Keeping Surgical Patients Warm to Improve Outcomes

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By Debra Wood, RN, contributor

Andrea Hagstrom, RN, MSN
Andrea Hagstrom, RN, MSN, nurse educator in perioperative services at Hartford Hospital reports patients and nurses like the Bair Paws Flex gown

Jan. 25, 2010 - Cold is not cool for surgical patients. Maintaining a normal body temperature during the perioperative experience can improve patient outcomes, and nurses are embracing technology, such as forced-air warming gowns, to help keep their patients toasty warm.

“Patients are happy and comfortable; results demonstrate that normothermia is maintained, eliminating unintended hypothermia,” said Andrea Hagstrom, RN, MSN, nurse educator in Perioperative Services at Hartford Hospital in Connecticut, which uses the Bair Paws FlexTM warming gown.

“[It] gives us the ability to warm the patient with one device throughout the three phases of the perioperative patient experience,” Hagstrom added.

Bair Paws Flex gown
The Bair Paws Flex gown lets patients control the temperature.

The American Society of PeriAnesthesia Nurses, in perioperative normothermia guidelines released in October 2009, said, “In an effort to reduce complications and costs associated with perioperative hypothermia, it is imperative to maintain normothermia throughout the course of the surgical continuum.” That may include passive measures, such as the use of blankets, socks and head coverings, or active warming with a forced-air convection warming system, circulating-water mattresses or other devices.

“You don’t wait,” said Mary Reiser, RN, nurse manager of ambulatory surgery at Westchester Medical Center in New York. “You want to maintain them as normothermic and start passive and active warming before hypothermia occurs.”

The guidelines indicate that prewarming for a minimum of 30 minutes may reduce the risk of subsequent hypothermia and that nonemergent patients should be normothermic before being transferred to the operating room or procedure area.

Nurses at Hartford Hospital place the single-use Bair Paws Flex gown on the patient in the pre-operative waiting area.

“Pre-warming allows the body to retain and maintain body heat, and it limits the rate of cooling during the intra-operative period,” Hagstrom explained. “Warming throughout the intra-operative period prevents unintended hypothermia because normothermia, or normal body temperature, is maintained as a result of the pre-operative warming.     

During the procedure, the Bair Paws Flex gown converts into an upper- or lower-body blanket. And after the surgery, nurses can return it to a gown for warming during the immediate post-operative phase, in the post-anesthesia care unit, unless it becomes soiled with prep solutions or body fluids during the procedure.       

Hagstrom added that patients like the gown, because it keeps them warm and they have the ability to adjust the temperature with a handheld device while waiting for surgery and when alert afterwards.

Charlaine Patterson, RN, MSN, CNOR
Charlaine Patterson, RN, MSN, CNOR, director of surgical services for Methodist Dallas Medical Center is pictured here with orthopedic surgeon, Dr. Phil Berry.

Patients may develop hypothermia for a number of reasons.

“Surgery patients are at risk for hypothermia due to exposure of large body surfaces for extended periods of time in a cool operating room,” said Charlaine Patterson, RN, MSN, CNOR, director of surgical services for Methodist Dallas Medical Center. “Patients that are anesthetized lose their ability to shiver, which is the body’s natural way to attempt to correct hypothermia.” 

Dallas Methodist uses the Bair Hugger forced-air warming system, a disposable blanket placed under the sterile drapes; a warming pad, placed under the patient when the procedure will not allow a warming blanket on top; and warm intravenous fluids and irrigation solutions.          

Bair Hugger
Many facilities use the Bair Hugger forced-air warming blanket.

“Since we have implemented these methods to maintain normothermia for our surgery patients, we have had very few patients that have a first postoperative temp below 96.8 F, which is the common definition of hypothermia,” Patterson said.      

Cynthia Harmer, RN, clinical manager of perioperative services at El Camino Hospital Los Gatos in Los Gatos, California, added that keeping patients warm reduces wound infection rates, decreases the likelihood of myocardial infarction and reduces mortality rates. It also can shorten the amount of time patients spend in the intensive care unit and their overall length of stay. El Camino Hospital also uses the Bair Hugger forced-air warming system.   

The Surgical Care Improvement Project, a national quality partnership of organizations interested in improving surgical care by significantly reducing surgical complications, has designated normothermia a quality measure. And effective in fiscal year 2011, which starts in October 2010, the Centers for Medicare and Medicaid Services will require hospitals to report peri-operative temperature management as a quality measure.

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