Wound bed preparation has been performed for decades in managing wounds of various etiologies. The wound healing process consists of a complex interlinked and independent cascade, which not all wounds follow in a consistent, organized manner. The TIMERS acronym, consisting of four general steps...
By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
Whirlpool therapy, or hydrotherapy, is one of the oldest adjuvant forms of treatment for wounds still in use today. It was originally used in pain management, but later found a use in wound management, particularly in the management of burn patients.
It is now commonly used to facilitate debridement in infected wounds, non-draining wounds, wounds with thick eschar, and on wounds with loosely adherent necrotic tissue or thick exudate. Typically, whirlpool therapy is used in 20 to 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 long-term use.
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.
Despite the popularity and wide use of whirlpool therapy, as well as the abundance of anecdotal evidence concerning its benefits, there is actually a lack of evidence from prolonged clinical trials demonstrating its efficacy. 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 the benefits of whirlpool therapy and further investigate 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 an expert in many key areas.
1. Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
2. 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.
3. Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003861.
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.