Perioperative hypothermia can be associated with significant patient morbidity and mortality, Hart, Bordes, Hart, Corsino, & Harmon (2011) describe a threefold increase in the incidence of morbid cardiac outcomes, increases in surgical blood loss, a 20% increase in allogeneic transfusion, and a tripling of surgical site infections (SSIs). Hypothermia is defined as a core body temperature less than 36ﹾC (98.8ﹾF). Patient transfers from surface to surface increase the risk of hypothermia in the perioperative setting unless interventions are put into place.
Having surgery is comparable to running a race, proper preparation for a race includes training, hydrating, and carb loading. Unfortunately, in preparation for surgery, patients often arrive dehydrated, sleep deprived and hungry, therefore their bodies are not prepared to handle the additional stress caused by surgery. In addition, core temperature needs to be maintained throughout the surgical experience to help optimize patient outcomes.
There are several interventions that can be implemented to decrease hypothermia and help your patient win the race and it starts in the preop phase of care. Preparing your patient with 10-30 minutes of preop warming using forced air is most effective in preventing perioperative hypothermia. In fact, Connelly, Cramer, DeMott, et al (2017) found that 81% of the experimental studies reviewed found that there was a significantly higher temperature throughout surgery and in the post anesthesia care unit for patients who received forced air prewarming.
Once the patient gets to the OR, a continuation of forced air should be used along with warmed intravenous fluids to maintain normothermia. If the patient has been prewarmed appropriately, the core temperature will be maintained more effectively.
Transferring the patient to the PACU is a critical time as the patient may become hypothermic due to the discontinuation of the forced air warmer in the OR. It is imperative to keep the patient covered with warm blankets during the transfer until the forced air can be continued in the PACU.
Leadership and front-line buy in are key when implementing a perioperative warming program. Present the evidence and use the AORN 2020 Guidelines for hypothermia and create workflow strategies by collaborating with the front-line staff. Improve patient outcomes and help them win the race by keeping them warm.
References
Connelly L, Cramer E, DeMott Q, et al. The Optimal Time and Method for Surgical Prewarming: A Comprehensive Review of the Literature. J Perianesth Nurs. 2017;32(3):199-209. doi:10.1016/j.jopan.2015.11.010
Hart, S. R., Bordes, B., Hart, J., Corsino, D., & Harmon, D. (2011). Unintended perioperative hypothermia. The Ochsner journal, 11(3), 259–270.
