based strictly on procedure time; we consider how long the patient will be in the OR.
For that reason, we prewarm most patients.
Despite active warming's clear benefits, plenty of surgical facilities still give patients
a warmed blanket in pre-op and consider that acceptable. It's not. Cotton blankets
might make patients feel warm and comfortable, but research shows the heat they
give off lasts for only about 10 minutes and does not impact core body temperature.
Passive warming with a cotton blanket also isn't an economic choice because it
increases linen costs and linen inventory. Staff must dedicate time to loading blanket
warming units and reapplying blankets in pre-op. That's a lot of inefficiency for no gain
in clinical outcomes.
Cost is often cited as a barrier to implementation of active warming methods. To
gain buy-in for active warming, consider you'll be saving money on postoperative
morbidity. Warm patients wake up quicker because they metabolize anesthetics at
an increased rate. They're able to fight off infection because their tissue oxygenation
levels are higher. They heal better and they're more comfortable.
• Intraop warming. Continue the warming method that was initiated in pre-op when
patients enter the OR. For procedures lasting longer than 30 minutes, increase the
ambient room temperature and, if appropriate, ask the surgeon to use warmed irriga-
tion solutions. This should be an agreed upon methodology between surgery and anes-
thesia leaders.
• Post-op warming. Patients can lose 0.5°C to 1.5°C of their body temperature as
they recover in the PACU. Regularly monitoring the patient's temperature therefore
remains imperative during the post-operative phase.
While patients are recovering, reassess and identify IPH risk factors. Observe
patients for signs and symptoms of hypothermia and continue active warming meth-
ods until the patient's minimum body temperature reaches 36°C.
All too often, staff in PACUs check patients' temperatures only when they arrive in
the unit and right before discharge. That's not often enough if active warming has
been discontinued, especially if the patient stays in the PACU for more than an hour.
You really should be monitoring temperatures upon admission to the PACU, within 15
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