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Angela Wetli
3207
Dowling
On my honor, I have neither given nor received aid on this assignment or test, and I
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
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
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
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-
Education of the entire surgical team regarding the importance of maintaining a patients
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:
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
Lynch, S., Dixon, J., & Leary, D. (2010, November). Reducing the risk of unplanned
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
Weirich, T. L. (2008, February). Hypothermia/warming protocols: Why are they not widely used
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