Prevention Guidelines for Hypothermia

Posted by Lauren Burke on

In July of 2019, the Association of Perioperative Registered Nurses (AORN) released updated guidelines for the prevention of hypothermia. Perioperative warming is essential in reducing postoperative pain, wound infections, blood loss and shivering. Adverse consequences are possible with unplanned perioperative hypothermia such as impaired wound healing, altered drug metabolism, adverse cardiac events and coagulopathies.

Warming techniques are a routine part of surgical patient management through various disciplines. Setting guidelines for the prevention of hypothermia helps to standardize processes and improve patient outcomes.

Accurate Patient Assessment

All surgical patients are at risk for hypothermia, and hypothermia can have serious consequences for the patient. The perioperative team must implement warming techniques to keep this complication at bay.

Selecting warming techniques starts before the surgery begins with a patient assessment. :

  • Pinpoint specific risk factors for perioperative hypothermia
  • Measure the patient’s temperature
  • Identify the patient’s thermal comfort level
  • Look for signs of hypothermia: shivering, piloerection, cold extremities

The patient assessment whether it is preoperative, perioperative or postoperative should include temperature monitoring.

Methods of Hypothermia Prevention

Methods for hypothermia prevention fall into one of three categories:

  • Active warming
  • Passive warming
  • Combination

Active warming is the application of heat while passive warming prevents heat loss.

Selecting Hypothermia Prevention Methods

Prevention method selection should be based on:

  • Patient factors such as age, gender and preexisting conditions like peripheral vascular disease
  • Surgical procedure factors such as length and anesthesia used: general or regional
  • If a pneumatic tourniquet or intermittent pneumatic compression device is in use
  • The positioning of the patient
  • Restrictions for warming equipment
  • Potential adverse effects of warming equipment

Every patient must be individually assessed to determine the right strategy for hypothermia prevention. Not every plan will work with every patient because variables change from person to person and surgery to surgery.

One Passive Method

AORN states at least one passive warming method is necessary for each patient in most cases. Some examples of passive methods include:

  • A cotton blanket
  • A surgical drape
  • Plastic sheeting
  • Thermal clothing
  • A non-linting wrap
  • Socks
  • Head covering
  • Reflective-composite fabric blanket or clothing

Passive warming should be part of every phase of perioperative care.

Adjunct Active Warming Techniques

Ideally, the perioperative team will use active warming with passive options. Examples of active warming like:

  • Forced-air warming system
  • Warm intravenous fluids and irrigants
  • Thermal exchange chamber

It is important to remember any single method may not be enough to prevent hypothermia. A combination of techniques may be the best approach. By monitoring the patient’s temperature, the team can make warming adjustments as needed to prevent hypothermal and the complications it brings.

References 

“Guidelines for Prevention of Hypothermia.” Hypothermia | AORN Facility Reference Center, Association of PeriOperative Registered Nurses, 1 July 2019, //aornguidelines.org/guidelines/content?sectionid=173731777&view=book.

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