HOTWATER BOTTLES.-Acommon cause of burns-particularly in the elderly, diabetics, and patients with circulatory impairments-is the hot water bottle. When you are filling the bottle, the water temperature must never exceed 125 E F (51 E C). Test the bottle for leaks and cover it so that there is a protective layer of cloth between the patient and the bottle itself.

HEATING PADS.-Heating pads present a dual hazard of potential burns and electrical shock. The precautions that should be taken when using heating pads are the same ones that should be used for hot water bottles: temperature control and protective cloth padding. Precautions you should observe to avoid shock include properly maintaining the equipment; conducting preuse inspections; testing the equipment for wiring and plug defects; and ensuring periodic safety inspections are conducted by Medical Repair personnel.

ICE BAGS ORCOLD PACKS.-Like hot water bottles, ice bags and cold packs (packaged chemical coolant) can cause skin-contact burns. This kind of burn is commonly referred to as local frostbite. The precautions taken for applying ice bags and cold baths are the same as those for hot water bottles with regard to attention to elderly, diabetic, and patients with circulatory impairments.

HYPOTHERMIA BLANKETS.-Like ice bags, hypothermia blankets can also cause contact burns. When using hypothermia blankets, check the patient's skin frequently for signs of marked discoloration (indicating indirect localized tissue damage). Ensure that the bare blanket does not come in direct contact with the patient's unprotected skin. This precaution is easily accomplished by using sheets or cotton blankets between the patient and the hypothermia blanket itself. When using this form of therapy, follow both the physician's orders and the manufacturer's instructions in managing the temperature control of the equipment.

HEAT (BED) CRADLE.-When using the heat (bed) cradle, protect the patient from burns resulting from overexposure or placement of the equipment too close to the area of the patient being treated. As with heating pads, heat cradles present the dual hazard of potential burns and electrical shock. Another hazard to keep in mind is that of fire. Ensure that the bedding and the heat source do not come in direct contact and cause the bedding to ignite. Occasionally, heat lamps are used to accomplish the same results as a heat cradle. Do not use towels, pillow cases, or linen of any kind to drape over heat lamps. In fact, no lamps of any kind should be draped with any kind of material, regardless of the purpose of the draping.

STEAM VAPORIZERS AND HOT FOODS AND LIQUIDS.-Steam vaporizers and hot foods and liquids are common causes of patient burns. When using steam vaporizers, ensure that the vapor of steam does not flow directly on the patient as a result of the initial positioning of the equipment or by accidental movement or bumping. Patients sensitive to hot foods and liquids are more likely burned. Also, because of lack of coordination, weakness, or medication, patients may be less able to handle hot foods and liquids safely without spilling them.

In the direct patient care units as well as in diagnostic and treatment areas, there is unlimited potential for inflicting burns on patients. When the modern electrical and electronic equipment and the potent chemicals used for diagnosis and treatment are used properly, they contribute to the patient's recovery and rehabilitation. When they are used carelessly or improperly, these same sources may cause patients additional pain and discomfort, serious illness, and, in some cases, death.