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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2 0 1 4
P A T I E N T W A R M I N G
W
hen cases involve
combinations of pro-
cedures on various
exposed body parts, as well as fre-
quent patient repositioning and
changes in the orientation of the OR
table, warming can be a challenge.
It's a challenge I know well, since 90% of my caseload involves cosmetic
surgery patients. In these cases, warming options can be limited by
inaccessibility of warming equipment (fluid warmers, for example) or by
interference with sterile fields, as with forced-air warming blankets.
The key in these and all challenging cases is to plan your warming
strategy ahead of time. Consult with the surgeon pre-operatively regard-
ing any changes in the position of the patient or OR table, and discuss
the sequence of procedures to be performed, so that you can readily
adapt warming modalities to those changes.
And speak up. For example, liposuction patients in particular can cool
down rapidly following the infiltration of several liters of room-temperature
tumescent solutions. Although not technically the domain of anesthesia, I
insist that surgical personnel warm tumescent solutions, when possible,
prior to infiltration.
Finally, if all else fails, improvise. In my practice, facelifts are a frequent
procedure. During these procedures I find myself positioned at the side of
the patient, often adjacent to the patient's lower extremities, far removed
from the surgical site. Our particular type of fluid warmer is not easily utilized
in this situation, due to the limitations of IV site and tubing length.
Nevertheless, I can often improvise. We use a forced-air warming blanket
WARMING
CHALLENGES
Plan
Your
Warming
Strategy
Ahead
of
Time
Pamela
Bevelhymer,
RN,
BSN
