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E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 1
When you educate staff on new
patient warming protocols, break
down the process into a series of
easy-to-follow steps:
• Have the pre-op nurse place a
body-warming blanket on the
stretcher.
• Place the patient on the
stretcher.
• Put the warming gown on
the patient.
• Attach the warming unit to the
gown and have the pre-op nurse
set the temperature to "high."
• Detach the warming unit when
the patient is transported to the
OR, and keep the detached unit
in pre-op.
• Have the OR nurse attach and
turn on the patient's underbody-
warming blanket as soon as they
arrive in the OR. (This step
ensures active warming contin-
ues during the induction, intuba-
tion, IV start, central line placement, urinary
catheter insertion and placement of pres-
sure site padding).
• Lower the setting of the body-warming
blanket during the procedure.
These are the basic steps to our protocol, but
we make constant tweaks and variations. For
instance, even though our pre-op nurse will
always set the warming gowns temperature to
"high," patients often adjust that setting based
on personal comfort. Patient temperatures are
checked once pre-operatively via a temporal
scan (across the forehead to behind the ear),
and intraoperatively on a continuous basis after
induction via an esophageal temperature probe.
— Kathy Abbott, BSN, RN
ologists about our options, we decided to prewarm
neuromuscular (NM) spinal fusion patients with
warming gowns. While we eventually made changes
to all our orthopedic procedures, we started with
this small subset of patients, a group that is signifi-
cantly exposed during surgery. We'd always had
trouble maintaining normothermia (core body tem-
perature of 36˚C) in them, and we needed to protect
this vulnerable group from the many potential
adverse reactions of hypothermia — infection, poor
wound healing, increased blood loss (and the poten-
tial need for a transfusion), decreased renal func-
tion and prolonged hospitalization.
For our initial trial, the vendor provided one box
of 20 gowns and three warming units free of charge.
After the trial, it cost us $8.23 per gown to prewarm
patients, a cost our hospital's leadership saw as a
reasonable investment in safety.
PROACTIVE APPROACH Active warming methods are critical components of programs designed to
prevent perioperative hypothermia.
ACTION ITEMS
Maintain Normothermia With Ease
Gregory
DeConciliis
