Hypothermia in the Or & Circulating Nursing Cristen Moore Westminster nursing school

Circulating Nursing Being an advocate for patient in OR

Pre Procedure Look at DPC Fill out whiteboards Help set up room Pull medications Go visit patient in pre op or holding 1st count

White Boards Patient Information OR Team Patient Name Consented Procedure & site Allergies Anticipated Disposition Blood status Circulator Scrub Technician Surgeon Residents Anesthesia Staff Other; Students,

DPC; Doctors Preference Card Patient information Surgeon, Anesthesiologist Tool sets Supply Charge List Medications Type of bed used Implants Special instructions

Pt. in room Push in room button Warm blankets Compression boots Position patient Help anesthesiologist with incubation Bear hugger Time out

During procedure Grab additional supplies & medications Dispense medications to back table Dispense needles to back table Dispense gloves to back table Charting Call family when procedure starts, every 2 hr. with update, and end of procedure Call PACU with report 20 min. before end or procedure

3 Counts Initial count Rays Laps Needles Blades Cottonoids Hypos End of procedure count Begging of closing End of closing

End of procedure Bed/stretcher from hallway Warm blankets Help with extubation Help transfer pt. to bed/stretcher Walk over to PACU

OR Medications Bacitracin ointment Heparin Bacitracin irrigation Compressed Surgifoam (gel foam) Powdered Surgifoam Thrombin Topical 5,000 units Warm NS

Implants Implant stickers 5 places Charge List Paper to patient/family Tracking form goes back to company Material management Bone book (tissue, serial #, with pt. sticker)

Thermoregulation Thermoregulation- Process of maintaining a stable temperature, core temperature 36.1 °- 38.2° Celsius Hypothermia- abnormally low core temperature, less than 35° Celsius Hyperthermia- body temperature above normal, 37.8° Celsius

Importance of Thermoregulation Healing Metabolism of medications Reduces infection

Hypothermia

Hypothermia Body’s temperature regulation is affected by a stressor. Can be induced during surgery to decrease the need for oxygen in the body tissues. Under close observation in the OR by the anesthesiologist

Nursing Diagnosis Risk for ineffective thermoregulation Risk for infection r/t loss of perfusion Ineffective thermoregulation r/t blood loss Ineffective thermoregulation r/t trauma

Goals Long Short Pt. will maintain a stable temperature, core temperature 36.1 °- 38.2° Celsius Pt. will ask for warm blankets as needed

Nursing Interventions Nurse will use bear hugger warming system per hospital protocol Nurse will get warm blankets for pt. pre procedure, end of procedure, PACU, post op, as needed Nurse will asses pt. temperature every 30 min. post procedure Nurse will administer antibiotics per md order pre procedure (infection/hyperthermia control)

Pre Existing Risk Factors Severity of illness Age >65 yr. Male Unintentional perioperative hypothermia is associated with severe complications and high mortality in elective operations Pre Existing Risk Factors Severity of illness Age >65 yr. Male Anemia Neurologic disorders Renal failure Resulting Risk factors Sepsis Wound infection Multiple organ failure Strokes MI Mortality rate increase 4X

Hypothermia Complications Increase peripheral resistance Coagulation Warming with an underbody warming system reduces intraoperative hypothermia in patients undergoing laparoscopic gastrointestinal surgery Hypothermia Complications Increase peripheral resistance Coagulation Hemorrhage Post-op shivering

Intervention vs. Control Group Less intraoperative hemorrhage in in intervention group than control group Reduced cases of ileus, anastomotic hemorrhage, leakage Hemoglobin showed little difference Reduced post operative shivering

References Billeter, T. B., Hohmann, S. F., Druen, D., Cannon, R., Polk, H. C. (2014). “Unintentional perioperative hypothermia is associated with sever complications and high mortality in elective operations.” Surgery 1245-1252. Pu, Y., Cen, G., Sun, J., Gong, J., Zhang, Y., et. al. “Warming with an underbody warming system reduces intraoperative hypothermia in patients undergoing laparoscopic gastrointestinal surgery.” International Journal of Nursing Studies vol. 51, 181-189. Treas, L. S. & Wilkinson, J. M. (2014). Basic nursing: Concepts, skills and reasoning. Philadelphia: F.A. Davis