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you choose should take certain variables into consideration. For example, take
into account the position of the patient, the length of the case and the amount
of surgical field exposure when selecting a warming modality. "The more skin
you've got exposed, the more heat loss you're going to have," says Dr. Hooper.
You may need to deploy multiple warming approaches — warmed blankets,
warm irrigation and IV fluids and forced-air warmers, for example —on a single
patient at different times during a procedure, she says.
Pre-warming: Like overinflating a balloon
One thing Dr. Hooper is certain of is the value of actively pre-warming patients
when it comes to preventing post-op hypothermia. Pre-warming reduces redis-
tribution hypothermia and it decreases core-to-peripheral temperature gradient.
Without pre-warming, it's likely your patient will become hypothermic — even if
you institute active warming after induction of anesthesia, according to a litera-
ture search.
While evidence suggests pre-warming for a minimum of 30 minutes may
reduce the risk of subsequent hypothermia, research has yet to definitively
show that pre-warming has the same level of efficacy as intraoperative and
post-op warming. "Getting those tissues warmed up in pre-op is like overinflat-
ing a balloon," she says. "It gives you a little bit of a cushion."
She theorizes that if patients enter the OR with a higher core temperature,
they'll be better able to withstand a drop in temperature once anesthesia is
administered. "At the very least, pre-warming may help bump up core tempera-
tures, so even when patients naturally lose heat, they won't drop into the
hypothermic range," says Dr. Hooper.
Don't forget about regulating room temperatures. Most surgeons prefer cool
ORs. Are your OR temperatures within the suggested range, according to
AORN's recommended practices and standards? Holly Coble, BSN, RN, CNOR,
specialty coordinator at Cone Health in Greensboro, N.C., found out for herself.
Ms. Coble monitored selected OR temperatures for 90 days on total joint proce-
P A T I E N T W A R M I N G
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