ADMINISTER A WHIRLPOOL TREATMENT
1. Body area to be treated
NOTE: The type of bath used for the treatment will be based on the client's injury or disability.
B. Gather Materials and Equipment
1. Whirlpool bath with accessories
2. Cleaning materials
5. Hydrotherapy chair with safety belt
7. Sterile towels
8. Sterile gloves
C. Prepare the Whirlpool Bath
1. Select the appropriate whirlpool bath. (See figure)
a. Arm whirlpools are prescribed
(1) To treat upper limb
(2) For full body immersion of small children
(3) To treat below the knee
(4) For head and face
b. Leg whirlpools are prescribed to treat lower limbs. A stool or specially designed sling can be placed inside the tub to immerse adults up the axilla.
c. Lowboy (a long, low whirlpool bath) is used to immerse the body when the lower limbs must not hang down.
NOTE: If a lower extremity is to be treated in the arm or leg whirlpool baths, a hydrotherapy chair with safety belt must be used.
NOTE: If hydrotherapy chair has wheels, ensure they are locked during the procedure.
D. Clean the whirlpool
E. Fill the whirlpool with water
NOTE: Use the appropriate water temperature prescribed below.
Water Temperatures for Hydrotherapy Guidelines
NOTE: If the temperature of the water is not indicated, use a temperature from 100 to 105 degrees F.
CAUTION: If the client has a peripheral vascular disease or a sensory loss, the temperature should not exceed 100 degrees F.
a. Add any medications or special solutions, if prescribed
b. Ensure turbine ejector power switch is in the "OFF" position
c. Plug the power cord into an approved electrical outlet
F. Explain the procedure to the client
The following information is provided to the client:
1. The client's area to be treated will be immersed into the water for 15 to 20 minutes.
2. The heat (if warm or hot water is used) and motion of the water increases circulation, will clean the area of the body, and cause relaxation throughout the entire body.
NOTE: Tell the client to report immediately any increase of pain or discomfort, as well as any sensation of nausea, difficulty breathing or weakness.
G. Prepare Client for Treatment
1. Instruct the client in the disrobing and gowning procedures appropriate for the body area to be treated. Provide the client with a gown or swim trunks, if indicated. Assist the client as appropriate.
NOTE: Provide a female chaperon, as appropriate, for female clients receiving treatment to the chest, trunk, or perineum.
2. Remove bandages, dressings, braces, or splints, carefully and cautiously, if applicable.
CAUTION: Provide adequate support during the treatment and during transfer of the body part when a brace or splint has been removed.
3. If open wounds are present, use a sterile technique when handling the area.
H. Visually Inspect Treatment Area
NOTE: Determine the presence of infection, edema, lesions, fever, circulatory disturbances, recent skin grafts, or other adverse conditions which may require additional precautions.
NOTE: If any condition is observed that has not been identified on the client's treatment care, consult the PT for guidance and record your observations on the referral. Also, record any additional instructions you receive from the PT.
I. Initiate Treatment
CAUTION: Ensure the floor area around the whirlpool bath is dry before and after transfers to avoid accidental slipping.
1. Instruct the client to immerse the body part to be treated into the water to be desired depth.
a. When treating an arm, place a folded towel over the rim of the tub to avoid pressure in the axilla.
b. When treating a leg, support the unaffected leg by allowing the foot to rest on a stool.
2. Position the agitator so that the stream of water will not strike an open wound, a sensitive area, a recent graft, or a fracture site that is not well healed.
CAUTION: Warn the client to keep away from the suction of the agitator.
3. Turn on the turbine ejector to the desired degree of agitation using the client's tolerance as a guide. The water flow should be comfortable for the client, yet strong enough to adequately treat the area.
4. Encourage range of motion (ROM) to the affected body part, if prescribed.
5. Set a timer for the treatment time from 15 to 20 minutes, according to the instructions on the client's treatment card.
6. Continuously monitor the client's response throughout the treatment by -
a. Checking the client's facial expression
b. Observing respirations
c. Asking how the client is tolerating the treatment.
NOTE: If the client is being treated in the Lowboy tank, the pulse and respirations should be checked periodically.
CAUTION: Do not leave the client unattended at any time during the treatment period.
7. If wound debridement is prescribed, it should be performed at this portion of the treatment using sterile technique in handling the client and wound.
J. Discontinue Treatment when Timer Alarm Sounds
Turn off the turbine ejector. Instruct the client to remove the body part from the water or assist the client out of the tub. Obtain additional assistance if the Lowboy tank is used or if the client was seated up to the axilla in the leg tank with a seat.
K. Don Sterile Gloves
L. Dry the Treated Area
NOTE: Use sterile towels if open wounds were treated.
M. Inspect the Treated Area
NOTE: Report any adverse reaction or unusual condition to the PT and record your observations on the client's referral.
N. Replace Bandages, Dressings, Braces, or Splints, if Applicable
O. Assist the Client to Redress, as Needed
P. Drain the Whirlpool Bath
NOTE: Remove electrical plug from wall outlet.
CAUTION: Ensure hands are dry before pulling wall plug.
Q. Provide Client Instruction for additional Care
Instructions should include:
1. ROM exercises
2. Strengthening exercises
3. Home treatments and/or return visits
NOTE: If the client is being treated in more than one clinic area, return times should be coordinated between the other clinics and ward (if applicable).
R. Record Appropriate Notes and Observations
NOTE: Ensure that progress notes are up-to-date and reflect the client's current condition.
S. Clean the Whirlpool
CLEAN A WHIRLPOOL BEFORE OR AFTER TREATMENT
A. Prepare the Area and Tank
1. Visually inspect the whirlpool tank for any matter or debris
2. Ensure the tank has a working thermometer
3. Dry wet floor areas with towels
4. Ensure the tank drain plug is open.
B. Gather Materials for Cleaning
1. Sanitary brush
2. Client examining gloves (disposable)
3. Waste receptacles
4. Germicidal disinfectant
5. Cloth towels
C. Rinse the Tank
1. Open the hot water (above 100 degrees F) valve to the fullest setting.
2. Use a sanitary brush to scrub all upright surfaces of the tank; the inner walls, shaft housing tube, thermometer, and any additional support devices (such as seat or cradles). Ensure to clean the area around the thermometer and turbine shaft housing tube.
NOTE: Raise and adjust the position of the motor unit to rinse, as needed.
3. Turn the water off.
4. Remove any foreign matter using gauze and a gloved hand. Dispose of any material in the appropriate waste receptacle.
D. Clean the Tank
1. Ensure the switch on the motor is in the "OFF" position.
2. After the whirlpool treatment, clean the tank before unplugging.
3. Close the drain plug.
4. Fill the tank approximately one-third to one-half full with hot water.
5. Lower the shaft housing into the tank and secure it in the down position.
6. Turn the motor switch to the "ON" position.
7. Adjust the water agitator control handle and the aerator control knob to a moderate, not forceful setting.
8. Add germicidal disinfectant to the tank
a. Arm tank - 2 ounces
b. Leg tank - 4 ounces
c. Lowboy tank - 6 ounces
NOTE: Adjust the water agitator handle and the aerator control knob, as needed, to prevent water jet overflow or excessive sudsing.
NOTE: If excessive sudsing occurs, use isopropyl alcohol to decrease the effect.
9. Use a sanitary brush to scrub all upright surfaces of the tank, the inner walls, shaft housing tube, thermometer, and any additional support devices (such as seats or cradles).
10. Continue scrubbing for 3-5 minutes, adjusting the motor assembly to gain access to hard to get to areas, as appropriate.
11. Turn the motor control to the "OFF" position.
CAUTION: Dry your hands completely, and then unplug the power cord. Drape the cord as appropriate. Do not allow the outlet to lie on the ground.
12. Open the drain plug. Let the tank drain, then close the drain.
13. Rinse the tank again with hot water and then crush to remove all suds and residue. Open the drain plug.