Use AORN’s Guideline to Prevent Hypothermia Copyright © 2015 AORN, Inc. All rights reserved. Used...

Use AORN’s Guideline to Prevent Hypothermia

Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

Byron L. Burlingame, MS, RN, CNOR, has been employed for the past 11years as one of the perioperative specialists in AORN's Nursing Department. Byron serves as the lead author for various guidelines, including the Guideline for Prevention of Unplanned Patient Hypothermia, which incorporates AORN’s evidence-based recommendations for preventing patient hypothermia and associated complications. Byron also serves on the Facility Guidelines Institute's Health Care Guidelines Revision Committee (HGRC) for the Guidelines for Design and Construction of Health Care Facilities and the FDA Surgical Fires Group. Byron has authored Clinical Issues columns and other articles published in the AORN Journal and other professional publications. Prior to coming to AORN, Byron worked as a circulator and in various levels of management in large and rural hospitals.

Developed and originally presented by Byron L. Burlingame, MS, RN, CNOR

These slides are taken from the webinar Use AORN’s Guideline to Prevent Hypothermia, presented October 28, 2015. To listen to the webinar, visit https://www.aorn.org/Events/Webinars/Previously_Recorded_Webinars.aspx. These slides are made available for educational use. Slides may be personalized for your facility and presentation. HOWEVER, THE VIEWS EXPRESSED IN THESE SLIDES ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN.

• List five contributing factors for hypothermia• List five potential complications related to hypothermia• Describe when and how to measure a patient’s temperature• Describe three methods of preventing hypothermia and when to

use them

Objectives


• What does the hypothermia guideline cover?

• What is excluded from this document?

MH

WHAT’S NEW


• Type and duration of the surgical procedure • Type and duration of planned anesthesia• Ambient operating room temperature• Procedure-related devices

CONTRIBUTING FACTORS


PATIENT-RELATED FACTORS• Age • Sex • Low body-surface area or weight • Cardiac situations• Preexisting medical conditions • Hypotension• History of organ transplant



Everybody needs to know—in the hand over of care, communicate factors that may contribute to hypothermia for the patient



When should you monitor the patient’s temperature?

a. Every procedure

b. Procedures longer than 15 minutes

c. Procedures longer than 30 minutes

d. Procedures longer than 60 minutes

Polling Question


Measure and monitor •Who•When

TEMPERATURE MEASUREMENT


•Device or method • Core temperature sites• “Near-core” temperature sites



•Use same method of temperature measurement • Calibration•Documentation



Evidence supports that hypothermia can lead to• Myocardial events • Increased peripheral vascular resistance • Left shift of the hemoglobin-oxygen saturation curve • Reversible coagulopathy (platelet dysfunction) • Postoperative protein catabolism and stress-response-altered

mental status • Impaired renal function

POTENTIAL COMPLICATIONS


Evidence supports that hypothermia can lead to• Postoperative pain • Decreased drug metabolism • Pressure ulcers • Poor wound healing • Incidence of infection



There is conflicting evidence about whether hypothermia contributes to• Surgical site infection • Blood loss• Wound complications• Mortality • Increased length of hospitalization • Increased length of time in the PACU



Do you apply a warming device, in addition to a blanket, to your patients before the patient arrives in the OR?

Yes

No

Polling Question


All phases of perioperative care– Period of patient preoperative warming –Hypothermia identified preoperatively

HYPOTHERMIA PREVENTION METHODS


ACTIVE WARMING METHODS • Increasing the ambient room temperature • Radiant warming• Forced-air warming – Hosing—do not use hose without the blanket manufactured for the forced-air

warming device.– Tenting—follow the manufacturer’s written instructions for use

• Water-filled mattress • Circulating water garment• Warmed irrigation fluids – Measure fluid temperature when administered



• Electric warming blankets• Carbon fiber blankets• Resistive polymer blankets• Electric heating pads• Thermal exchange chambers• Negative pressure warming systems



PASSIVE WARMING METHODS

Insulating devices• Cotton blankets • Surgical drapes• Plastic sheeting • Blankets or garments made of reflective composite fabric – Space blankets



ANESTHESIA REGULATED METHODS• Warmed IV fluids– use technology designed for this purpose

• Warmed anesthesia gases



When hypothermia is identified on admission to the PACU, methods of warming should be initiated: • forced-air warming • radiant warming devices • passive thermal measures • ambient room temperature at or above 24° C [75.2° F]• warmed IV fluids• warmed oxygen



• Collaborative discussion among the team members– Planned procedure – Patient positioning – IV access sites–Warming equipment constraints

• Manufacturer's written instructions for use

DECIDING WHICH METHOD TO USE


• Warming method used• Warming device identifier• Temperature settings when applicable

DOCUMENTATION


• Contents of nursing assessment• When to measure temperature• When warming equipment should be used • Time frames and methods for cleaning and maintaining

warming equipment • Documentation requirements• Competency requirements related to hypothermia prevention–New equipment– Clinical signs and symptoms of hypothermia –Measures for preventing hypothermia

POLICIES AND PROCEDURE


• New equipment• Clinical signs and symptoms of hypothermia • Measures for preventing hypothermia

COMPETENCY REQUIREMENTS


Guideline for prevention of unplanned patient hypothermia. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.

REFERENCE


Questionsand Answers


Use AORN’s Guideline to Prevent Hypothermia Copyright © 2015 AORN, Inc. All rights reserved. Used...

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