Prevention of hypothermia throughout all perioperative stages
Ensuring that every patient undergoing surgery is adequately warmed is crucial, regardless of whether it is to maintain their comfort in chilly operating rooms or to prevent the adverse effects of perioperative hypothermia. Moreover, keeping patients warm has both medical and financial benefits as it enhances patient satisfaction and prevents negative outcomes. Warming practices should start right from the patients’ arrival and continue until just before their discharge. This approach plays a significant role in hospitals’ success, as it reduces poor outcomes or dissatisfied patients.
- In preoperative period. Prevention of hypothermia and associated risks starts from warming of patients soon after arrival in pre-op. While helping patients slip on their surgical gowns, discussing the benefits of warming protocols can help capture their attention. Additionally, wrapping patients in a warmed cotton blanket can make them even more receptive to the active warming methods that will be utilized during their stay. Educate patients on how prevention of perioperative hypothermia can lower the chances of surgical site infections, cardiovascular complications, surgical blood loss, and delayed wound healing.
In addition to reducing recovery times, maintaining normothermia is crucial for ensuring patients' comfort during their hospitalization. In fact, some patients have described post-surgery shivering as even more unbearable than the pain they experience.
- In the operating room. To ensure patient comfort during their transition to the operating room, it's important to have a staff member waiting in the hallway to provide a freshly warmed cotton blanket. Many patients perceive the OR as being as cold as a freezer, so these small steps can ease their discomfort. Once the patient is on the surgical table, switch to using a conductive patient warming system with pads (e.g. RAMONAK-03 by TAHAT).
For prevention of hypothermia, a variety of active warming methods should be used, including full-body blankets, under-body warming pads, depending on the procedure. Use conductive underbody thermal pads to keep patients warm and facilitate surgical access.
After positioning the patient on the table, it's advisable to use a warmed prepping solution on the surgical site. For example, a 2% chlorhexidine gluconate (CHG) and 70% isopropyl alcohol solution that can be warmed to 30°С (86°F) in a fluid warming cabinet (e.g. THERMO by TAHAT). If warming of prepping solutions is not possible, it's recommended to store them in the pre-op or PACU, where the temperature is higher than in the OR.
It's important to keep patients actively warmed throughout their time in the OR and monitor their core temperature during all phases of surgery. It's also crucial to maintain the OR's temperature within the range recommended by national guidelines. For example, the Association of periOperative Registered Nurses (AORN) recommends a thermostat setting between 20°С (68°F) and 24°С (75°F).
Prevention of hypothermia can also be achieved by using warmed IV fluids. These fluids can be heated in warming blanket cabinets set to 38°С (100°F) or via intravenous fluid warmers (e.g. Ampir-01 or Ampirmini by TAHAT). Research shows that using warmed IV and irrigation fluids reduces vasoconstriction and keeps patients' core temperature half-a-degree warmer during surgery than using room temperature fluids. Additionally, warm grounding pads that are used to protect patients during electrosurgery.
- In the PACU. It's essential to continue monitoring patients' temperatures and actively warming them until they achieve a normothermic temperature at least 15 minutes after arriving in the PACU. By keeping patients warm, the hospital can discharge them sooner. Shivering can increase the risk of cardiovascular stress, oxygen consumption, carbon dioxide production, and overall cardiac output, which can result in complications such as myocardial infarction, ischemia, or hypoxemia in older, frail, or other high-risk patients. While there are many clinical benefits to warming, it's usually sufficient to inform patients that the goal is a quick and comfortable recovery.
Standard protocol must include warming patients throughout their surgical journey. In pre-op, use warmed cotton blankets, and in the OR and PACU conductive patient warming systems with pads. For patients with higher BMIs, postoperative prevention of hypothermia can often be achieved using only warmed cotton blankets.
Keep patients actively warmed throughout all perioperative stages.
Ensuring patients have a positive experience is crucial. It's essential to do everything to make their stay as comfortable as possible. It's a good idea to ask patients if there's anything else that can be done to enhance their experience throughout their stay, including before they leave the facility. This is especially important as patient satisfaction surveys are often sent out after discharge. It's important not to let a patient's discomfort with temperature undermine the excellent clinical care they received at the facility.
Ensuring that patients are comfortable is crucial to guarantee that they have a positive experience, which in turn can result in them returning for future medical needs. Hospitals and clinics that utilize warming devices provide superior care compared to their competitors. The ability to keep patients warm throughout their stay is a significant factor when patients are contemplating where to receive elective surgery in the future.