A hot-pack made of a dense polymer and covered with a cloth was manufactured as a warming instrument. This hot-pack can be readily warmed in a microwave oven. The present study was performed to examine the effects of warming the lower limbs using this hot-pack on the temperature and blood flow at various sites including the toe, mid-thigh, chest, and forehead. The results were as follows: 1. Hot-pack warming raised the deep body temperature. 2. Lower limb warming by the hot-pack increased the blood flow, by which the increase in temperature spread to the central part of the body. 3. The deep body temperature fell following the removal of the hot-pack, and, in addition, by sweating. It is suggested that hot-pack warming might be useful for inducing sleep in elderly people

Chika OHSHIMA

Department of Nursing, Nagoya University School of Health Science

Etsuko FUJIMOTO

Faculty of Nursing and Social Welfare, Fukui Prefectural University

Hiromi ARITA

Ishikawa Prefectural Nursing University

Kitasato University Hospital

Ryo SASAKI

A hot-pack made of a dense polymer and covered with a cloth was manufactured as a warming instrument. This hot-pack can be readily warmed in a microwave oven. The present study was performed to examine the effects of warming the lower limbs using this hot-pack on the temperature and blood flow at various sites including the toe, mid-thigh, chest, and forehead. The results were as follows: 1. Hot-pack warming raised the deep body temperature. 2. Lower limb warming by the hot-pack increased the blood flow, by which the increase in temperature spread to the central part of the body. 3. The deep body temperature fell following the removal of the hot-pack, and, in addition, by sweating. It is suggested that hot-pack warming might be useful for inducing sleep in elderly people.5KJ00007501939POriginal articledepartmental bulletin pape

FUJIMOTO, Etsuko

SASAKI, Ryo

ARITA, Hiromi

OHSHIMA, Chika

Aino University Institutional Repository / 藍野大学学術機関リポジトリ

 AINO JOURNAL, Vol. 7, 2008, pp.  13-19 Original articleThefor the hot-packdevelopmentEtsukoRyowarming on the    deep  bodyof a nursing FUJIMOTOSASAKIHiromiChikaARITANurse,OHSHIMAcareProfessor,of HealthKitasatoAssociateinstrument temperatureto induce sleepDepartment of  Nursing, Nagoya University SchoolScience, NagoyaUniversityProfessor,Fukui PrefecturalHospital,FacultyUniversity,Assistant Professor,Sagamiharaof Nursing andFukuiSocialIshikawa Prefectural NursingWelfare,University,IshikawaAbstractA hot-pack made of a dense polymer and covered with a cloth was manufactured as a warming instrument. This hot-pack can be readily warmed in a microwave oven. The present study was performed to examine the effects of warming the lower limbs using this hot-pack on the temperature and blood flow at various sites including the toe, mid-thigh, chest, and forehead. The results were as follows:  I. Hot-pack warming raised the deep body temperature. 2. Lower limb warming by the hot-pack increased the blood flow, by which the  increase in temperature spread to the central part of the body. 3. The deep body temperature fell following the removal of the hot-pack, and, in  addition, by sweating. It is suggested that hot-pack warming might be useful for inducing sleep in elderly people.IntroductionKey words : hot-pack, sleep induction, warming, deep body temperature,           surface temperature, subcutaneous temperature, blood flow Sleeping can be induced by the temporal rising, followed by long-term falling, of the deep body temperature (DBT) (Furukawa and Honda, 1994; Oda et al., 2001). Hot-water bathing induces sleep by raising the body temperature (Agishi et al., 2004). Therefore, taking a bath at night is desirable for the induction of sleep. However, usually nursing facilities for the elderly usually provide a bathing service in the daytime due to cost performance and staff shortages (Tsutsumi et al., 2002).  Such daytime bathing tends to induce sleep in the elderly during the daytime. This may cause an inverted sleeping rhythm, which is commonly noted in the elderly people. An instrument readily avail-able even during the night, which canskininduce bathing-like effects, would greatly contribute to the improvement of sleeping rhythms in elderly people.  We have developed a hot-pack made of dense polymer, which can be readily heated in a microwave oven. The present study was performed to examine the ef-fects of this hot-pack on the body tempera-ture and blood flow. The warmed hot-pack was placed on the lower limbs of the subject, and changes in the DBT were meas-ured. In addition, changes in the skin sur-face  (SS) and subcutaneous region  (SCR) temperature, and skin blood flow (SBF) at various sites including the toe, mid-thigh, chest, and forehead were measured. Wheth-er hot-pack warming of the lower limbs can induce sleep in elderly people was dis-cussed. 13Materials and Methods1. Preparation of the hot-packlower limbsAINO JOURNAL,for warming the The simple, easily applicable hot-pack  was prepared in the shape of a boot. The  corecomponent of the hot-pack is made of a  densepolymer, and the hot-pack can be readily heated in a microwave oven. In the present study, the hot-pack making up the  "foot-warming boot" was divided into several small parts so as to be easily applied to the subject's limb. Each part was covered with cloth to promote comfort when it was put on the skin of the subject. The hot-pack was prepared  as follows: a suitable amount of dense  polymer (Kao) was soaked in a 125 ml of water, and  the resulting soft gel material was arranged into a block of 16 x 10.5 cm. Twelve such blocks were prepared. Blocks were covered with a cloth overlaying a polyester sheet. The cloth itself was made from a weave of cotton  (70%) and jute (30%). Three types of hot-pack  were used for one side of the body.  Accordingly, three pairs of hot-packs were prepared for both sides. Each type of hot-pack contained two blocks. Of the three types of hot-pack, one was used for the foot comprising the dorsal and plantar parts, and the other two for the ante-tibial part (Fig. 1).2. Subjects All four subjects were healthy males, ranging from 21 to 30 years old. All subjects were male to avoid the menstrual DBT fluctuations seen in the females. All experiments were started at 5 o'clock in theVol. 7, 2008evening to minimize the influence of the circardian rhythm. The subjects were in-structed to avoid intense exercise. They were asked to sleep for more than 8 h on the day before the experiment, and fast for at least 2 h before tests. They wore a T-shirt and shorts, and were bare-footed.3. Experimental room The experiments were conducted in the student practice room of Ishikawa Nursing University, with a temperature of 24-26°C and humidity of 50-60 %.4. Study periodsExperiments were performed30, 2006 to September 26, 2006.5. Methods(1) Proceduresfrom August The subject lay quietly in the supine posi-tion for 20  min. Temperature probes were positioned near the tympanic membrane (peri-tympanic membrane region: PTM). Other temperature probes were placed on the subcutaneous region (SCR) and skin sur-face (SS) of each body site as described below. Probes for skin blood flow (SBF) were also put on the skin surface as out-lined below. Warmed hot-packs were placed on the subject's lower limbs, and warming was applied for 50  min. The war-ming was discontinued by removing the hot-packs from the limbs. The subject retai-ned the supine position for a further 20  min after the end of warming. Through-out the experiment, the subject's wholeFig. 1 Hot-packs and their positions 14FUJIMOTO et  al  : The effect of hot-pack warming on the deep body temperaturebody was covered with a blanket. When the temperature rose to 43°C at the inter-face between the skin and hot-pack, a cloth was inserted between them. When the hot-pack temperature fell below 38.5°C, hot-packs were replaced with newly heated ones. As the control, the same procedures were applied to the same subjects, but hot-packs were not heated.6. Ethical consideration  It was confirmed that there was no risk of low-temperature burn in this experiment. The purposes and methods of this study were fully explained to the subjects orally as well as in written form, and signed consent was obtained from all subjects who participated in this experiment. Results (2) Measurement of PTM temperature  The temperature monitor (TM-201D, By-temp) was used as a probe for the PTM. The temperature was recorded every 1  min for 90  min. (3) Measurement of SCR temperature (2-10      mm below the skin surface)  The probe, Core-Temp  (CN100B, Terumo), was used to measure the subcutaneous tem-perature at the left mid-thigh (medial part), left chest (2-finger breadth lateral to the left nipple), and forehead. The temperature was recorded every 1  min for 90  min. (4) Measurement of SS temperature  A handy-type thermometer (LT-8 SERIES, Gram Corporation) was positioned at the big toe of the left foot,  mid-thigh of the left leg, chest, and forehead. The tempera-ture was recorded every 1  min for 90  min. 5. Analysis The average SS, SCR, and PTM tempera-tures measured for 10  min immediately before warming were used as the baselines for each subject. The differences in the temperatures from the baselines were calculated for 70  min (50  min during warming and an additional 20  min following the end of warming) in each subject. Then, the average differences were calculated for each subject. Concerning SBF, the average values were obtained for each subject during the 10  min immediately before warming, and used as the baseline. The average differences from the baselines were calculated every 10  min for 70  min, as above.1. Changes in PTM temperature  All 4 subjects showed an increase in the PTM temperature. The average differences were always higher than those of controls throughout the experiment (Fig. 2). The average temperature elevation continued after the end of the warming, with a 0.25°C ele-vation 10  min following the end of warming.  On the other hand, the range of temperature decrease was small. All subjects continued to show an elevation of 0.1 to 0.42°C from the baselines at 20  min following the end of warming.2. Changes in SCR  temperature All subjects showed an increase in the SCR temperature of the mid-thigh by warming of the lower limbs. The average SCR tempera-tures of the 4 subjects were always higher than those of controls, with a maximum value of  0.32°C at 10  min following the start of warming (Fig. 3). The temperature gradually decreased and returned to the control level 20  min after the end of warming.  Average SCR temperatures of the chest  ere always higher than the controls, with   maximum difference of 0.28°C (Fig. 4).Fig. 2 Changes in PTM temperatue 15AINO JOURNAL,Fig. 3 Changes in SCR temperature of the mid-thighFig. 4 Changes in SCR temperature of the chestThe temperature decreased in the same manner as described above following the end of warming.  Regarding the forehead, the subjects showed various temperature fluctuations within  ±0.1°C. However, at the end of war-ming, all subjects showed a temperature 0.1°C higher than controls.  Such a condi-tion continued for a while thereafter (Fig. 5).  Thus, the maximum rise in temperature was 0.32°C at the mid-thigh, 0.28°C at the chest, and  0.1°C at the forehead. This showed that the nearer the site was to the warming site, the higher the  SCR tempera-ture.3. Changes in SS temperature  All subjects showed an increased tem-perature of the big toe by warming the lower limbs. The maximum elevation was 10°C, the minimum was 1.8°C, and the maximum average change in the 4 subjects was 4.2°C. The temperature fell by 1.6°C within 1  min after the discontinuation of warming (Fig. 6). Vol. 7, 2008Fig. 5 Changes in SCR temperture of the foreheadFig. 6 Changes in SS temperature of the toeFig. 7 Changes in SS temperature of the mid-thigh At the mid-thigh, the average tempera-ture of the 4 subjects reached a maximum 20  min after the commencing the warming, and remained higher than the control until 40  min after beginning of warming. Howev-er, the temperature gradually dropped to lower than the control at the end of warm-ing (Fig. 7). This lower temperature condi-tion continued for a while thereafter.  Regarding the chest, the subjects showed16FUJIMOTO et  al  : The effect of hot-pack warming on the deep body temperaturean increase in temperature. However, at the end of warming, only one subject  main-tained the elevated temperature, while the other three showed a fall in temperature. The average temperature reduction was larger than in control (Fig. 8).  Concerning the forehead, the average tem-perature rose until 20  min after the  begin-ning of warming, and fell below the  basel-ine thereafter. The control cases showed no distinct changes of temperature (Fig. 9).4. Changes in SBF By warming, the average SBF of the big toe was higher than the control (80% higher at maximum) throughout the experimental  pe-riod (Fig. 10). Similarly, the warming of the lower limbs increased the SBF at the mid-thigh by ca. 60% over the baseline (Fig.  11).  For the chest, the average SBF was little changed between the start and end of warm-ing, with only a  6% increase at  20  min  fol-Fig. 8 Changes in SS temperature of the chestFig. 9 Changes in SS temperature of the foreheadlowing the end of warming  (Fig.  12). Three subjects showed a decrease in the blood flow of the forehead. The average value of the 4 subjects was 25% lower than the baseline at the end of warming  (Fig.  13). This average value was also lower than that of control subjects.  The nearer to the warming point, the higher the blood flow rate was. That is, the blood flow rate became higher at the big toe, mid-thigh, chest, and forehead in this order (Fig. 14) by warming of the lower limbs.Fig. 10 Changes in SBF of the toeFig. 11 Changes in SBF of the mid-thighFig. 12 Changes in SBF of the chest17AINO JOURNAL,Fig. 13 Changes in SBF of the foreheadFig. 14 Average blood flow rate in each place5. Others  All four subjects claimed that they felt too hot, with sweating over the whole body, during warming of the lower limbs. Sweating continued even after hot-pack removal. All subjects stated that the hot-pack had a soft touch to the skin.Discussion1. Changes in DBT  The present study was performed to explore to what extend hot-pack warming of the lower limbs has an effect on DBT elevation. The DBT was measured in the PTM in the present study. The thermometer was of the non-contact type. Therefore, the temperature was somewhat lower than that measured in the rectum. However, the temperatures of both the PTM and rectum showed a good cor-relation (Nishiyama and Hanaoka, 1996). It is generally recognized that the  SCR tempera-ture of the forehead reflects the DBT (Iwasaki and Nomura, 2005; Harioka et al., 1993). Accordingly the subcutaneous temperature at the forehead was also measured in the presentVol. 7, 2008study.  The temperature in the PTM was raised by 0.25°C. Similarly the  SCR temperature at the forehead was raised by 0.13°C. These values are smaller than those  ob-tained at the mid-thigh (0.32°C), and chest (0.28°C). These results are consistent with previous reports that the DBT cannot be markedly changed in response to external effects (Goudsouzian et al., 1973).  Although the range of elevation was small, hot-pack warming exhibited a dis-tinct effect on the elevation of the DBT. This is supported by the comments of  sub-jects that they felt hot during hot-pack war-ming of the lower limbs.  It is known that there is a temporal eleva-tion, subsequently followed by a fall in body temperature, before sleep induction (Furukawa and Honda, 1994; Oda et al., 2001). In the present study, the tempera-tures in the PTM and forehead did not fall until  20  min following the end of warming. Hashiguchi (2002) reported that the rectal temperature did not fall until  27  min  follow-ing the end of bathing or hot water shower-ing. The DBT falls by natural heat loss ac-celerated by the increase in blood flow caused by a preceding elevation of the body temperature (Michikami et al., 1999). It is said that the raising of the PTR by  0.20°C induces a fall in the DBT due to the regulatory mechanism of the body in-cluding sweating. In some subjects, the tem-perature of the PTM was raised by 0.25°C at  10  min following the end of warming. The subjects underwent sweating. The skin temperature fell at all sites examined after the end of warming. It is suggested that the central temperature regulation mec-hanism might also contribute to the lower-ing of the DBT after hot-pack removal from the lower limbs.2. Changes in temperature at SCR and SS, and   changes of SBF  The average  SCR temperature of the 4 subjects rose at the mid-thigh, chest and forehead by warming the lower limbs. The average SBF of the 4 subjects increased at the toe, mid-thigh and forehead by warming the lower limbs. An increase in blood flow induces a rise in heat conduction by blood vessels (Smith and Kampine, 1989).  By warming the lower limbs, the SBF 18FUJIMOTO et  al  : The effect of hot-pack warming on the deep body temperaturewas increased, and the temperatures at the SCR and SS were raised. The sole of the foot is rich in capillary networks that become expanded by temperature elevation, resulting in an increase of blood flow. The-refore, it is considered that lower limb war-ming is a more effective method for rais-ing the body temperature than warming at any other sites.  The temperature of the SS at the fore-head fell markedly even during warming the lower limbs. It is likely that sweating during the experiment might lead to a fall in SS temperature at the forehead due to heat loss through evaporation. The fall in temperature occurring in the later stages of warming at the mid-thigh and chest may also be caused by sweating. However, the drop in temperature occurred much later, and showed a much smaller range in the mid-thigh and chest than in the forehead. This is probably because the mid-thigh and chest were covered with a blanket, while the forehead was exposed.  The increase in skin blood flow was max-imal at the toe, followed by the mid-thigh and then chest. Since the hot-pack was in direct contact with the toe, the raised tem-perature might have had a direct effect on blood flow within the toe. It is conceiva-ble that the increased blood flow at the mid-thigh and chest was caused by the indirect effects of the warmed blood from the lower limbs. This is consistent with the fact that the rates of increase of tempera-ture in the  SCR and  SS are also in the same order as above. Summary The present study indicated that hot-pack warming might induce sleep by temporally increasing and subsequently decreasing the body temperature, as seen when taking a bath. The hot-pack used in the present study can be easily heated in a microwave oven. Therefore, this hot-pack warming method is useful for sleep induction in elderly people in nursing facilities, where the number of staff is limitedfor bathing of residents.   We think that kind of hot-pack can also be applicable treating sleep-arousal rhythm disorder.Acknowledgementsthis for This study was supported in part by a Grant-in Aid for Scientific Research (EF, HA) and for Young Scientists (CO) from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and by a Grant from Mitsubishi Foundation (EF)ReferencesAgishi Y, Nakaya J, Fujimoto  E: Nyuyoku to Suimin(Bathing and Sleeping).for Heath and LaborJapanese)Report of Research GrantScience: 83-92, 2004 (inFurukawa T, Honda Y: Sleeping-arousal cycle of human.Gendai no Seirigaku.  3rd Ed. Tokyo, Kanehara Pub. 414-415, 1994 (in Japanese)Goudsouzian NG, Morris RH, Ryan JF: The effects of a      warming blanket on the maintenance of body     temperature in anesthetized infants and children.  Anesthesiology 398: 351-353. 1973Harioka T, Sone T, Monura K, et al.: Relative accuracy and      precision of two non-invasive thermometry system.Masui 42: 856-861, 1993 (in Japanese)Hashiguchi N, Ni F, Tochitara Y: Effects of room      temperature on physiological and subjective      responses during whole-body bathing, half-body      bathing and showering. Journal of Physiological     Anthropology and Applied Human Science 21:  277-    283, 2002Iwazaki M, Nomura  S: Examination of the relaxing effects      of the local warm pack application — Comparison      of the influences of two treatments: warm pack      application to the back and warm foot soaks —.      Journal of Japanese Society of Nursing Research 28:     33-43, 2005 (in Japanese)Michikami D, Kamiya A, Fu Q, et al.: Effect of local plantar      heating on core temperature and skin sympathetic      nerve activity in humans. The Autonomic Nervous     System. 36: 552-563, 1999 (in Japanese)Nishiyama Y, Hanaoka K: A new medium-sized probe of      the non-tactile type for tympanic membrane      temperature monitoring. Masui 45: 1164-1167,     1996 (in Japanese)Oda  S, Kiyono A, Takumi  S, et al.: In Japanese Journal of     Physical Fitness and Sports Medicine (Tairyoku  Kagaku) 50: 946. 2001 (in  Japanese)Smith JJ, Kampine JP: In Circulatory Physiology (Junkan      no Seiri, translated by J. Muramatsu, et  al.). 2nd Ed.      Tokyo, Igaku-Shoin. 151-174, 1989 (in Japanese) Tsutsumi M, Kawamura  S, Kondo M, et al.: The present     practices and the effects on the residents of evening     bathing in the facilities for elderly. Bulletin of the     School of Nursing Yamaguchi Prefectural Uni-    versity 6: 103-109, 2002 (in Japanese) 19

The effect of hot-pack warming on the deep body temperature -for the development of a nursing care instrument to induce sleep-

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The effect of hot-pack warming on the deep body temperature -for the development of a nursing care instrument to induce sleep-

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