section name header

Introduction ⬇

Heat applied directly to the patient’s body raises tissue temperature and enhances the inflammatory process by causing vasodilation and increasing local circulation, which promotes leukocytosis, suppuration, drainage, and healing. Heat also increases tissue metabolism; reduces pain caused by muscle spasm, muscle strains, or minor aches and stiffness; and decreases congestion in deep visceral organs.1

Direct heat may be dry or moist. Dry heat can be delivered at a higher temperature and for a longer time than moist heat. Devices for applying dry heat include the hot-water bottle, electric heating pad with or without circulating water, and chemical hot pack.2

Direct moist heat softens crusts and exudates, penetrates deeper than dry heat, is less drying to the skin, produces less perspiration, and is usually more comfortable for the patient.2 Devices for applying direct moist heat include warm compresses for small body areas and warm packs for large areas.

Direct heat application can’t be used on a patient at risk for hemorrhage. It also is contraindicated if the patient has a sprained limb in the acute stage (because vasodilation would increase pain and swelling) or a condition associated with acute inflammation, such as appendicitis. Direct heat should be applied cautiously to pediatric and older adult patients2 and to patients with impaired kidney, cardiac, or respiratory function; arteriosclerosis or atherosclerosis; impaired sensation; diabetes; or a spinal cord injury. It should be applied with extreme caution to heat-sensitive areas, such as scar tissue and stomas. Don’t apply heat to an open wound after trauma, to inflamed or edematous areas, to a localized malignant tumor, to the testes, to the abdomen of a pregnant woman, or over metallic implants.2

NURSING ALERT Don’t apply direct heat over a fentanyl transdermal system or its surrounding area, because an increase in temperature increases fentanyl release from the system, which may result in overdose and death.3

Equipment ⬆ ⬇

Equipment

Vital signs monitoring equipment • watch, clock, or timer • Optional: gloves, towel, sterile towel, dressings, adhesive tape, or roller gauze.

For a Hot-Water Bottle

Hot-water bottle • hot tap water • pitcher • bath (utility) thermometer • absorbent, protective cloth covering.

For an Electric Heating Pad

Electric heating pad • absorbent, protective cloth covering or heating pad cover.

For a Chemical Hot Pack (Disposable)

Chemical hot pack • protective cloth covering.

For a Warm Compress or Pack (Sterile or Nonsterile)

Warm compress or pack • basin or sink of hot tap water • container of sterile water, sterile normal saline solution, or prescribed solution • sterile bowl or basin • fluid-impermeable pad • sterile or nonsterile bath (utility) thermometer • waterproof trash bag • sterile or nonsterile waterproof covering • Optional: sterile forceps, clean container, hot-water bottle or chemical hot pack.

Preparation of Equipment ⬆ ⬇

Preparation of equipment

Inspect all equipment and supplies. If a product is expired, is defective, or has compromised integrity, remove it from patient use, label it as expired or defective, and report the expiration or defect as directed by your facility.

Hot-Water Bottle

Fill the bottle with hot tap water to detect leaks and warm the bottle; then empty it. Run hot tap water into a pitcher and measure the water temperature with the bath (utility) thermometer. Adjust the temperature as ordered, usually to 115° to 125° F (46.1° to 51.7° C) for adults.

PEDIATRIC ALERT Adjust water temperature to between 105° and 115° F (40.6° to 46.1° C) for children younger than age 2.

ELDER ALERT Adjust water temperature to between 105° and 115° F (40.6° to 46.1° C) for older adult patients.

Next, pour hot tap water into the bottle, filling it one-half to two-thirds full. Partially filling the bottle keeps it lightweight and flexible to mold to the treatment area. Squeeze the bottle until the water reaches the neck to expel any air that would make the bottle inflexible and reduce heat conduction. Fasten the top and check the bag for leaks. Place the bag in an absorbent cloth covering, and secure the cover with tape or roller gauze.

Electric Heating Pad

Check the cord to ensure it is not frayed and doesn’t have damaged insulation. Then plug in the pad and adjust the control switch to the desired setting. Wrap the pad in an absorbent, protective cloth covering, and secure the cover with tape or roller gauze. If the pad comes with its own cover, inspect the cover and fasteners to ensure that all are intact. Follow the manufacturer’s instructions for use for an electric heating pad that circulates water.

Chemical Hot Pack

Select a disposable pack of the correct size. Then follow the manufacturer’s directions (strike, squeeze, or knead) to activate the heat-producing chemicals. Place the pack in a protective cloth covering and secure the cover with tape or roller gauze.

Sterile Warm Compress or Pack

Warm the container of sterile water or another solution (sterile normal saline solution or prescribed solution) by setting it in a sink or basin of hot tap water. Measure its temperature with a sterile bath (utility) thermometer. If a sterile thermometer is unavailable, pour some heated sterile solution into a clean container, check the temperature with a regular bath thermometer, and then discard the tested solution. Adjust the temperature by adding hot or cold tap water to the sink or basin until the solution reaches 120° F (48.9° C) for 
adults.

PEDIATRIC ALERT Adjust the water temperature to 100° F (37.8° C) for children or for an eye compress.

ELDER ALERT Adjust the water temperature to 100° F (37.8° C) for older adult patients or for an eye compress.

Pour the heated sterile solution into a sterile bowl or basin. Then, using sterile technique, soak the compress or pack in the heated solution and wring out excess solution while maintaining sterility. If necessary, prepare a hot-water bottle or chemical hot pack to keep the compress or pack warm.

Nonsterile Warm Compress or Pack

Fill a bowl or basin with hot tap water, normal saline solution, or prescribed solution and measure the temperature of the solution using a nonsterile bath (utility) thermometer. Adjust the temperature as ordered, usually to 120° F (48.9° C) for adults.3

PEDIATRIC ALERT Adjust the water temperature to 100° F (37.8° C) for children or for an eye compress.

ELDER ALERT Adjust the water temperature to 100° F (37.8° C) for older adult or for an eye compress.

Soak the compress or pack in the hot liquid and wring out excess liquid. If necessary, prepare a hot-water bottle, K pad, or chemical hot pack to keep the compress or pack warm.

Implementation ⬆ ⬇

Implementation
  • Verify the practitioner’s order if needed.
  • Gather and prepare the necessary equipment and supplies.
  • Perform hand hygiene.4,5,6,7,8,9
  • Confirm the patient’s identity using at least two patient identifiers.10
  • Provide privacy.11,12,13,14
  • Explain the procedure to the patient and family (if appropriate) according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation.15 Tell the patient not to lean or lie directly on the heating device, because direct contact reduces air space and increases the risk of burns. Warn the patient against adjusting the temperature of the heating device or adding hot water to a hot-water bottle. Advise the patient to report pain immediately and to remove the device if necessary.
  • Make sure the room is warm and free of drafts.
  • Raise the bed to waist level before providing care to prevent caregiver back strain.16
  • Perform hand hygiene.4,5,6,7,8,9
  • Put on gloves or sterile gloves as needed to comply with standard precautions.17,18,19
  • Obtain the patient’s temperature, pulse, and respirations to serve as a baseline for comparison. If direct heat treatment is being applied to raise the patient’s body temperature, monitor the patient’s temperature, pulse, and respirations throughout the application.
  • Expose only the treatment area, because vasodilation will make the patient feel chilly.
  • Assess the treatment area for open lesions, edema, bleeding, and evidence of altered circulation, because the risk of damage to tissue is increased if the area is already traumatized.

Applying a Hot-Water Bottle, an Electric Heating Pad, or a Chemical Hot Pack

  • Before applying the heating device, press it against your inner forearm to test its temperature and heat distribution. If it heats unevenly, obtain a new device.
  • Apply the device to the treatment area and, if necessary, secure it with tape or roller gauze. Begin timing the application.
  • Assess the patient’s skin condition frequently; remove the device if you observe increased swelling or excessive redness, blistering, maceration, or pallor, or if the patient reports discomfort. Refill the hot-water bottle as necessary to maintain the correct temperature.
  • Remove the device after 20 to 30 minutes, or as ordered.

Applying a Warm Compress or Pack

  • Place a fluid-impermeable pad under the treatment area.
  • Remove the warm compress or pack from the bowl or basin. (Use sterile forceps throughout the procedure to maintain sterility, if needed.)
  • Wring excess solution from the compress or pack. Excess moisture increases the risk of burns.
  • Apply the compress or pack gently to the treatment area. After a few seconds, lift the device and check the skin for excessive redness, maceration, or blistering. When you’re sure the compress or pack isn’t causing a burn, mold it firmly to the skin to prevent air from reducing the temperature and effectiveness of the warm compress or pack. Work quickly so the compress or pack retains its heat.
  • Apply a waterproof covering (sterile, if necessary) to the warm compress or pack. Secure it with tape or roller gauze to prevent it from slipping.
  • Place a hot-water bottle or chemical hot pack and waterproof covering over the compress or pack to maintain the correct temperature. Begin timing the application.
  • Assess the patient’s skin at regular intervals. Remove the heating device if you observe excessive redness, maceration, or blistering, or if the patient experiences pain or discomfort. Change the compress or pack as needed to maintain the correct temperature.
  • After 15 or 20 minutes, or as ordered, remove the device.

Completing the Procedure

  • Dry the patient’s skin with a towel (sterile, if necessary), as needed. Note the condition of the skin and redress the area, if necessary. Obtain the patient’s temperature, pulse, and respirations to compare with the baseline. Then make sure the patient is comfortable.
  • Return the bed to the lowest position to prevent falls and maintain patient safety.20
  • Discard used supplies in appropriate receptacles.19
  • Remove and discard your gloves, if worn,19 and perform hand 
hygiene.4,5,6,7,8,9
  • If the treatment is to be repeated, store the equipment in the patient’s room, out of reach; otherwise, return it for proper cleaning and disinfection.21,22
  • Document the procedure.23,24,25,26

Special Considerations ⬆ ⬇

Special considerations
  • Make sure that closure devices aren’t in direct contact with the skin, because they may cause burns.
  • If the patient has decreased sensation because the patient is unconscious, anesthetized, cognitively or neurologically impaired, or insensitive to heat, stay with the patient throughout the treatment and inspect the skin frequently, because thermal burns may occur.2
  • When direct heat is ordered to decrease congestion in internal organs, the application must cover a large enough area to increase blood volume at the skin’s surface.2 For relief of pelvic organ congestion, for example, apply direct heat over the patient’s lower abdomen, hips, and thighs. To achieve local relief, you can concentrate heat only over the specified area. (See Using moist heat to relieve muscle spasm.)
  • As an alternative method to apply a sterile moist compress or pack, use a bedside sterilizer to sterilize the compress. Saturate the compress with tap water or another solution and wring it dry. Then place the compress in the bedside sterilizer at 275°F (135°C) for 15 minutes. Remove the compress with sterile forceps or sterile gloves, and wring out the excess solution. Then place the compress in a sterile bowl, measure its temperature with a sterile thermometer, and allow it to cool to 120° F (48.9° C). Follow the manufacturer’s instructions for heating compresses, and avoid overheating.

Patient Teaching ⬆ ⬇

Patient teaching

If direct heat application will continue at home, teach the patient and family (if appropriate) how to use the equipment and check the equipment for safety concerns. Also, teach the patient and family to check the patient’s skin at regular intervals for signs and symptoms of excessive exposure to heat.

Complications ⬆ ⬇

Complications

Heat application can cause burns. Electrical shock may occur from improper use of an electric heating pad.

Documentation ⬆ ⬇

Documentation

Record the time and date of direct heat application; the type, temperature or heat setting, duration, and site of application; the patient’s temperature, pulse, respirations, and skin condition before, during, and after treatment; and the patient’s tolerance of the treatment. If complications occur, document the name of the practitioner notified, the date and time of the notification, prescribed interventions, and the patient’s response to those interventions. Document teaching provided to the patient and family (if applicable), their understanding of that teaching, and any need for follow-up teaching.

References ⬆

  1. PetrofskyJ., et al. (2013). Moist heat or dry heat for delayed onset muscle soreness. Journal of Clinical Medicine Research, 5, 416–425. (Level VI)
  2. CravenR. F., et al. (2021). Fundamentals of nursing:

    Concepts and competencies for practice

    (9th ed.). Philadelphia, PA: Wolters Kluwer.
  3. Janssen Pharmaceuticals, Inc. (2021). Duragesic® (fentanyl transdermal system) prescribing information. http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/DURAGESIC-pi.pdf
  4. Accreditation Association for Hospitals and Health Systems. (2020). Standard 07.01.21. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  5. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Infection control. 42 C.F.R. § 482.42

    .
  6. The Joint Commission. (2021). Standard NPSG.07.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  7. Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in health-care settings:

    Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

    . MMWR Recommendations and Reports, 51(RR-16), 1–45. https://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf (Level II)
  8. World Health Organization. (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge, clean care is safer care. https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1 (Level IV)
  9. DNV GL-Healthcare USA, Inc. (2020). IC.1.SR.1. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  10. The Joint Commission. (2021). Standard NPSG.01.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  11. Accreditation Association for Hospitals and Health Systems. (2020). Standard 15.01.16. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  12. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Patient’s rights. 42 C.F.R. § 482.13(c)(1)

    .
  13. DNV GL-Healthcare USA, Inc. (2020). PR.2.SR.5. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  14. The Joint Commission. (2021). Standard RI.01.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  15. The Joint Commission. (2021). Standard PC.02.01.21. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  16. WatersT. R., et al. (2009). Safe patient handling training for schools of nursing. https://www.cdc.gov/niosh/docs/2009-127/pdfs/2009-127.pdf (Level VII)
  17. Accreditation Association for Hospitals and Health Systems. (2020). Standard 07.01.10. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  18. SiegelJ. D., et al. (2007, revised 2019). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf (Level II)
  19. Occupational Safety and Health Administration. (2019). Bloodborne pathogens, standard number 1910.1030. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS (Level VII)
  20. GanzD. A., et al. (2013, reviewed 2021). Preventing falls in hospitals:

    A toolkit for improving quality of care

    (AHRQ Publication No. 13-0015-EF). Rockville, MD: Agency for Healthcare Research and Quality. https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html (Level VII)
  21. Accreditation Association for Hospitals and Health Systems. (2020). Standard 07.02.03. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  22. RutalaW. A., et al. (2008, revised 2019). Guideline for disinfection and sterilization in healthcare facilities, 2008. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf (Level I)
  23. The Joint Commission. (2021). Standard RC.01.03.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  24. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Medical record services. 42 C.F.R. § 482.24(b)

    .
  25. Accreditation Association for Hospitals and Health Systems. (2020). Standard 10.00.03. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  26. DNV GL-Healthcare USA, Inc. (2020). MR.2.SR.1. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)