Publish Date: August 28, 2019
Too many patients experience some form of unplanned perioperative hypothermia in which their core body temperature drops below 96.8° F during surgery. A drop in core body temperature can lead to adverse patient outcomes such as myocardial events, infections, poor incision healing, postoperative pain, and increased blood loss.
AORN’s latest update to the Guideline for Prevention of Hypothermia provides new evidence supporting more detailed recommendations to improve hypothermia prevention, according to Byron Burlingame, MS, BSN, RN, CNOR, AORN senior perioperative practice specialist and author of the guideline updates that were published in AORN’s online Facility Reference Center July 1.
“The biggest barrier to preventing perioperative hypothermia is not having the best option that fits the patient,” Burlingame shares, noting that patient size, co-morbidities and the projected duration of the procedure can uniquely influence hypothermia risk.
The updated guideline puts more detailed focus on preoperative selection of patient warming methods based on patient factors, procedure, operative position, location of IV access and warming device constraints. Identifying the patient’s specific needs is also discussed in the update in order to maintain a safe core body temperature prior to anesthesia induction.
Implementing the Updates
AORN now recommends that every patient receive some form of hypothermia prevention, one major change to practice in the guideline update that impacts every surgical patient. “This major change in practice requires team collaboration when choosing the best method,” Burlingame stresses.
He offers four important ways for teams to implement this and other updates for preventing hypothermia during surgery into practice:
- Assess every patient preoperatively—This is to determine the best method of hypothermia prevention, including active warming, passive warming or a combination of the two. “If your first choice is not available then use a second choice. Frequently the best intervention is to use a combination of methods,” Burlingame says.
- Monitor the patient throughout intraoperative care—Anesthesia exposure is associated with 80% of heat loss in surgical patients, this is why it is important to implement active warming methods on hand, as these are the only methods that counter the effects of anesthesia.
If the patient is not pre-warmed prior to arrival, the active warming device should be started as soon as possible when the patient arrives and prior to induction of anesthesia, Burlingame recommends. “The challenge is that many people may wait until everything is done to turn on and apply a warming device, which often requires catching up to maintain normothermia.”
- Continue to manage patient core body temperature after surgery—A postoperative focus on achieving patient normothermia should continue in postoperative care until the patient’s temperature is stabilized. “If the same temperature monitoring method used in intraoperative care is not used in postop care, it is recommended to use a different method.”
To help rally your team around ramping up hypothermia prevention practices, Burlingame suggests looking to the purpose statement in the guideline update, which lists the complications related to the patient becoming hypothermic in addition to the improvements in patient satisfaction scores when the patient is warmed.
He also points to evidence-based rationale cited throughout the update for actions to prevent hypothermia. “With so much good evidence out there to support perioperative hypothermia prevention, there are patients still sent to the OR with no hypothermic measures instituted—perioperative nurses have the power to change this.”
Listen to Burlingame’s detailed explanation of the guideline updates through this free-to-members webinar and take advantage of updated members-only Guideline Essentials’ resources on the guideline update to bring your team together to prevent perioperative hypothermia.