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Running head: TEMPERATURE CONTROL FOR SURGICAL PATIENTS 1

Temperature Control for Surgical Patients

Angela Wetli

Bon Secours Memorial College of Nursing

Quality and Safety

3207

Dowling

November 29, 2015

On my honor, I have neither given nor received aid on this assignment or test, and I

pledge that I am in compliance with the BSMCON Honor System.

Temperature Control for Surgical Patients

During a patients surgery, it is important to maintain their body temperature to prevent

complications. At St Francis Eastside there are multiple methods available to be used by the

surgical staff, but not every warming method is used for each patient. Because of this, some

patients arrive in the post anesthesia care unit with a lower body temperature than is ideal.

Studies have shown that complications associated with hypothermia include increased blood

loss, arrhythmias or cardiac arrest, prolonged recovery, impaired immunity, delayed wound
healing, and increased risk for infection. Unplanned hypothermia also increases cost for patients

and hospitals (Wu, 2013, p. 302).

There are multiple factors that can effect a patients temperature during the perioperative

period. It is important for the surgical staff to recognize the importance of maintaining a normal

body temperature for these patients, and implement warming methods in order to achieve this

throughout their surgery. Maintaining normothermia is important for patient safety, positive

surgical outcomes, and increased patient satisfaction. Causes of unplanned hypothermia in the

OR include cold room temperatures, the effects of anesthesia, cold IV and irrigation fluids, skin

and wound exposure, and patient risk factors (Lynch, Dixon, & Leary, 2010, p. 553).

St Francis has purchased a forced air heating system that can be used for each patient. It

involves a patient gown that can be attached to the heating system that blows warm air into the

gown. This gown is placed on the patients in the preoperative area. The patient can also be kept

warm in the OR with this system. Forced-air is by far the most commonly used intraoperative

warming technique. Efficacy of the method is well established, and forced-air heating is both

inexpensive and remarkably safe (Roder et al., 2011, p. 667). A policy has been put into place

that any patient whose surgery is planned for greater than 60 minutes will be given a warming

gown. Since this is a new policy, some nurses are not following the protocol and providing the

patients with this warming gown.

Another warming method for the surgical patient would be to administer warmed IV

fluids rather than fluids that are at room temperature. The preoperative area where the patients

IV is started does not have a fluid warmer, therefore when the IV is started, the bag of fluid is

room temperature, not warmed. It would be beneficial for a fluid warmer to be purchased for the

preoperative area. A study was conducted on 30 patients undergoing abdominal surgery. 15


TEMPERATURE CONTROL FOR SURGICAL PATIENTS 3

patients were given fluids that were at room temperature, and 15 patients were given warmed IV

fluids. The major finding of our pilot study is that using infusion of warm fluids during

abdominal surgery is effective to keep patients nearly normothermic during abdominal surgery,

which may prevent the patients from adverse outcomes caused by hypothermia (Hong-xia, Zhi-

jian, Hong, & Zhiqing, 2010, p. 368). Another complication of postoperative patients who

experience hypothermia during the OR period is post anesthetic shivering. We also found that

the infusion of warm fluid can decrease the incidence of post anesthetic shivering. The shivering

is a physiological response to the hypothermia during surgery, which is uncomfortable for the

patients and increases oxygen consumption by 40% to 120% (Hong-xia et al., 2010, p. 369).

There are additional measures that can be taken by the surgical team to help prevent

patients temperature from dropping during their surgery. A warm blanket can be placed between

the patient and the cold operating room table. Skin exposure can also be limited during the prep

time and the surgery itself. Surgical team awareness, education, and understanding of the effects

of hypothermia are necessary components to enhance the way clinicians provide quality, cost-

effective patient care (Weirich, 2008, p. 333).

Education of the entire surgical team regarding the importance of maintaining a patients

temperature in order to prevent complications from hypothermia is imperative. This includes

hospital administration, who should be made aware that it is estimated that complication from

hypothermia can lead to increased hospital costs of $2500 to $7500 (Weirich, 2008, p. 333).

Education during staff meetings regarding patient warming procedures would be beneficial since

this would include each of the surgical team. An IV fluid warmer should be purchased for the

preoperative department in order to provide each patient with warm IV fluids beginning with the

IV start. A warming gown should be provided for every patient in the preoperative area whose
TEMPERATURE CONTROL FOR SURGICAL PATIENTS 4

surgery will last greater than 60 minutes. The patients exposure to cool air in the operating room

should be limited whenever possible. And last, the patients temperature should be monitored

continuously until the surgery is over. The incidence of hypothermia during surgery can be

reduced by prevention, treatment, and increased clinician awareness of the problem. The surgical

team (ie, surgeons, preoperative nurses, circulating nurses, scrub persons, and PACU nurses) can

implement many interventions to reduce the threat of hypothermia (Weirich, 2008, p. 338).

After staff education and the implementation of standardized warming measures have

been put into place, a record of each patient that arrives in the PACU with a lower than ideal

temperature should be kept. The PACU charge nurse can keep a log of these patients and present

the information during the perioperative staff meetings. The entire team can monitor the

outcomes and provide ideas regarding any improvements that need to be made.

It is the job of a perioperative nurse to provide safe, compassionate care to the surgical

patient. Every effort should be made to ensure that each patient is treated equally and with the

highest quality of care that St Francis Eastside can provide. Nurses can impact the patients

outcome by ensuring that the patients are as comfortable as possible. Keeping perioperative

patients normothermic should be a high priority for nurses. Not only does this make the patient

feel more comfortable and increase his or her satisfaction, but normothermia also decreases the

patients time in the post anesthesia care unit (Weirich, 2008, p. 333).

An example of a chart to report patient temperatures that fall out of the expected range:

Number of patients arriving in PACU with temp <97.8

2015 Jan Feb Mar Apr May Jun Jul Aug Sept Oct No Dec
TEMPERATURE CONTROL FOR SURGICAL PATIENTS 5

v
#

Patient

s
Total
TEMPERATURE CONTROL FOR SURGICAL PATIENTS 6

References

Hong-xia, X., Zhi-jian, Y., Hong, Z., & Zhiqing, L. (2010, December). Prevention of

hypothermia by infusion of warm fluid during abdominal surgery. Journal of

PeriAnesthesia Nursing, 25, 366-370. http://dx.doi.org/10.1016/j.jopan.2010.10.007

Lynch, S., Dixon, J., & Leary, D. (2010, November). Reducing the risk of unplanned

perioperative hypothermia. AORN Journal, 92, 553-565.

http://dx.doi.org/10.1016/j.aorn.2010.06.015

Roder, G., Sessler, D. I., Roth, G., Schopper, C., Mascha, E. J., & Plattner, O. (2011). Intra-

operative rewarming with Hot Dog resistive heating and forced-air heating: a trial of

lower-body warming. Journal of the Association of Anaesthetists of Great Britain and

Ireland, 66, 667-674. http://dx.doi.org/10.1111/j.1365-2044.2011.06722.x

Weirich, T. L. (2008, February). Hypothermia/warming protocols: Why are they not widely used

in the OR. AORN Journal, 87, 333-344. http://dx.doi.org/10.1016/j.aorn.2007.08.021

Wu, X. (2013, March). The safe and efficient use of forced-air warming systems. AORN Journal,

302-308. http://dx.doi.org/10.1016/j.aorn.2012.12.008