Choosing Wisely:

Don’t use whirlpools for wound management.

Rationale and Comments: Whirlpools are a non-selective form of mechanical debridement. Utilizing whirlpools to treat wounds predisposes the patient to risks of bacterial cross-contamination, damage to fragile tissue from high turbine forces, and complications in extremity edema when arms and legs are treated in a dependent position in warm water. Other more selective forms of hydrotherapy should be utilized, such as directed wound irrigation or a pulsed lavage with suction.
Sponsoring Organizations:
  • American Physical Therapy Association
  • Sources:
  • Institute for Clinical Systems Improvement guideline
  • Disciplines:
  • Surgical
  • References: • Institute for Clinical Systems Improvement (ICSI). Pressure ulcer prevention and treatment protocol. Health care protocol. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jan. 88 p.
    • Association for the Advancement of Wound Care (AAWC) venous ulcer guideline. Malvern (PA): Association for the Advancement of Wound Care (AAWC); 2010 Dec. 7 p.
    • Water use in hydrotherapy tanks [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2009 Aug 10 [cited 2014 Apr 23]. Available from:
    • Berrouane YF, McNutt LA, Buschelman BJ. Outbreak of severe pseudomonas aeruginosa infections caused by a contaminated drain in a whirlpool bathtub. Clin Infect Dis. 2000;31(6):1331–7.
    • McCulloch J, Boyd VB. The effects of whirlpool and the dependent position on lower extremity volume. J Orthop Sports Phys Ther. 1992;16(4):169–73.

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