1. Use AORN’s Guideline to Prevent Hypothermia
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

2. Developed and originally presented by Byron L. Burlingame, MS, RN, CNOR
Byron L. Burlingame, MS, RN, CNOR, has been employed for the past 11years as one of the perioperative specialists in AORN's Nursing Department. Byron serves as the lead author for various guidelines, including the Guideline for Prevention of Unplanned Patient Hypothermia, which incorporates AORN’s evidence-based recommendations for preventing patient hypothermia and associated complications. Byron also serves on the Facility Guidelines Institute's Health Care Guidelines Revision Committee (HGRC) for the Guidelines for Design and Construction of Health Care Facilities and the FDA Surgical Fires Group. Byron has authored Clinical Issues columns and other articles published in the AORN Journal and other professional publications. Prior to coming to AORN, Byron worked as a circulator and in various levels of management in large and rural hospitals.
These slides are taken from the webinar Use AORN’s Guideline to Prevent Hypothermia, presented October 28, To listen to the webinar, visit These slides are made available for educational use. Slides may be personalized for your facility and presentation. HOWEVER, THE VIEWS EXPRESSED IN THESE SLIDES ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN.

3. Objectives List five contributing factors for hypothermia
List five potential complications related to hypothermia
Describe when and how to measure a patient’s temperature
Describe three methods of preventing hypothermia and when to use them
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

4. MH What’s New What does the hypothermia guideline cover?
What is excluded from this document? MH
The “Guideline for prevention of unplanned patient hypothermia” covers assessing patients for factors associated with unplanned intraoperative hypothermia, monitoring patient temperatures, preventing unplanned perioperative patient hypothermia, and developing policies and procedures and education for perioperative personnel related to maintaining patient normothermia. The following topics are beyond the scope of this guideline: planned, intentional, or therapeutic hypothermia; rewarming after an intentional or accidental hypothermic event; pharmacological agents used for prevention of hypothermia (eg, amino acids, fructose, carbohydrates); a cost-benefit analysis of treatment methods; treatment for shivering; treatment for accidental or extreme hypothermia related to trauma or conditions outside of a health care facility; and care and treatment for patients experiencing a malignant hyperthermia crisis.
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

5. CONTRIBUTING FACTORS Type and duration of the surgical procedure
Type and duration of planned anesthesia
Ambient operating room temperature
Procedure-related devices
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6. CONTRIBUTING FACTORS PATIENT-RELATED FACTORS Age Sex
Low body-surface area or weight
Cardiac situations
Preexisting medical conditions
Hypotension
History of organ transplant
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

7. CONTRIBUTING FACTORS
Everybody needs to know—in the hand over of care, communicate factors that may contribute to hypothermia for the patient
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

8. Polling Question When should you monitor the patient’s temperature?
Every procedure
Procedures longer than 15 minutes
Procedures longer than 30 minutes
Procedures longer than 60 minutes
a. Every procedure
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

9. TEMPERATURE MEASUREMENT
Measure and monitor
Who
When
Who do we monitor? Everyone—especially those undergoing long procedures.
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

10. TEMPERATURE MEASUREMENT
Device or method
Core temperature sites
“Near-core” temperature sites
How and where do we monitor the temperature?
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

11. TEMPERATURE MEASUREMENT
Use same method of temperature measurement
Calibration
Documentation
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

12. POTENTIAL COMPLICATIONS
Evidence supports that hypothermia can lead to
Myocardial events
Increased peripheral vascular resistance
Left shift of the hemoglobin-oxygen saturation curve
Reversible coagulopathy (platelet dysfunction)
Postoperative protein catabolism and stress-response-altered mental status
Impaired renal function
Now that we know the patients temperature, why do we care?
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

13. POTENTIAL COMPLICATIONS
Evidence supports that hypothermia can lead to
Postoperative pain
Decreased drug metabolism
Pressure ulcers
Poor wound healing
Incidence of infection
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

14. POTENTIAL COMPLICATIONS
There is conflicting evidence about whether hypothermia contributes to
Surgical site infection
Blood loss
Wound complications
Mortality
Increased length of hospitalization
Increased length of time in the PACU
What else does the evidence say?
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

15. Polling Question
Do you apply a warming device, in addition to a blanket, to your patients before the patient arrives in the OR? Yes No
Yes
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

16. hypothermia prevention methods
All phases of perioperative care
Period of patient preoperative warming
Hypothermia identified preoperatively
How do we prevent the complications from occurring?
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

17. hypothermia prevention methods
ACTIVE WARMING METHODS
Increasing the ambient room temperature
Radiant warming
Forced-air warming
Hosing—do not use hose without the blanket manufactured for the forced-air warming device.
Tenting—follow the manufacturer’s written instructions for use
Water-filled mattress
Circulating water garment
Warmed irrigation fluids
Measure fluid temperature when administered
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

18. hypothermia prevention methods
Electric warming blankets
Carbon fiber blankets
Resistive polymer blankets
Electric heating pads
Thermal exchange chambers
Negative pressure warming systems
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

19. hypothermia prevention methods
PASSIVE WARMING METHODS
Insulating devices
Cotton blankets
Surgical drapes
Plastic sheeting
Blankets or garments made of reflective composite fabric
Space blankets
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

20. hypothermia prevention methods
ANESTHESIA REGULATED METHODS
Warmed IV fluids
use technology designed for this purpose
Warmed anesthesia gases
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

21. hypothermia prevention methods
When hypothermia is identified on admission to the PACU, methods of warming should be initiated:
forced-air warming
radiant warming devices
passive thermal measures
ambient room temperature at or above 24° C [75.2° F]
warmed IV fluids
warmed oxygen
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

22. DECIDING WHICH METHOD TO USE
Collaborative discussion among the team members
Planned procedure
Patient positioning
IV access sites
Warming equipment constraints
Manufacturer's written instructions for use
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23. DOCUMENTATION Warming method used Warming device identifier
Temperature settings when applicable
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

24. POLICIES AND PROCEDURE
Contents of nursing assessment
When to measure temperature
When warming equipment should be used
Time frames and methods for cleaning and maintaining warming equipment
Documentation requirements
Competency requirements related to hypothermia prevention
New equipment
Clinical signs and symptoms of hypothermia
Measures for preventing hypothermia
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

25. COMPETENCY REQUIREMENTS
New equipment
Clinical signs and symptoms of hypothermia
Measures for preventing hypothermia
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

26. REFERENCE
Guideline for prevention of unplanned patient hypothermia. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.

27. Questions and Answers
Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.