Please read Important Points to be Observed with all Treatments before performing this treatment.

Contraindications and Cautions - check with your doctor if:

1. Loss of skin sensation over large areas of chest or back due to paralysis or stroke

2. Leg or feet oedema, severe varicose veins, peripheral vascular disease, obstructed circulation

3. Malignancy in chest area

4. Tendency to bleed (haemorrhage)

5. Stomach or bowel ulcers

6. Omit cold if pleurisy pain.

7. Any condition where circulation in feet and legs is poor (like extreme vascular disease of feet and legs) or where there is a loss of sensation (feeling) in feet or legs in severe diabetes.

Definition

A fomentation consists of a local application of moist heat to the body surface. A fomentation is usually made of blanket material: 50% wool to retain heat and 50% cotton to retain moisture and be more durable.

Equipment

1. Large wool blanket - 1

2. Sheet - 1

3. Pillow - 1

4. Large buckets - 2

5. Towels - 10

6. Fomentation pads and covers - 5 each (if you have them)

7. Large kettle or canning kettle - 1 (if using boiling water or steaming method)

8. Basin of ice water

9. Friction mitts use these as cold compresses on the head during the fomentation

10. Foot tub or container large enough and deep enough; 20 litre / 5 gallon can or dish pan may be used but water should be at least 10 cm / 4" deep. The deeper the water, the greater the heating effect.

11. Material for protection of bed (rubber sheet or plastic)

12. Pitcher or dipper to add hot water to Hot Foot Bath

Preparation of the Fomentation

Boiling Water Method

1. Fold a large bath towel lengthwise and twist as much as possible; place middle three-quarters into boiling water and let it become thoroughly soaked.

2. Lift out of water and pull hard to wring out all the water possible. Let it untwist by dropping one end and hold the other end.

3. Lay it over the towel placed on the patient's body if the towel is very hot.
   OR
   Place hot towels on the skin surface and quickly remove it to avoid burning; watch it very carefully to lift the towel if heat is not tolerated. The towel will cool off rapidly. Practice this skill thoroughly before you work on your patent.

4. Cover with another towel

5. Repeat procedure 3 or 4 times. In between the hot towels, briskly wipe the body surface with ice-cold cloth and then blot the moisture quickly. It the moisture that burns the skin, therefore the skin must be dry completely before the next application.

Steaming Method

1. Soak completely and wring out 5 large bath towels or fomentation pads in water

2. Place the towels or pads on the grid of a large canner (32 qts or ltrs)

3. Place enough water in the canner below the grid and boil it for 20 minutes - towel or pads should not touch the water.

Micro-wave Method

1. Take a large bath towel soaked in cold water; wring out all the water possible.

2. Place the single towel in a black plastic garbage bag or other strong plastic bag

3. Place the bag in the micro-wave oven and turn to high for 4 minutes (or until steaming)

4. Quickly remove towel and use it on the body surface; if it is very hot, place a dry towel on skin area before applying the very hot towel.

Procedure

Important Considerations

• Be sure the water in the Hot Foot Bath does not burn the patient; consider the age and vitality of the patient. Be especially careful with thin or aged persons and children

• Always ask if fomentations are burning the patient. If they are too hot, lift the fomentation, dry the skin and add another towel between the patient and the fomentation.

• Be sure the patient is always properly draped to avoid chilling.

• Always have the room warm before you begin treatment; make sure there are no drafts.

• Applications should be short (3-5 minutes) very hot, with cold between fomentations.

• Keep towels under fomentations dry, moisture will increase the chance of burning the patient.

• Parts where bone is close to the skin surface are especially apt to burn (due to less blood flow), so keep extra towels on hand to use to protect these areas more if necessary.

Preparation for Treatment

• Explain procedure to patient

• Have the room warm and free of drafts; secure privacy

• Have the patient remove clothing, drape with sheet. For bed patients, cover with bath blanket and remove gown.

• A plastic cover or even a heating pad may also be used over the fomentation to help retain heat.

• If cerebral congestion may occur, have cold compresses to apply to neck as well as to the head. In heart disease or with pulse of 130 or above, place an Ice Bag over the heart.

Treatment

• Have all the equipment ready

• Have patient disrobe

• Have blanket on bed or table then place sheet on top of blanket

• Have patient lie on sheet and wrap blanket completely around the patient exposing only his head

• Prepare the water in the Hot Foot Bath (40°C / 104°F); fill only half full; place your hands under the patient's feet and you lower them into the water. Completely wrap the bucket and the legs with the sheet and the blanket.

• Continue to check with the patient that the foot bath is hot through the treatment. Add hot water frequently.

• Cover part to be treated with fomentations with a bath towel.

• Apply one fomentation under the patient's back, have them lie on it.

• Apply fomentations across the chest, leave for 3-5 minutes; when the fomentation becomes comfortable, that is the time to change.

• Protect sensitive parts and bony prominences with as many towels as are necessary.

• Lift fomentation and rub hand firmly over the towel to remove moisture if unbearably hot; if necessary place another towel between fomentation and patient, placing the dry towel next to the skin.

• In cases with Pleurisy pain, have the fomentation as hot as can be tolerated and omit the cold between changes.

• Apply Cold Compress to head and/or neck; change every 2-3 minutes; use Ice Bag to heart if needed.

• Give three fomentations to the front of the chest, applying Cold Mitten Friction to the area between each application. Be sure to dry part well before applying another fomentation; change towel that is next to the skin if it becomes the least bit damp.

• After last fomentation, before removing the foot bath, perform the Cold Mitten Friction to entire body.

Cold Mitten Friction

• Do not expose more than one part of the body at a time, avoid chilling

• Avoid skin lesions

• Success of the cold mitten friction depends on the speed and vigor of the treatments

• Wring mittens quickly from cold water, rub vigorously for 5-8 seconds

• Quickly cover the part with dry towel and dry with friction

• Cover the area with dry bath blanket and proceed with the next body part

• Start with extremities then chest and finally the back

Arm - uncover one arm and have patient hold her arm up

• 1. Start rubbing at fingers and work up to (and include) the shoulder

  2. Flip mitts around so the part that was at the back of your hand is now on the palm

  3. Work down from shoulder to fingers

  4. Dry quickly with friction and cover

  5. Repeat to other arm, and both legs

• When finished the cold mitten friction, ask patient to lift feet above foot tub and you pour cold or iced water over feet; remove from tub and rub and dry feet thoroughly

• Be sure to leave the patient with a dry body, gown, sheets and blankets. Any dampness will cause a chill and make the person worse.

Completion of Treatment

• Leave the patient comfortable and free of perspiration

• Patient is to rest in bed for at least 1 hour.

• Remove equipment and leave area tidy

• Report the effect of the treatment, the reaction of the patient, and any deviation of results noted