Preprocedure Warming Maintains Normothermia Throughout the Perioperative Period: A Quality Improvement ProjectResearch supports the practice of preprocedure warming as a method to prevent the development of unplanned perioperative hypothermia. ASPAN defines hypothermia as a core temperature lower than 36°C. The purpose of this quality improvement project was to explore the idea that preprocedure warming maintains perioperative normothermia. Information was obtained through retrospective chart reviews (n = 148). Temperatures were compared for patients who received standard preprocedure care versus patients who were warmed with a warming gown for one hour preprocedure.
Research News: Perioperative NormothermiaWARMING A PATIENT in the PACU is a routine, almost instinctive action of the perianesthesia nurse. Further, patients often mention, “Those warm blankets feel so good!” We know that body temperature plays an essential role in patient perception of the perioperative experience, and that maintaining normothermia can ward off many costly, adverse events.1
ASPAN’s Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative Normothermia: Second EditionCLINICAL PRACTICE GUIDELINES are systematically developed guidelines or statements designed to assist the practitioner and/or patient in making appropriate health care decisions in specific clinical circumstances.1-3 Guideline development involves a deliberate process of problem identification and validation; exploration and retrieval of literature; rigorous review, critique, and synthesis of the evidence; and design and recommendation of a practice change.4-6 Guideline recommendations are based on a body of evidence that can arise from multiple sources including meta-analysis, systematic reviews, randomized controlled trials (RCTs), and expert opinion.
Prevention of Hypothermia by Infusion of Warm Fluid During Abdominal SurgeryPerioperative hypothermia can lead to a number of complications for patients after surgery. The aim of this pilot study was to evaluate the efficacy of warm fluids in maintaining normal core temperature during the intraoperative period. We studied 30 American Society of Anesthesiologists (ASA) physical status I or II adult patients who required general anesthesia for abdominal surgery. In the control group (n = 15), fluids were infused at room temperature; in the test group (n = 15), fluids were infused at 37° C.
Revisiting the ASPAN Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative NormothermiaSURGICAL SITE INFECTIONS (SSI) are the second most frequently reported health care associated infection (HAI), accounting for 17 percent of all HAIs annually for a total of 500,000 infections.1-2 Multiple analyses of hospital costs associated with SSI have found mean increases in costs ranging from 3,500 to 18,000 dollars, with an increased length of stay (LOS) of 4 to 14 days for each SSI.2-3 Total direct and indirect medical costs associated with SSI can add up to 10 billion dollars each year.
Incidence of Postoperative Hypothermia and the Relationship to Clinical VariablesA prospective, quantitative, correlational study was conducted to determine the incidence of postoperative hypothermia and the relationship of hypothermia to numerous clinical variables previously studied. The study reflects the researchers’ interest in updating previous data regarding the incidence of hypothermia. Although hypothermia remains a significant clinical concern, interventions aimed at minimizing hypothermia have evolved over the past 20 years, thus prompting new interest in determining the extent to which hypothermia exists in today’s PACU patients.
Normothermia and Patient Comfort: A Comparative Study in an Outpatient Surgery SettingASPAN guidelines for the prevention of unplanned perioperative hypothermia define normothermia as a core temperature between 36 and 38°C and an acceptable level of warmth. Over a six-month period, more than 30% of the same-day surgery patients experienced hypothermic core temperatures on admission to the preoperative unit. The purpose of the study was to compare two preoperative warming methods (forced-air gowns vs traditional warmed cotton blankets) on oral body temperatures, and patients reported “thermal” comfort in ambulatory surgery patients.
Therapeutic Hypothermia: A Case StudyApproximately 300,000 people experience sudden cardiac arrest (SCA) per year. The percentage of people who survive to discharge from the hospital is a dismal 10% to 25%. After SCA and the administration of cardiopulmonary resuscitation, these individuals can suffer what is known as “post resuscitation syndrome.” This syndrome includes post–cardiac arrest brain injury, a cycle of cerebral edema and cell death that can lead to permanent neurological damage. In two landmark studies, therapeutic hypothermia (TH) was found to improve the chances of being discharged from the hospital post SCA by significant percentages.
Comfort, Satisfaction, and Anxiolysis in Surgical Patients Using a Patient-Adjustable Comfort Warming System: A Prospective Randomized Clinical TrialComfort warming systems aim to produce a comfortable local environment over which the individual patient has control. We studied a patient-adjustable comfort warming system using the Bair PAWS (Patient Adjustable Warming System) (Arizant Healthcare, Inc, Eden Prairie, MN), specifically to study comfort warming rather than therapeutic warming. One-hundred thirty patients were enrolled in this prospective randomized clinical trial, with 58 patients randomized to the patient warming gown, and 72 randomized to the warm blanket group.
Postoperative Rewarming: Are There Alternatives to Warm Hospital BlanketsMild postoperative hypothermia remains a frequent complication among surgical patients during the immediate postoperative period. Current literature describes a variety of rewarming methods directed toward the treatment of this problem. In 1998, ASPAN developed a Clinical Guideline for the Prevention of Unplanned Perioperative Hypothermia. Eleven studies comparing different methods of postoperative rewarming have been published since the release of that guideline. This article introduces a systematic review of these studies to identify the most effective methods of rewarming surgical patients postoperatively.
ASPAN's Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative NormothermiaCLINICAL PRACTICE GUIDELINES are systematically developed guidelines or statements designed to assist the practitioner and/or patient in making appropriate health care decisions in specific clinical circumstances.1-3 Guideline development involves a deliberate process of problem identification and validation; exploration and retrieval of literature; rigorous review, critique, and synthesis of the evidence; and design and recommendation of a practice change.4-6 Guideline recommendations are based on a body of evidence that can arise from multiple sources including meta-analysis, systematic reviews, randomized controlled trials (RCTs), and expert opinion.
Unintentional Hypothermia: Implications for Perianesthesia NursesEveryday throughout the United States and globally, patients undergo surgery and anesthesia. Inadvertent hypothermia, a core body temperature less than 36°C (96.8°F), remains a significant concern for these patients. Although the untoward physiological outcomes are well-documented, perianesthesia nurses remain challenged with keeping patients warm before, during, and after surgery. The ability to promote normal thermal balance in surgical patients requires a team effort. Using best evidence to guide clinical practices aimed at promoting thermal balance in the surgery patient is critical to the provision of safe, quality care.
A Clinical Evaluation of the Cost and Time Effectiveness of the ASPAN Hypothermia GuidelineIt is known that perioperative hypothermia increases the cost of care and places surgical patients at increased risk for adverse outcomes. The American Society of PeriAnesthesia Nurses (ASPAN) developed the Clinical Guideline for the Prevention of Unplanned Perioperative Hypothermia to specify a systematic approach to the maintenance of normothermia in surgical patients, making use of newer active warming technologies as well as passive warming techniques. The purpose of this study was to test the cost and time effectiveness of the ASPAN Hypothermia Guideline as compared with usual care.
Comparison of Temperature Measurement Devices in Post Anesthesia PatientsA descriptive correlational study was used to evaluate the correlation/agreement of oral and axillary temperature measurements to patient core temperatures obtained in the OR. Data collectors recorded oral or axillary patient temperature from 752 patients on admission and discharge from the PACU. Results indicated that there was a moderate correlation between each of the current devices and core temperature, but no agreement between core temperature and either device. Recommendations were made to use just one device throughout the organization, or to use the device used on admission throughout the hospitalization.
Adoption of the ASPAN Clinical Guideline for the Prevention of Unplanned Perioperative Hypothermia: A Data Collection ToolPerioperative hypothermia remains a common occurrence despite the development and dissemination of a clinical practice guideline for the prevention of unplanned perioperative hypothermia by ASPAN. Unfortunately, a process for measuring compliance with and adoption of this guideline has yet to be developed. The purpose of this article is to describe a medical record abstraction method for determining the degree of adoption of the ASPAN Clinical Guideline for the Prevention of Unplanned Perioperative Hypothermia in the perianesthesia setting.
Chill Can KillYOU ARRIVE in the Phase I PACU and check the assignment board to find you are assigned to care for the only critical care patient on the schedule today: a patient having an elective abdominal aortic aneurysm repair. Although the patient went into the OR at 7:00 am, he is not expected to arrive in PACU until after lunch.
Temperature Measurement in the Phase I PACUPerioperative hypothermia remains a common occurrence in the Phase I PACU. Identification of and appropriate intervention for this complication is of prime importance in the prevention of adverse outcomes. This article provides an overview of perioperative hypothermia and offers a summary of the most common methods used to measure body temperature.
Surgical considerations in the elderlyThe number of older adults in America is rising every year. This increase in the elderly population will have a direct impact on health care delivery and perianesthesia nursing. Consequently, nurses need to increase their knowledge regarding the geriatric patient undergoing surgery. Areas of particular importance for nurses are preoperative assessment, medications taken by the elderly, preoperative instructions, intraoperative nursing care, postoperative nursing care, and discharge planning. Also of particular concern for the elderly surgical patient are nutrition, skin integrity, pain management, and promotion of sleep and comfort.
Geriatric anesthesia implicationsThe geriatric patient will continue to pose challenges during the perianesthesia period. By age 80, the older adult has experienced many physiological and anatomical changes, many starting during the 4th decade of life. Changes in tissue mass and function in major organ systems demand special perianesthetic care planning to optimize patient outcomes. Understanding the physiology of aging will assist the perianesthesia nurse in planning perianesthesia care for their patients. Consequently, emphasis should be placed on cautious preanesthesia screening and evaluation, so that astute diagnosis and treatment of comorbid diseases are thoughtfully considered in relationship to the type of anesthesia when caring for the postanesthesia patient.