around it
you cannot cross a sterile field - you cannot cross over
anything
even if you are all sterile you do not cross over a sterile
field - you are contaminating the sterile field if you do
keep in mind that you have two hands - if there is
something that you want on the left hand side of the sterile
field, but you are right hand dominant, take that left hand
and pick it up
anything on the sterile field: if the table that you were putting
your equipment on was wet, and the cloth packaging was put on
the wet surface, that cloth package would absorb that moisture
if anything can absorb moisture, it can also absorb
pathogens so it is not considered sterile
Surgical Asepsis Lab

the same with the packaging - if you picked up packages

and they were all saturated with water or were wet, YOU
CANNOT USE THEM
you need to dispose of them
on the other hand if you spilled something on the outside
(the inside of the packages are lined with wax) and you
open the packaging and you see that its dry, thats
different
the packages are lined on the inside with wax so
normally the item on the inside shouldnt be so
saturated with moisture if something happened to
spill on the outside of the package
the sterile field must be at the level of your waist or above

anything below the waist is considered to be

NONSTERILE
therefore thats why you see the dramatic television shows
where you see the hands up in the air because if the hands
are down, they are lower than the level of the waist
also pathogens travel downwards - pathogens could be
traveling downwards onto the sterile field if the hands are
down

Surgical Asepsis Lab

you never turn your back on the sterile field

when you set up your equipment, it all has to be set up in
the span of your view
at the bedside table, set up a triangle between yourself,
your workspace, and your patient
if you were using a liquid: when you open that liquid, you are
going to open it and put the base of the lid on the table (NOT ON
THE STERILE FIELD) - so essentially the open end is facing up
face down = CONTAMINATION
check the liquid for expiration date or when it was opened
NS (normal saline) in the hospital setting is only good for
24 hours
so if you open the sterile bottle of NS or your
irrigation solution - if you open that:
you need to put the patients name
room number
date opened
time opened
if you opened the bottle and you come into the room to do
a dressing, and its not labeled like that YOU DISCARD
THAT BOTTLE and get a fresh one
the way you hold the bottle - the label should be facing
your palm so that if the liquid drips, the drips wont go onto
the label and that label remains always readable
if you were using a bottle of liquid that has been opened
already and you have checked your date, you always
consider the lip of the bottle to be contaminated
so you always pour a little bit of the liquid out first in either a paper cup or a trash can - and then
continue on with whatever you have to do

Surgical Asepsis Lab

so once again you always have to lip it

what technique is called - you have to lip it to
cleanse that side of the bottle that has been
previously used
this is rinse any pathogens that might have
landed in that area
if you open a sterile field, you dont want to leave it open for an
extended period of time
the longer it is open, the more potential it has of pathogens
landing in it
you want to do things in a timely manner - you want to
have your equipment prepared
you could either set up your sterile field and then
remove your dressing or you could remove your
dressing and then set up your sterile field - you could
do it either way depending on how fluent you are
as beginners we might want to remove the dressing
first and then open up the sterile packages and set
up the sterile field (how Prof. Saur taught us)
risk could occur in either direction: you could either
be leaving the wound exposed while setting up the
sterile field, or you could be leaving the sterile field
exposed while removing the dressing
the point is: you need to be quick - you need to
be fluent with your motions
be conscious if you have to sneeze or cough - do not cough and
sneeze; try to keep talking while working over a sterile field
limited
if your patient has a central venous dressing, and that
dressing was being changed, you would ask the patient to
turn their head away from the dressing, and not to speak
while you were doing that dressing on their neck for the
same purpose of keeping the amount of microorganisms to
a minimum
The key to doing a sterile dressing:
maintaining asepsis
be organized: if you know you have to do dressings, you have to
think ahead of time of the supplies that you have to bring with
you
so you might quickly check your progress note - when the
nurse gave you report you ask the nurse what kind of
dressing is it?
is it just two 4 X4s and a combine?
what sort of supplies am I going to need
Surgical Asepsis Lab

you dont an enormous amount of extra supplies with you

into the patients room because once its in the room, it
should not leave the patients room - it doesnt go back
into the room
so you dont just bring a whole box of 4 X 4s into the
room because once you bring the whole box, it stays
in the patients room
now you can use it throughout the day but if it
doesnt get used on the patient, then it gets
discarded regardless
take a look at what is already in the patients room it may decrease the chances of you bringing extras
into the room
this is part of the environmental assessment be aware of whats in the room
concerning the liquid bottle : pull out 300ml
a dressing change is a doctors order
Pressure Ulcer Care
this is by hospital policy order
this means that in the hospital its a standing order on how you
take care of skin integrity and the nursing follows that order
its not that nursing is doing their own thing - they are following
an order - its universal throughout the whole hospital
-in surgery, surgical asepsis is used as well
its the natural barrier between the patient and the microorganisms
-after surgery, surgical asepsis is used for prevention of infection
-infection that is acquired in the hospital is called a nosocomial infection
-there are some methods for maintaining surgical asepsis:
sterilization
will completely destroy all microorganisms from an object
different ways of using sterilization:
using an autoclave
using moist heat
using a gas sensitive heat - ex: usually an ethylene oxide
gas
household method: boiling water
its disinfecting
boil something in rapidly boiling water for 15 minutes
boiling is not as effective or efficient because it
doesnt kill spores and viruses this is what
you would teach your patients in a home
setting
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radiation using X - rays or ultraviolet lights

some of these methods are most costly than others
we can use antiseptic agents on the skin - there would be
certain antiseptics that the doctor would order
iodine compounds

Applying the sterile gown

the sterile gown comes in a package
usually in that package would come a splashguard, and a mask also,
and a cap - these would be applied first, and then the sterile gown
goes on after
the mask you would just pick up on the sides, put the rings around
your ears and then you put the shield on and again pick that up with
your hands and then put that however around your head and then the
cap would cover all of the ends
the cap you would pick up and handle from the inside and just bring it
across your head
you are not touching the outside sterile part
then you would proceed to take the gown from the inside

always open the package that the gown comes in away from you
when you are handling sterile equipment just let it all drop
after you have the gown on, a colleague will have to tie the back
for you as you cannot put your hands in back of you
gloves cover the sleeve of the gown - skin should not be exposed
anything past the waist down is considered contaminated
your hands would have to remain upward
Surgical Asepsis Lab

when everything is finished, then you can take the gloves off,
wash your hands, then remove the cap off by slipping your hands
inside (skin to skin)
for the mask: if you are still in the isolation room, it should
stay on until the end but at this point (the end) you are
taking everything off
for the gown: you can now go in back of you and untie the
gown because since its the end you can break the sterile
field
handle the gown in the same way as when you put it
on: handle it from the inside because you dont want
to pick up any of the contaminants that might be on
the outside of the gown
take it from the neckline; you could even pull it inside
out if you wanted to and just roll it so that the inside
is now on the outside now and then you would
discard the gown in the back
whole point: you just dont want the contaminants
the first part: youre sterile you dont want to contaminate
the patient
the second part: you dont want to take any pathogens that
you just took from the procedure and contaminate
anything else
Applying Sterile Gloves
wash your hands
raise the table to the level of your waist
open the sterile packaging containing the gloves
place your knuckles near the top so that it makes it easier to
open up the packaging
place the packet back on the firm surface and open it away from
you
the outside packaging you dont have to worry so much about you can handle the outside packaging
make sure that the surface is clean and dry
always work away from you then closes to you
the outside of the second packaging containing the gloves show
you how to put the gloves on

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if by chance when you put the gloves on and it doesnt go on correctly,

as long as your hands are in there and sterile its okay - sterile to sterile
can touch
use the other sterile gloved hand to adjust the glove
so you would wash your hands before you put the sterile gloves on
if you were in with the patient and you were going from clean
gloves to putting on sterile gloves - USE HAND SANITIZER
BEFORE PUTTING ON THE STERILE GLOVES AT BEDSIDE
-in the OR there is the circulating nurse:
does all of the extra things that have to be done so that everyone else
can stay in their position
she can be called whenever extra supplies are needed in the OR some of it is environmental and some of it is regarding the surgical
procedure
that nurse is prepared to do everything and anything to retain the
sterility of the room
-when you are changing your patients dressing, you are going to explain
what you are doing to your patient most of the time, unless its the very first
dressing WHICH THE SURGEON CHANGES
-afterwards, the surgeon will write the order for the specification as to what
he wants done for the next dressing
-so he may choose that he wants a dry sterile dressing, he may choose that
he wants a wet to dry dressing
-he may choose that he wants you to apply a certain type of medication
-he is not going to tell you have many gauze you need
-so when you go to do your dressing, you want to be sure that:
the sponge gauze - also known as cover sponges and 4 X 4 - are NOT
thready, stringy gauze
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reason: strings could be falling off of the gauze and getting lost
into the wound
if the strings get lost in the wound, infection could potentially
happen
generally the cover sponge is called a 4 X 4
the 4 X 4 come two in the package - so usually when you are
doing a simple dressing, youll cover it with a wicking sponge(4 X
4) - it will absorb the extra drainage away from the wound
abdominal pad - much thicker
this is the protective covering that goes over the absorbent
portion of the dressing
has a blue line on the outside which can be X Rayed
this always stays outside of the wound
colloidal dressing
its almost like a second layer of skin
its protective
Drains
-inserted in the OR
Closed Drainage System - completely closed system
Hemovac
anything that is going to self contained and is going to
collect the drainage is closed
used for deep wound drainage
lots of times you can see these in orthopedic surgeries
used for larger quantities of drainage
holds 400ml
contains a sharp edge which gets sewn into the wound
has a spring support and it works on self suction again
squeeze it all the way downward and then you cap it
in order for this to be functioning, it has to be in a closed
position
you can delegate the emptying of the Hemovac to a UAP
as long as you explain to her what to look for and the color
of the drainage but keep in mind that you will be looking at
the color of the drainage everytime you step into your
patients room
and later on you can compare her findings with yours
and say yes thats exactly what it was

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sometimes a doctors order would call for low suctioning the Hemovac would be attached to a suctioning device that
is attached to the wall and that device would be suctioning
out the drainage instead
when you go to empty this, you are using clean gloves to
protect yourself from body secretions
you are always being careful not to let it splash in your
eyes
when you work with these kinds of drainage
systems(Jackson Pratt and Hemovac), you would
empty it out in a small cup
you should have gloves on
cup used is usually a sterile urine cup and the
patients name is on that
you will place it on the bed or wherever
you can place it on a firm surface
do not look directly into the cup as you are
pouring it out because there is a risk for the
blood splashing into your eyes - always away
from what you are doing - to the side
observe the color, the consistency and then
you discard it
if there is an odor, you can smell it from a
safe distance - you dont have to hold it
directly under your nose and take a whiff
Jackson Pratt
holds about 100ml to 125ml
blue edge - part that sits in the wound
see this often in mastectomies, and various other chest
surgeries
its self suctioning - if you pinch it in a certain, its causing
a negative pressure inside of the wound
its going to help draw the solution out into this container
that sort of looks like a hand grenade
the little container is calibrated - it can read the
amount of drainage
types of drainage:
arterial: frank blood (bright red) - bleeding
actively - something is bleeding

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sanguineous: dark red drainage - see this 3 or

4 days after surgery
serosanguinous: pink tinged drainage
serous: clear drainage
so the sequence is this: arterial sanguineous
serosanguinous serous
if the sequence changes, then you would
have to start to think that something is
happening
if you see pus, you might see some white
and green threads in there - thats
purulent drainage and thats a sign of
infection
purulent drainage has to be mentioned
and reported to the doctor
in addition you would take a closer
look at the wound and see what
the wound is looking like too
Open Drainage System
Penrose
open system
latex tubing
surgically implanted into the wound and be dangling out

purpose: wicking also so that the drainage would just seep

and travel down the tube
very often you would see it with a sterile safety pin
on it - it came from the OR and it was sterile (sterile
safety pin)
purpose of the safety pin is to anchor the tube so
that it doesnt get pulled into the wound from the
outside

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when the doctor decides that the drainage is minimal and

it has to be discontinued, the doctor just comes and just
pulls it right out
the drainage goes into the 4 X 4 and the 4 X 4 absorbs the
drainage
T tube
another open system
same concept as the Penrose drainage system - drainage
would travel on it
Amount of Drainage on 4 X 4
Small
scant amount of drainage
small amount of moisture on the inside of the dressing
Moderate
when you take the dressing out, maybe about half of the 4 X 4 is
filled but some of the edges are unsoiled
Large
the whole cover sponge (4 X 4) is saturated with drainage

Documentation
when you change a dressing you have to document it
ex: you have a dry sterile dressing and it has a small amount of pink
tinged liquid on the inside and it was on the upper right thigh
documentation of site: upper right thigh wound dressing
changed. small amount of serosanguinous drainage noted.
you have to look at the wound - not only the dressing - and you
have to describe the wound
description of the wound: some purulent discharge noted.
surrounding perimeter uneven and red | or you could say
surrounding edge uneven and red it was an open wound
you want know from you patient: whether they are in pain
so you describe what you saw in the dressing, you
describe what you saw in the wound, and you describe
the type of dressing you put on
description of type of dressing you put on: dry sterile
dressing reapplied | or dry sterile dressing applied
documentation all together: upper right thigh wound dressing
changed. small amount of serosanguinous drainage noted. some

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purulent discharge noted. surrounding perimeter uneven and

red. dry sterile dressing applied
dry sterile dressing is typically a set of gauze and a combine;
now if the wound needed more than that, then you would have to
add more of a description in the documentation than just dry
sterile because then if you added more, there was a larger
amount of drainage
so you might either put two sets of four 4 X 4s in place to
absorb the drainage
if when you are looking at the wound and you decide that it needs to
have a specimen
the specimen usually comes in a little catheter - it looks like a
giant Q tip in a tube
the yellow portion of the tube is agar - the medium in which the
microorganism lives in
you crack it to activate it - it says inactive unless you crack
that bottom part of the tube (containing the agar)

before you put anything in that culture you will fill out the
label with the patients identification
then you are going to swab the wound: you go from top to
bottom
everything you do in wound care is top to bottom
or cleanest to dirtiest
the cleanest part of the wound is in the center
of the wound itself and then you move away
from it
if you were going for a anaerobic (organisms that live
without oxygen) organism - that one you would have to
rapidly put back into the medium because you dont want

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any oxygen getting into the tube - you dont want to kill it
off before we save it
doctor has ordered a C&S (culture and sensitivity) and he has
ordered an antibiotic; the nursing priority: culture and
sensitivity FIRST before antibiotics are started
the culture has to go down first - REMEMBER THAT
you can get culture in the swabs, the culture can go into
the little containers
all of these go into the specimen bags and then the slip for
the lab goes into a pocket or pouch thats separate from
the pocket that the specimen goes into
Koziers: shouldnt damage the new tissue that is growing; clearly
kind of indicates that if the wound looks clean dont worry about
cleaning it off because youll wipe some of the new granulated
tissue
if the wound has exudate, wipe it off, but dont dry it - leave that
moisture on - the skin could use it as long as it isnt saturated
if you were irrigating a wound, you might put the wicking 4 X 4 in
to get some of the solution thats in that wound and discard that
and just leave a little bit - you wouldnt leave that deep wound
filled with fluid
question: why would a patient have those deep type of wounds
when the skin is healing, if whatever area of the body that the
doctor is doing surgery - if there was a major infection inside,
they would leave a wide open tissue
if the tissue itself was inflamed, they wouldnt want to sew it and
adhere it also - for whatever the reasons are: if you have a
wound that is wide open like that, we pack it because otherwise
what would happen is these two pieces (edges) will seal and you
would end up with an open pocket on the inside of the wound
and thats how you get abscesses and fissures
fissures are just openings - little tracks that run under the skin
you have to make sure that this open pocket fills in and grows
upward and as it grows up you use less packing
if packing you would indicate how much gauze was used generally if you have to use more than 2 gauze in a wound then
you would use something called Kerlix
if you use multiple little 4 X 4s into that deep wound, once
again theres potential that it could slip into the base of the
wound and now has gone unseen and the patient ends up

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with a major, whopping abscess infection and the patient

suddenly has high fever, there is sudden pain, alot of
purulent drainage and everyone is trying to figure out what
happened
patient gets sent down to X-ray for a look and they
end up going back to OR where the doctor just
probes into the wound a little bit deeper and they
find one of these scrunched up 4 X 4s - sometimes
that happens
so if you are packing a wound, if you have to use multiple
pieces, look for something thats one continuous piece and
thats usually Kerlix

you just kind of roll it and pack it in and then it gets slipped
in and then the wound gets covered with a 4 X 4 and then
with an abdominal pad - the usual sterile dressing
procedure

-when you are applying a dressing, you apply it according to the body part
-if you applying a dressing near the buttocks, you have to be conscious about
not close off the rectal area
you have to conscious that the dressing is going to seal and that there
are no feces that is going to ooze up into the wound
sometimes Prof. Saur would see people not thinking and put the
dressing right over the rectum
so you have to be conscious of the area
you also have to be aware of the size of the wound
for example if you have a dipping wound you would use
something called a fluffed 4 X 4 and then you would cover it everything has to be covered
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if the wound sinks in, you would have to be able to

describe that
you would have to say how far it sinks it (approximately)
explanation of slightly dipping wound using trusty
thumbs: circular shaped. approximately 1 inch X 1 inch.
with an indentation of about a inch in the center.
essentially, describe what you are seeing
measure with your thumbs - they are always with
you!

Materials needed for a dressing change:

red biohazard bag used for collecting the old dressing + everything
else
set of 4 X 4
abdominal pad
tape
clean gloves and sterile gloves
Purell(hand sanitizer)
If patient is in pain, give the patient an analgesic before proceeding with the
sterile dressing change
explain to the patient what you are going to be doing
the previous dressing will be in place and the previous person who did
that dressing will have put their initials and the date and the time
when you are putting the date, time and initials, you are putting it on a
separate piece of tape after you have finished taping up the dressing
when you are setting up your working space, you always set up in the order
you are going to be using your supplies:
4 X 4 closest to you and first to be put on the patient
abdominal pad
gloves
purell
tape
-for the biohazard bag, cuff it when you put it on the patients bed (before
starting the sterile dressing) because when it gets filled, you can just grab
onto it from under the cuff and you can close it and your hands dont have to
touch the contaminated portion
the biohazard bag goes away from the patients face
Procedure:

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start off by washing your hands

set up the biohazard bag on the side of the patients bed
make sure your table is above your waist
put on your clean gloves to take of the patients previous dressing
when you are taking the tape off, always work furthest away
from you and then closest to you
reasons:
so you are not cross contaminating things
pick up the old dressing and scoop it and away from the patients
face so that they are not going to see the contents of the
dressing
Goal: to pick up the all of the contents - the 4 X 4s and the
abdominal pad in one scoop
if you cant scoop up all at once then dont worry about it just scoop up what you can and then - pause - and look at
the dressing
you are looking at:
color
COCA
odor
consistency is it thick? is it
watery?
amount
now that you have observed that, you just take it without
touching - drop it into the biohazard bag
now after observing the dressing and discarding the old
dressing, you are now going to observe the wound is it
healing? or is it not?
if it is healing you should expect to see: pink, moist,
maybe the edges are closing
if its not healing, you should expect to see: possibly
some black tissue, some pus, some raw red blood,
maybe a mushy appearance, maybe the edges are
not nicely adhering
take off your clean gloves, and use Purell before putting on
sterile gloves
set up the sterile field
if it happened that the 4 X 4 slipped to the edge, that is
considered contaminated - even though you took it out of a
brand new package - you would have to open a new one
apply the 4 X 4

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once you place the 4 X 4 on the wound you cannot change

its position - you have to be precise
apply the abdominal pad
once the abdominal pad is placed onto the wound the
sterile procedure is over and you can take your gloves off
tape
you dont have to apply tape with your gloves on
you tape the middle one first to anchor it in position
you dont want the tape edges to be too long think
of the patients skin integrity under that tape
you want about inch to an inch - not 3 or 3
inches to the side
it doesnt matter where you go for the next two pieces of
tape
tape according to anatomy
apply the small piece of tape that contains your initials, date and
time on the dressing also
Wet to Dry Dressing (really wet to damp)
an extra set of 4 X 4 essentially 2 sets of 4 X 4s
saline bottle
make sure that it has its label on it (date and the time it has
been opened on it) if it has been opened before
if you opened it, put the date and the time that you have
opened it
only good for 24 hours!!
if you are doing a wet to dry dressing, and it is just with normal saline,
what you can do is, as you are preparing your equipment, the order of
your equipment this time will be:
cleansing 4 X 4 using this first
dressing 4 X 4
abdominal pad
before you put your gloves on, you are going to open all of your
equipment and set up your sterile field
now you are going to take the normal saline, and you are going to tip a
little bit of it in a bag to clean the edge (lip it) if it has been opened
beforehand
saturate the 4 X 4 by pouring the saline onto the package

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now you are ready to do your wet to dry dressing which usually is
packing but it could also be where you are just putting the wet 4
X 4 over it
usually when you take the wet 4 X 4, you pick it up, and fluff it
(make it a little airy) and just sit it on top of the wound thats
what wet to dry really is
fluff the wet 4 X 4 and sit it on top of the wound
put the dry 4 X 4 over the wet 4 X 4
put the abdominal pad over the 4 X 4 and you secure it (tape and label
with your initials, date and time)
purpose of a wet to dry dressing: to draw some of the moisture but also the
moisture - its a way of debriding because as it is drying, the old dead tissue
is adhering to the dressing
-so its going to pick up the dead tissue
-wet to damp makes sense because the dressing should be damp by the time
you come back to take it off
-have to remove the dead tissue before the granulated healthy tissue can
grow
-in addition to that type of debridement (wet to dry), there is the chemical
debridement - the collagenous dressing
-some of them have enzymes and it will deteriorate the tissue that they
want because sometimes what happens is that - especially pressure ulcers its a black leathery piece of skin(eschar) over the wound
-we need to get rid of that eschar - you cant just rip it off because its
like ripping off a scab and it is going to be extremely painful
-so we need to use the chemical debridement
-sometimes the surgeons will come down (as well as the PAs) and they
will come down with the sterile kit and they would use a suture scalpel and
just cut that black piece off - its just dead tissue so they just lift it and cut it
off
-reason: the new tissue is not going to generate until we get rid of the
dead tissue
-if the dressing gets stuck and you have your sterile field set up and you
want to remain sterile you can do that dressing with one hand - if you had to

Return demo: dry sterile dressing

show understanding of asepsis wash your hands, etc

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be organized - bring all of the supplies:

4X4
abdominal pad
red biohazard bag
tape
clean gloves and sterile gloves
Purell (hand sanitizer)
be sure to check the doctors order
describe skin, any drainage, surrounding tissue - mention pain level in
documentation
on tape: date, time, and initials (yours)
two terms we should know:
evisceration: the wound had been in the healing process but there was
some sort of pressure on the wound and then the visceral organs
protrude out
dehiscence: the wound has just burst open but the organs are not
protruding out
your patient will be in extreme pain
if either of these two happen, both are SURGICAL
EMERGENCIES
you would put a sterile dressing over that take your 4 X
4s or your large dressing and saturate it with normal
saline and you would put the saline soaked 4 x 4 over that
area and then put a dressing over it
reason for saline: to keep the visceral organ that is
protruding moist because it shouldnt be exposed to
the air - you dont want it to dry out
while you are doing this someone is calling the surgical
team to come up
most likely the patient is being prepared to go back to the
OR
lay the patient down

Hot and Cold Therapy

doctors will sometimes order heat therapy or cold therapy
these are ways to promote comfort and alleviate pain
non - medication treatment alleviating pain without medication
sometimes we do both for the patient or one or the other

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need a doctors order

Heat - thermotherapy
in general when you apply heat:
increases circulation vasodilation
increases blood flow to that area where the heat is
relaxes the muscle tissue
aids in the healing process because it increases the blood flow to
the area which brings increased oxygen and the white blood cells
to the wound
also aids in soft tissue repair because again the heat therapy
brings increased oxygenation because it is bring increased blood
supply to that area
so there is increased oxygenation into the tissue in that
area, increased nutrients to that area
not used for acute inflammatory phase of a musculoskeletal
injury(like a sports injury) you apply cold to a sprained ankle
for the first 24 hours to decrease the swelling(ice off and on) and
then after that edema - that initial trauma has gone down, then
you can start applying the heat for the muscle relaxation
purpose
used more for chronic inflammation but not trauma
ex: arthritis
blocks the transmission of pain - has sort of a sedative effect
heat therapy applications: remember to use a barrier between
that application and the skin never put it directly on the skin
moist heat amplifying the intensity
leave heat on for 15 to 20 minute intervals put it
on and then take it off and then evaluate the skin
integrity
leave it off for awhile until the patient is
uncomfortable and then you put it back on again
never put any type of heating device in the
microwave because you cant regulate the
temperature that you are going to have
what you can do is: turn the faucet on and you hold
your water bottle under the hot water and then as
you pour the water out, you can check and see if its
at the temperature you want it to be
so heat the water in the sink

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after applying you want to observe the color of the

skin because when you take it off you would expect it
to be red and warm called hyperemia because of
its an increase of the blood flow to the area
Sitz Bath
apply warm water into the bag that hangs at the
bedside and the end portion sits in the pan and the
patient literally sits into the pain
its usually for:
hemorrhoids surgery
perineal issues
women who have just given birth

How Heat Is Transferred:

Conduction
transfer from hot to cold
ex: putting a hot pad or a cold pad on the skin
Radiation
exchange of heat through the air without any intervening
medium
ex: heat lamp - used to be used on pressure ulcers
ex: radiator
Convection
heat is transferred by contact in a circulating motion by either a
gas or a fluid
ex: whirlpool
ex: aquathermic pad
Evaporation
transfer of heat by the liquid converting to vapor
ex: when patient is running a fever and so you give them a
tepid bath
ex: on a hot, hot, day you spray yourself with moisture - a
cool moisture

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Cold therapy - Cryotherapy

diverts the circulation away from that area its going to constrict (its
going to slow it down)
vasoconstriction: decreases blood supply which then causes
paleness to the skin
if you have profuse bleeding going on, you would apply cold
reduces edema
helps to increase pain threshold - be careful because if the patient is
numb, they are risk for other types of damage
can only stay on for 15 to 20 minute intervals
area that had the cold compress put on it should remain a lower
temperature for 1 to 2 hours after - unlike with heat therapy whereas
soon after the temperature goes back to normal
use if for pain relief
controls hemorrhaging
slows inflammatory process because its slowing the metabolism slowing circulation
you put cold in that area, it's going to slow everything
cold feeling has 4 stages
feel the cold stage 1
then feel a tingling/stinging stage 2
feel almost like a burning sensation stage 3
numbness stage 4

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if your patient is complaining of numbness and its not 15

minutes, you are going to take that cold compress off of
the patient at that time
essentially if they complain of numbness before the
15 minutes are up because thats where tissue
damage occurs because there is no blood supply
flowing to the area that you are working on

Methods of Cold Therapy Application

ice pack or gel pack
chemical cold pack - has to be activated
can put ice chips in a glove wrapped in a washcloth for local areas acts like a makeshift ice pack
cold sponge bath - tepid not hot but its not cold
cooling blanket
can be used to bring a temperature down but then we can use it
for the other extreme - bringing temperatures up
essentially: can be used for hypothermia or hyperthermia can be used either way
-patient coming in with stroke-like symptoms: it has been found that
hypothermia improves the strokes outcome because it decreases
circulation and metabolism so it decreases having the stroke itself
-hypothermia improves the chances of surviving a stroke because if you use
hypothermia on a patient who is having an impending stroke(ischemia), it
reduces the damage of the stroke because its reducing the metabolism
for either of these two therapies, if it is put on for a long period of time it
may affect the blood pressure so you have to be conscious of that
selection of hot or cold therapy depends on:
nature of the injury
the age of the client
who has sensitive skin: the elderly and the babies
people who might be immunosuppressed - their skin
might be fragile
people who are on steroids - their skin might be
fragile
you want to be concerned about the skin integrity before
you apply heat and cold
sensory impairments of the patient:

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the

patients who have issues with their spine - some sort of

spinal trauma
diabetics and neuropathy of the feet
someone who is not responsive - unconscious
patients who have had a stroke and have paresis
paraplegics cant move at all
they would not be able to tell you about whether its
too hot or too cold so you would have to be careful
with that
area of the body
certain parts of the skin are more sensitive than other
parts
have to be conscious of the length of time of the treatment
you are leaving in

Surgical Asepsis Lab