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

2. Circulating Nursing
Being an
advocate
for patient
in OR

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

4. 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,

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

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

7. 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

8. 3 Counts Initial count Rays Laps Needles Blades Cottonoids Hypos
End of procedure count
Begging of closing
End of closing

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

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

11. 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)

12. 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

13. Importance of Thermoregulation
Healing
Metabolism of medications
Reduces infection

14. Hypothermia

15. 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

16. 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

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

18. 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)

19. 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

20. 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

21. 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

22. 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
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,
Treas, L. S. & Wilkinson, J. M. (2014). Basic nursing: Concepts, skills and reasoning. Philadelphia: F.A. Davis