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In the Heat of the Moment
Eloise Broadbent
Registered Nurse
Austin Health
Content to be covered
Hypothermia within the operating suite
Causes of hypothermia
Adverse effects of hypothermia
Thermometry device trial
Acknowledgements
Hypothermia Definition
When our core temperature decreases below 36⁰C ₁
The hypothalamus regulates our temperature ₁
Causes of Hypothermia
• Usually unintentional ₁
• Cold room temperatures ₁
• Large wound exposure ₁
• High flows of unhumidified gases ₁
• Room temperature fluids ₁
• Anaesthetic agents ₁
Theatre Temperatures
12 OPERATING SUITES
USUALLY CONTACT
ENGINEERING TO CHANGE THEATRE
TEMPERATURE
OPERATING SUITES 1-4 HAVE THERMOSTATS
How quickly do patients lose heat?
Phase threePhase three
•reaching a steady point of state ₁
Phase twoPhase two
•more gradual decline during the following 3-4 hours
Phase onePhase one
•1-2⁰C within first hour
Adverse effects of hypothermia
Cardiac complications ₄
Wound infections ₅ Coagulopathies ₄ Prolonged recovery times ₄
Increased hospital length of stay ₄
Warming tactics utilised in the operating suite
Humidified gas
Forced air warmer
Warmed intravenous fluids
Warming mattresses
Increasing the theatre temperature
Effects of pre-warming
30 minutes pre-operatively with the forced air warmer
eliminates the temperature gradient
in phase one ₂
Also, patients love it!
Stop! Trial time!
Ba
ck
gro
un
d Unplanned Intensive Care stay post minor surgical procedure due to a cardiac arrest caused by hypothermia, whilst the patient was in the Recovery Unit
Aim
Inclusion Criteria
GENERAL ANAESTHETIC
50 PATIENTS EACH TRIAL
TRIAL PERIOD: FEBRUARY 2018 –
APRIL 2019
Devices• Devices currently used within
Recovery and the Operating Suite:
Temporal artery thermometer
Nasopharyngeal thermometer
• Trial devices:
Sublingual thermometer
Indwelling catheter thermometer
Tympanic thermometer
Methodology
• Document final nasopharyngeal temperature of case
• Document surgical procedure
• Place form in allocated box
Anaesthetist
• Document temporal artery thermometer temperature
• Document trial device temperature
• Place form in allocated box
Nurse
33.5 34.5 35.5 36.5 37.5 38.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
Dif
fere
nce
be
twe
en
me
asu
re
me
nts
Temperature (⁰C)
Temporal Artery Thermometer versus
Nasopharyngeal Thermometer
Upper Lower Middle Difference Linear (Difference)
33.5 34.5 35.5 36.5 37.5 38.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
Dif
fere
nce
be
twe
en
me
asu
re
me
nts
Temperature (⁰C)
Tympanic Thermometer versus
Nasopharyngeal Thermometer
Middle Upper Lower Difference Linear (Difference)
33.5 34.5 35.5 36.5 37.5 38.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
Dif
fere
nce
be
twe
en
me
asu
re
me
nts
Temperature (⁰C)
Sublingual Thermometer versus
Nasopharyngeal Thermometer
Middle Upper Lower Difference Linear (Difference)
33 34 35 36 37 38 39
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
Dif
fere
nce
be
twe
en
me
asu
re
me
nts
Temperature (⁰C)
Indwelling Catheter Thermometer versus
Nasopharyngeal Thermometer
Upper Lower Middle Difference Linear (Difference)
Resu
lts
Staff feedback on thermometry devices
Sublingual thermometer
Tympanic thermometer
Indwelling catheter thermometer
Temporal artery thermometer
So, what now? • Don’t just rely on a number, constantly assess your patient
• Early recognition
• Increased awareness throughout the operating suite
• Increased use of warming devices
Conclusion
Untreated/undetected hypothermia →
adverse events → prolonged hospital
stay
Awareness regarding hypothermia has
increased
Utilise warming devices
Ensure best evidence bases practice
thermometry devices are utilised
Ack
no
wle
dg
em
en
ts • Thank you Professor Phil Peyton
Dr. Verna Aykanat
Ms Reneé Barbour
Ms Belinda John
Michael Broadbent
Thank you and stay warm!
Refe
ren
ces
1. Brunicardi F., Andersen D. K., Billiar T. R., Dunn D. L., Kao L. S., Hunter J. G., … Pollock R. E. (2019). Schwartz's Principles of Surgery, (11th ed.). New York, NY: McGraw-Hill.
2. Butterworth J.F., Mackey D.C., Wasnick J.D. (2018). Morgan & Mikhail's Clinical Anesthesiology, (6th ed.). New York, NY: McGraw-Hill.
3. Deutschman, C. S., Neligan, P. J. (2016). Is hypothermia useful in managing critically ill patients? Which ones? Under what conditions? Evidence-Based Practice in Critical Care (2nd ed.). (pp. 133-143). Philadelphia, PA: Elsevier.
4. Maerz L.L., Rosenbaum S.H., (2018) Chapter 4 - Critical Illness, Stoelting'sAnesthesia and Co-Existing Disease (7th ed.), (pp 53-78), http://dx.doi.org/10.1016/B978-0-323-40137-1.00004-1.
5. Sessler D. I. (2009). Temperature Monitoring and Perioperative Thermoregulation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614355/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614355/