MODULE

HOT MOIST PACK (HMP)

Definition

-Hot packs are superficial heating agents that transfer heat to the body via conduction where they are in contact with the skin surface to which they are applied.(Michlovitz, Hecox, et.al.)

- It consists of canvas or nylon cases, filled with a hydrophilic silicate or sand. The hydrophilic silicate absorbs a large quantity of water and has a high heat capacity.

- It is stored in a hydrocollator tank, a thermostatically controlled cabinet, at a temperature between 70’C and 75’C (158’F and 165’F)by Michlovitz, while 73.9’C – 79.4’C (165’F and 175’F)by Hecox, and 160 – 170’F by Tyrone Reyes, MD.

- By Hecox, new packs should be left in the tank for at least 24 hours to absorb as much moisture as possible and achieve the desired temperature.

- by Tyrone Reyes and Ofelia Reyes, the unit should be cleaned once a month. This is done by draining the tank and cleaning it with mild soap and hot water.

- Hot packs are applied over layers of towels, usually 8 layers for 20-30 minutes.

- Between treatments, the packs should be left in the tank for at least 20-30 minutes.

- The patient should only feel a mild to moderate sensation of heat during the application.

- During the application, the therapist is advisable to check hot pack every 5 minutes to detect the skin color and patient’s subjective feelings about the amount of heat being perceived.

- According to Hecox, the temperature of a hot pack drops quickly once the pack is removed from the tank. Therefore, the more quickly the pack is covered and placed on the patient, the warmer it will be during the treatment.

By Michlovitz:

Advantages of Using Hot Packs

1. Ease of preparation and application.

2. Variety of shapes and sizes available.

3. Moist, comfortable heat

4. Relatively inexpensive to purchase and replace.

Disadvantages of Using Hot Packs

1. No method of temperature control once applied to patient.

2. Do not readily conform to all body parts.

3. Sometimes awkward to secure in place on a patient.

4. Do not retain for longer than about 20 minutes.

5. It is a passive treatment, not requiring active patient participation.

6. Leaking hydrophilic or gel packs must be discarded.

By Hecox

Procedures:

1. By using a metal or wooden tongs, remove the hot pack from the tank. Allow the excess water to drop off and place or cover it with a terry cloth or towel (usually 6 – 12 layers). Additional toweling maybe necessary, depending on the patient’s physical condition and heat tolerance.

2. Place the pack on the appropriate body area and if necessary by the use of Velcro straps, secure it firmly to prevent it from slipping off the area.

3. The patient should then be properly draped with a sheet to prevent chill if the air in the room is cool.

4. Always provide the patient with a method of calling when they feel any discomfort. Explain to the patient that if the therapist is not immediately available and he feels too uncomfortably, the patient can remove the hot pack.

5. The patient’s skin should be inspected after 5 minutes to ensure that no extremely hot red areas or burns occurred.

6. It is advisable to have timers in each treatment room so that the duration of treatment can be monitored.

POST TREATMENT PROCEDURE:

1. Dry and inspect the patient’s skin.

2. Replace the drape sheet or clothes to avoid the patient’s becoming chilled.

3. Replace the pack in the tank.

4. Hang the covers and toweling to dry.

5. Put the towel layer that was next to the patient’s skin in the laundry hamper.

INDICATION:

By HECOX:

1. used before or in conduction with other techniques like before traction, massage, ROM exercise and etc, to achieve relaxation and sedation.

By MICHLOVITZ:

1. used to reduce pain and muscle spasm

2. help improve tissue extensibility / ROM

CONTRAINDICATION:

By HECOX:

1. Local infection

2. Dermatologic conditions

By Tyrone Reyes, MD:

1. Skin eruptions at the site of application.

2. Desensitized skin.

3. Peripheral vascular diseases.

4. Scars and new skin.

PRECAUTIONS

1. Do not let the patient to sleep during the treatment.

2. Check the sin of the patient every 5 minutes.

3. Make sure that the patient is aware.

4. If the patient can’t tolerate hot packs, used other superficial heating modality.

5. Don’t let the patient sit or lie on a hot pack.

TYPES of HMP

Hot Packs are designed to fit every contour of the body. The hot packs can be used in many types of pain management and therapy. These packs provide up to 35 minutes of deep soothing therapeutic moist heat.

1. Standard: 10” x 12”

2. Neck Contour: 24” x 6 ½”

3. Half: 5” x 12”

4. Oversize Pack: 15” x 24”

5. Special Eye-Size 2

6. Knee / Shoulder Hot Pack

7. Hand SizE Hot Pack

8. 10" x 24" Hot Pack

9. 10" x 18” Hot Pack

Other equipment in this application:

1. Standard Hot pack Terry Cloth cover

It is constructed with 4 layers of all terry cloth material to withstand repeated machine washing and drying. Hot pack terry covers come in whisper gray color. Standard Hotpack Terry Covers are washable and reusable.

2. Hand Contour Hot Pack Terry Cover

The Hand Contour Hot pack Terry Cover is constructed with 4 layers of all terry material to withstand repeated machine washing and drying. Hand Contour 11" x 14"

3. Hot Pack Cover Drying Rack

- a convenient way to dry your hotpack covers.

4. Folding Hot Pack Cover Rack

- Space saving rack for drying your hotpack covers.

- This wall mount rack has a stainless steel base and 6 folding hooks.

5. Stainless steel hotpack tongs.

6. Hydrocollator Heating Unit – a stainless steel water tight container with

a thermostat, pack holders or rack and insulation. It must be grounded.

SPECIAL PRODUCTS of Gel packs:

It can either be used as Hot / Cold pack. Heat in the Microwave or Cool in the

Freezer. It has a frost free cover and soft texture. Perfect for those bumps or scrapes. You can use it to treat strains, sprains, tendonitis, and other injuries that require cold or hot therapy. It is non toxic and biodegradable gel.

1. Gel Pack 6 x 20-perfect for you neck and upper back

2. Gel pack 3x5 ice and hot pack for small areas of the body like elbow and wrist.

3. Gel pack 6 x 10 in dimensions for those small-medium focused areas of the body like a shoulder or hip.

4. Gel pack 10x13 in dimension for those large focused areas of the body like your lower back or upper back.

5. Trisectional Gel Packs 9x16 in dimension for those hard to reach areas of the body like your neck and upper back.

FLUIDOTHERAPY

- A superficial heating/ dry heat agent that transfer heat energy by CONVECTION (a transfer of heat energy through fluid).

- Fluidotheraphy system uses air-fluidized small solids particles as the heat-transfer medium and suspended by circulating air, thus producing an effect similar to circulating warm liquid.

- According to HECOX, The thermal conductivity and specific heat of the particles and air allow the temperature of the unit to be higher than that of water used therapeutically. With this, the patient can safely tolerate a higher temperature.

- To MICHLOVITZ, the combination of air- flowing around the high surface area of the finely divided particles, and the bulk movement of solids produces high heat fluxes and uniform temperatures throughout, thus providing massaging action, sensory stimulation, and levitation.

-for Michlovitz, the Fluidotherapy temperature range of 39’C to 48’C (1102.2’F – 118.4’F) while for Hecox, temperature range of 46.1’C to 50.6’C (115’F – 123’F)

- the duration treatment is usually 20 minutes.

ADVANTAGES:

BY MICHLOVITZ:

1. Convenient, easy to administer.

2. Temperature of application can be controlled.

3. Agitation of dry particles can be controlled for comfort.

4. Variety of sizes of units allows for most body areas to be treated.

5. Allows for some active exercise to be carried out during treatment.

6. Dry, comfortable heat.

7. Can be used for desensitization of hypertensive hand/ finger(s) or foot/toe(s).

By Hecox:

1. The circulating, air-blown, warmed particles give the patient feeling of lightness and surrounding warmth.

2. The limb is free to move, active exercise is possible.

3. The therapist can insert his hand through a separate access sleeve to perform PROM (passive range of motion) or stretching procedures or to assist the patient exercise.

4. Can tolerate high temperature than other superficial heating modalities.

5. Circulating particles can surround even parts.

DISADVANTAGES

By MICHLOVITZ:

1. Relatively expensive modality.

2. Intolerance of some patients to enclosed container (claustrophobic feeling).

3. Intolerance of some patients to dry material used

By Hecox:

1. The limb units are too small to accommodate more than a distal limb: thus, they cannot be used to treat a back, hip, or shoulder.

2. Open wounds cannot be treated unless they are protected.

Technique of Application

Before initiating the following procedures, the therapist must inspect the part for skin integrity, good circulation, and sensitivity to heat:

Procedure:

1. Wash and dry the part to be treated because other patient will be using the same container.

2. Remove all jewelry from the part being treated.

3. Check the part for open wounds. If present, cover the wound.

4. Insert the part into the sleeve and close it snugly around the more proximal portion of the limb so that the particles do not come out once the blower is turned on.

5. Set the thermostat at the desired temperature, depending on the patient’s tolerance.

6. Turn the timer on.

7. Instruct the patient about how to exercise or stretch during the treatment.

POSTTREATMENT PROCEDURE

1. After the treatment, loosen the sleeve.

2. Before removing the limb from the unit, help the patient remove all the particles so the treatment area remains clean.

3. Inspect the once again and continue to other treatment.

INDICATION

Decrease pain Increase mobility Desensitize skin/scar increases circulation

CONTRAINDICATION

Severe circulatory obstruction disorders (i.e. arterial, venous, or lymphatic disorders) Systemic infectious diseases (fluidotherapy treatment may increase core body

temperature and thus contribute to a fever)

PRECAUTION

over malignancies Open wounds. A light, non occlusive dressing should be used to prevent the particles

from contaminating the wound. Severely impaired skin sensation

FLUIDOTHERAPY UNIT

1. The FLU110D Fluidotherapy Unit is designed to treat single extremities including the hand, wrist, elbow, foot & ankle. Holds 30 lbs of CELLEX media, a small solid particles.

2. The FLU115D Fluidotherapy Unit is designed to treat up to two hands or two feet independently or at the same time. Removable from stand for easier access in lower extremity applications. A double extremity unit holds 40 lbs (18.1kgs) of CELLEX media.

3. FLU210D Fluidotherapy Unit is a large single extremity Fluidotherapy unit. For one knee, hand, elbow, ankle or foot. It incorporates pulse mode. Holds 60 lbs (27kgs) of CELLEX media.

SUMMARY OF HOT PACK AND FLUIDOTHERAPY

HOT PACK FLUIDOTHERAPY

Type of Heat Moist Heat Dry Heat

Composition canvas or nylon cases, filled with a hydrophilic silicate or sand

air-fluidized small solids particles

Temperature maintained 70’C and 75’C (158’F and 165’F)by Michlovitz

73.9’C – 79.4’C (165’F and 175’F)by Hecox

160 – 170’F by Tyrone Reyes, MD.

39’C to 48’C (1102.2’F – 118.4’F) by Michlovitz

46.1’C to 50.6’C (115’F – 123’F) by Hecox

Duration 20 minutes 20 minutes

Machine Hydrocollator Tank Fluidotherapy Unit

TYPES 1. Standard

2. Neck Contour

3. Half Pack

4. Oversize Pack

5. Special Eye-Size Pack

6. Knee or Shoulder Pack

1. FLU110D

2. FLU115D

3. FLU210D

Indication used before or in conduction with other techniques like before traction, massage, ROM exercise and etc, to achieve relaxation and sedation.

used to reduce pain and muscle spasm

help improve tissue extensibility / ROM

Decrease pain Increase

mobility Desensitize

skin/scar increases

circulation

CONTRAINDICATION Local infection

Dermatologic conditions

Skin eruptions at the site of application.

Desensitized skin.

Severe circulatory obstruction disorders (i.e. arterial, venous, or lymphatic disorders)

Systemic infectious diseases (fluidotherapy treatment may increase core body temperature and thus

Peripheral vascular diseases.

Scars and new skin.

contribute to a fever)