Tepid sponging is a nursing procedure involving the application of lukewarm water (generally 29°C to 32°C) to the skin surface using a sponge or soft cloth in order to reduce elevated body temperature (fever) through evaporative and conductive heat loss mechanisms. This non-pharmacologic method of antipyresis is often employed in conjunction with or prior to the administration of antipyretic medications.

Purpose of Tepid Sponging

• To promote reduction of pyrexia (fever) in febrile patients

• To provide comfort and prevent febrile seizures, especially in pediatric cases

• To stimulate vasodilation, thereby enhancing peripheral circulation

• To support the body’s homeostatic mechanisms when fever becomes detrimental

• To supplement pharmacologic treatment where medication alone is insufficient or contraindicated

Indications

Tepid sponging is indicated in the following situations:

1. Persistent hyperthermia (typically ≥38.5°C) not responding promptly to antipyretics

2. Febrile convulsions or history of convulsions, especially in children

3. Drug allergy or contraindications to antipyretics

4. Situations where physical cooling is preferred over pharmacologic methods

5. Supportive care in infectious diseases associated with high fever (e.g., malaria, dengue, typhoid)

Contraindications

The procedure is not suitable in the following conditions:

• Chilling or shivering, which may paradoxically increase body temperature

• In patients with hypothermia, subnormal temperature, or shock

• Neonates, unless directed by pediatric guidelines

• Patients with cardiac conditions where rapid temperature changes could induce stress

• In cases where skin conditions (e.g., burns, dermatitis) may be aggravated by water application

Physiological Basis

Tepid sponging reduces temperature through the principles of:

• Evaporation: Heat is absorbed from the body surface to convert water into vapor, thereby cooling the skin.

• Conduction: Direct heat transfer occurs from the warmer body to the cooler sponge or cloth.

• Vasodilation: Tepid water promotes peripheral blood vessel dilation, improving heat dissipation from the body core to the surface.

The hypothalamic thermoregulatory center monitors internal body temperature and adjusts responses. Tepid sponging supports these mechanisms when endogenous control is overwhelmed or compromised.

Materials Required

• Basin with tepid water (29°C–32°C; verify using thermometer)

• Two small towels or soft sponges

• Bath towel or sheet for privacy

• Waterproof sheet to protect the bed

• Thermometer (preferably digital)

• Gloves (optional but recommended for infection control)

• Patient gown (clean and dry)

• Waste disposal bag

Preparation Phase

1. Patient Assessment:

• Confirm presence of fever and its degree via thermometer.

• Assess skin integrity, sensory response, and any contraindications.

• Review medical records for underlying causes and treatment plans.

2. Environment Preparation:

• Ensure privacy by drawing curtains or closing the door.

• Keep the room at a comfortable ambient temperature (~25°C).

• Avoid direct exposure to drafts or fans during sponging.

3. Explain Procedure:

• Inform the patient about the purpose and what to expect.

• Address any fears of discomfort or cold sensations.

Procedure

1. Hand hygiene is performed and gloves worn.

2. The patient is placed in supine or semi-Fowler’s position, ensuring comfort and access to exposed skin areas.

3. The water temperature is verified as tepid (not cold) using a thermometer or inner wrist.

4. A waterproof sheet is placed under the patient’s body to protect the bedding.

5. The face, neck, and arms are sponged first using gentle strokes.

6. Proceed to chest, abdomen, back, and then lower limbs, following a head-to-toe sequence.

7. The axillae and groin areas may be targeted to enhance cooling, as they are rich in blood vessels.

8. Avoid prolonged wetness by gently patting the skin dry with a towel.

9. Observe for shivering, discomfort, or changes in consciousness.

10. Once complete, dress the patient in a clean, dry gown and ensure the bed linen is dry and warm.

11. Measure temperature again after 30 minutes and evaluate effectiveness.

Post-Procedural Care

• Monitor temperature, pulse, and respiratory rate at 15–30 minute intervals.

• Assess for chills, pallor, or discomfort.

• Document:

  • Initial and post-sponging temperature

  • Duration and areas covered

  • Patient’s tolerance and skin condition

  • Any adverse reactions

• Reinforce hydration if permissible, as fever may cause fluid loss.

Precautions and Safety Measures

• Never use cold water or ice as this can induce vasoconstriction, shivering, and paradoxical temperature elevation.

• Discontinue sponging if the patient exhibits shivering, hypotension, or increased distress.

• Always maintain dignity and privacy throughout the procedure.

• Maintain infection control protocols, especially in patients with contagious illnesses.

• Refrain from sponging open wounds or inflamed skin areas.

• Avoid excessive exposure time; the procedure generally lasts 15 to 20 minutes.

Potential Complications

• Shivering and discomfort if water is too cold or the room is inadequately warm

• Inadequate temperature reduction if evaporation is hampered

• Skin irritation in sensitive patients

• Hypothermia if not properly monitored

• Psychological distress due to perceived vulnerability or exposure