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PATIENT WARMING
Patient warming: on the inside and out
There is increasing awareness of the need to warm patients with forced air or other warming devices, but infusion and insufflation of cold fluids and gas can also contribute to inadvertent perioperative hypothermia. Now there is increasing interest in the role of nutrition in maintaining normothermia.
Although it is widely acknowledged that inadvertent perioperative hypothermia is associated with poorer surgical outcomes, patients continue to leave the theatre in a hypothermic state – increasing their risks of surgical site infection, cardiac complications, bleeding and mortality. A study by Dr Esther Godfrey and colleagues, from the department of anaesthesia, at the Royal Gwent Hospital, showed that hypothermia occurs in around
half of patients undergoing surgery – despite national guidelines for its prevention.1
NICE Guidance
So, what exactly does best practice look like? NICE guidance2
states that the patient’s
temperature should be measured and documented in the hour before they leave the ward or emergency department. If the patient’s temperature is below 36.0˚C, active
warming should be started preoperatively on the ward or in the emergency department (unless there is a need to expedite surgery because of clinical urgency).
If the patient’s temperature is 36.0˚C or above, active warming should be commenced at least 30 minutes before induction of anaesthesia, unless this will delay emergency surgery. Active warming should be maintained throughout the intraoperative phase. The patient’s temperature should be measured and documented before induction of anaesthesia, then every 30 minutes until the end of surgery.
Standard critical incident reporting should be considered for any patient arriving at the theatre suite with a temperature below 36.0°C and induction of anaesthesia should not begin unless the patient’s temperature is 36.0°C or above (unless there is clinical urgency.) Patients should be warmed intraoperatively from induction of anaesthesia, using a forced- air warming device, if they are: l Having anaesthesia for more than 30 minutes
l Having anaesthesia for less than 30 minutes and are at higher risk of inadvertent perioperative hypothermia
After surgery, the patient’s temperature should be measured and documented on admission to the recovery room and then every 15 minutes. Ward transfer should not be arranged unless the patient’s temperature is 36.0˚C or above
SEPTEMBER 2018
The theatre team should consider a resistive heating mattress or resistive heating blanket if a forced-air warming device is unsuitable. After surgery, the patient’s temperature should be measured and documented on admission to the recovery room and then every 15 minutes. Ward transfer should not be arranged unless the patient’s temperature is 36.0˚C or above. If the patient’s temperature is below 36.0˚C, they should be actively warmed using forced-air warming until they are discharged from the recovery room or until they are comfortably warm. Patients should be kept warm when back on the ward and their temperature should be measured and documented on arrival at the ward, then as part of routine four-hourly observations. If the patient’s temperature
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