Parrafin Wax Application

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Parrafin Wax Application
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1.Paraffin Wax / Paraffin Bath

• Paraffin wax is a simple, convenient, reasonably
  efficient method of applying conducted heat to
  the extremities.
• It is a combined immersion technique with
• Paraffin wax mineral oil for conductive heat
  gains.
• For therapeutic use
• 7 units of wax ---------1unit mineral oil.
• The paraffin wax is then kept at low temperature
  and remains warm for a longer time than water.

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• Heat exchange by conduction
• In the case of parraffin, it provides superficial
  heat with a depth of 1 cm.

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Characteristics of Paraffin Wax

• Paraffin has a slow thermal conductivity
• ? Slow heat diffusion (6 times lower than
  water).
• Paraffine wax has a low melting point (55).
• When the oil is added, the paraffin will remain
  at a temperature of 40 to 44C.
• This low specific heat will enhance the patient
  to tolerate heat from the paraffine better than
  from water of the same temperature.
• better tolerance to heat for the patient.

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Characteristics of Paraffin Wax

• 2.Self insulator It gives moist heat
• there is a layer between the skin and the wax
  producing heat and sweating which does not
  evaporate.
• After removal the heated part cools quickly ( by
  evaporation).
• 3. It is analgesic This insulating layer keeps
  the heat and is effective in relief of pain.

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Equipment used for paraffin wax applications

• Wax is placed in a parrafin bath
• Small sizes for home use exist.
• 2 stainless steel containers wooden or bakelite
  insulator heating wire.

• The water melts the wax. Thermometer reading
  should also be taken. The wax has to be melted
  in advance and it takes 3 to 4 hours or heated
  constantly.

Paraffin petrolatum oil
Water at 72C
Thermostat at 44 C Maximum
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Operation of the Apparatus

• Normally, parrafin wax has a melting point of
  55C.
• Large bath have a capacity of 25 kg of paraffin.
• You will then add 5 liters of light petrolaneum
  oil to lower the melting point and prevent burns.
• To melt the paraffin turn the switch on to heat
  the coil, the water for 1 hour prior to
  treatment.
• Always check the temperature with thermometer
  before ttt.
• For busy clinics, the bath can be plugged in day
  night to be ready for use.

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Care of the Paraffin Bath Apparatus

• The patients body part should be cleaned before
  ttt.
• Bath is to be cleaned regularly (every 6 months)
  while the paraffin is liquid. Disconnect the unit
  from electrical outlet dip the parraffin out of
  the bath with a small pan in another container.
• Remove clean the slats , remaining paraffin can
  be removed and sediments removed with paper
  towels.
• Replace then the parrafin back in the bath and
  add new paraffin as needed.

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Physiological Responses to Paraffin Wax Therapy

• Heat production
• in the first 2 min a marked increase in skin
  temperature 12C to 13C.
• While wax wrapping the temprature drops.
• Then after 30 min. at the end of the treatment
  to
• 8C at skin level.
• 5C at subcutaneous fascia.
• 2C -3C in superficial muscles.

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Physiological Responses to Paraffin Wax

• 2. Circulatory effects
• Stimulation of superficial capillaries
  arterioles ? local hyperemia ? reflex
  vasodilatation of capillaries in the skin (
  pink).
• ? reflex heating of the joints.
• ? skin t drops quickly after 15-20 min.
• ? reduces then vasodilatation.
• N.B Exercises after wax is important to ? ROM
  and muscle strength.

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Physiological Responses to Paraffin Wax

• Analgesic effects
• Most important effect as sedative effect on
  tissue.
• Moist heat gives a soothing effect.
• Very good prior to the exercise for superficial
  joints.
• Stretching effects wax leaves the skin moist,
  soft and pliable. It is useful for stretching
  scars and adhesions.

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Indications

• 1. Pain and musle spasm especially in the distal
  extremities ( toes and fingers).
• 2. Oedema and inflammation gentle heat reduces
• Post-traumatic swelling of the hands and feet
• Swelling of the hands in rheumatoid arthritis.
• Swelling of the hands in degenerative joints
  disease.
• Especially in sub-acute and early chronic stages
  or inflammation.
• ! Caution is needed in acute phase of arthritic
  pain and swelling.
• 3. Adhesions and scars wax softens and
  facilitates the mobilization and stretching
  procedures.

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Contraindications

• Impaired skin sensation (hot/cold sensation
  test) anaesthesia, hypostasia, hyperesthesia,
  parastesia.
• Some dermatological conditions eczema,dermatis.
  (report any reactions after ttt).
• Circulatory dysfunction ( varicose veins, DVT,
  arterial disease)
• Analgesic drugs as pain tolerance to heat is
  impaired.
• Infections and open wounds ( as it increases the
  infective activity) such as in blood born
  infections.

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Contraindications (cont)

• Cancer, tumors or tuberculosis ( TB) in the area
  to be treated as it ? the metabolic activity
  rate of growth.
• Gross oedema with a very thin and delicate skin
  covering the area .
• Lack of comprehension ( children, senile , head
  injuries, confused, agitated,)
• Deep Xray therapy within three months prior to
  treatment ? bloodflow thus impaired sensation.
• 10. External or internal metal fixators, implants
  (metal plates in orthopedics).

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Advantages

• 2 or 3 patients can be treated in the same time.
• Useful for pt. with poor heat tolerance, dry
  scaly skins, after Plaster of Paris removal.
• Can be followed by therapeutic exercises.
• Can be carried out at home.
• Wax can mold around the bony contours of feet
  hands.
• Heat is applied evenly by conduction.

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Disadvantages

• Not sterile or not very desinfected procedure.
• Messy technique, floor should be protected.
• Sedimentation occurs in bottom of the bath ?
  should be regularly cleaned (daily or every 2
  days).
• Contamination by air unless covered by lid.
• Water collects at bottom of bath.

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Techniques of Application

• Technique I by Dipping Create paraffine glove by
  10 repeated dippings. Fingers are in Abduction.
  Dont tip above the level of the previous glove.
• Technique II by Immersion
• dip once for having a glove then and immerse for
  15 to 20 min.
• Never immerse at first for a long time without
  making a glove dry before to have insulation.

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Techniques of Application

• Technique III
• ( Parrafin wax with infrared cabinet)
• same as technique I II
• place in heat cabinet at 70C
• or under infrared lamp at 0.5 m distance.

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Techniques of Application

• Technique IV ( Tray technique)
• Dip twice then immerse for 15 minutes. Remove
  the hand and place in a tray containing
  semi-liquid paraffin.
• Ask patient to move hand and make shapes out of
  the solidifying wax.

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Application Techniques.

• 5.
• Technique V( Parraffin with elevation) Same
  technique as I then place the hand in elevation
  under a hot air cabinet.
• Alternatively the hand can be placed in
  elevation with a towel or blanket wrapped around
  hand for 20 min.
• 6. Technique VI ( Bandaging) Wax can be also
  applied to the knees and elbow by applying
  elasto-crepe bandages which have been immersed in
  wax.
• Then brushing more wax on the bandages using a
  paint brush.

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Analysis of the Techniques

• Technique I (Dipping) query need for wrapping in
  towel as there is a strong rise in temperature
  initially.
• Technique II( by immersion) will maintain a more
  constant temperature as the extremity remains in
  the bath.
• Technique V ( Elevation) is useful for the
  oedematous hands, with dry scaly skin.
• Technique VI ( with bandaging) has limited use
  only for home technique.

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Thank you

• Thank you