Perioperative Hypothermia Prevention Strategies

This assignment provides a comprehensive overview of perioperative hypothermia prevention strategies, highlighting various methods such as active body surface warming systems, forced-air warming, and the use of blankets or mattresses with built-in heating. It also discusses the importance of maintaining normothermia during surgical procedures to prevent complications. The assignment includes a list of references from peer-reviewed articles and journals, providing evidence-based information on effective prevention techniques.

LITERATURE REVIEW
ON
THE USE OF ACTIVE VERSUS PASSIVE
WARMING IN PREVENTING
POSTOPERATIVE HYPOTHERMIA

Table of Contents
INTRODUCTION...........................................................................................................................1
BACKGROUND.............................................................................................................................1
Definitions...................................................................................................................................2
Aim..............................................................................................................................................2
Postoperative interventions or strategies-...................................................................................3
Primary result:.............................................................................................................................4
Secondary results:.......................................................................................................................4
Results..............................................................................................................................................5
Interventions used by nurses ...........................................................................................................5
Active warming methods............................................................................................................5
Passive Warming methods..........................................................................................................7
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Temperature control or hypothermia in the post anaesthetic care unit is one of the
important element in achieving the improved outcome of patient. The literature shows that the
low body temperature of service users is connected with rise in co- morbidities and threat to
patients. The following literature will pay a keen emphasis on the relevance themes which are
linked to postoperative hypothermia (Campbell et.al. 2015). Active and passive rewarming will
be analysed and evaluated in every research articles which will be discussed in literature.
The review will also focus on rationale and background of the topic which has been
chosen and also the search strategy will also be discussed. The articles would be reviewed
properly, evaluated and synthesis into an argument which will be logical in order to suggest the
most valid, specific and innovative methods for best practice. In order to support the discussion
evidence based literature will also be used. The main objective of the literature is to create an
appropriate clinical-aid in diagnosing postoperative hypothermia and developing a protocol
which is warming in the PACU of the hospital.
In accordance to Belayneh, Gebeyehu & Abdissa 2014 the fall in body's temperature
below 36 degree Celsius is termed as Inadvertent postoperative Hypothermia. This can be appear
after when patient has undergone any surgery in which anaesthetic medications were used.
Another reason can be that the skin of patient was highly exposed, prolonged or extended during
the surgery that directly impacts the functions of the regulatory body. It hampers the functioning
of the body structure. The PACU nurses have the responsibility to recognise postoperative
hypothermia and analyse the condition of patients promptly and accurately which can help them
in preventing complications.
BACKGROUND
Many studies shows that postoperative hypothermia has vivid outcomes which can be
faced by service users such as issue in wound healing, and postoperative surgical site infection,
problem in bleeding, heart related complications, or weak immune system form anaesthetic
medicines. Postoperative hypothermia can one of the major reason for depression, anxiety, stress,
restlessness and weakness. These signs and symptoms can be seen in them after undergoing
surgery. These problems faced by service users can severely impact their well-being and can
cause delay in their recovery in PACU. This also results in rise of expenses for patient, which
may occur as a serious concern for them. It is expected from PACU nurses to have a keen
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understanding of the disease, should be qualified enough to handle the situation, and managing
the consequences arising from anaesthesia. Nurses should also take care of patients safety and
well-being while imparting comfort and care. They must make sure that the service users are
kept in safe and secure conditions (Feldheiser et.al. 2016).
Thus, the review of literature will analyse and evaluate the effect of hypothermia in the
postoperative service users and the suggestions in the administration of postoperative
hypothermia in the PACU. Moreover, this would help in laying emphasis on implementating
articulate effective strategies to encourage patient comfort and prevent consequences which are
linked with postoperative hypothermia.
Definitions
For reviewing the literature these definitions were being used:
Normothermia- A body temperature which lies between the temperature of 36 degree
Celsius to 38 degree Celsius.
Hypothermia- This is a condition where the body temperature falls below 36 degree
Celsius.
Passive warming- It is basically utilizing insulation system to decrease or prevent
occurrence of heat loss in body with the help of conduction, convection, vaporization and
radiation (Frisch et.al. 2017).
Active warming- It can be define as the way which is used to develop and exchange
warmth or heat to a person who is suffering from postoperative hypothermia. It can be trasnfered
with the help of conduction, radiation or convection.
Aim
The main objective of the review of literature is to critique and develop an overview of
written material which is connected with the productivity and efficiency in handling with
inadvertent postoperative hypothermia to service users who had undergone surgical process by
making use of evidence based practice, care and interventions. Determining nursing
interventions for patients suffering from hypothermia and using passive and active warming
methods to detect, prevent and cure the disease (Giuliano & Hendricks 2017).
The critical appraisal skills program tool was used in order to do keen analysing and
evaluation of the literature that consists of retroactive and potential cohort researches, systematic
review, randomized controlled trials, single descriptive, retrospective case-control trials, and
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quasi experimental method. The total number of service users taken in study were 1242 who
have gone through various types of surgical processed were involved in the study.
Research articles which are being involved in the literature review were determined using
various databases like Pub-Med, Med-line, Ebsco, CINAHL between year 2008- 2015. The
search was made using English language and many keywords were also used while making the
search. Also, inclusion and exclusion criteria were being utilised. The included key-terms were
such as postoperative, hypothermia, inadvertent, evidence based care, PACU, active and warm
warning were used in order to conduct study (Han et.al. 2014). These criteria made the search
more specific and authentic. The excluded keywords consists of patient, nursing care, health-care
professionals and many more.
The strength of using these methods was it provides a lot of relevant information towards
the chosen topic that helped in reaching the conclusion and results. Also, while making search no
other language like French, German, Chinese, Hindi were used in the study. It only focused on
the articles published by authentic and relevant publishers. The search was fully based on the
ethical principles and codes. Population which were taken in the study was based on the age
factors. Mainly study was based on the patients whose age was between 18 years- 65 years (Horn
et.al. 2016).
Postoperative interventions or strategies-
The review of literature has determined various interventions in order to solve the
problem which are as follows-
 Detecting loss of heat by making use of thermal or passive warming methods.
 Using active warming tools in order to exchange heat to service users.
 Making use of purely pharmacological evidences and interventions.
 Deploying pre-warmed venomous and supplying liquid.
 Using pre-warmed drug gases.
The literature review includes examining and determining critically the interventions
which are being implemented in the research. They lay emphasis on the studies which are related
to following-
 Service users who have gone through general anaesthesia and are of 18 years or above
age.
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 The tools used by PACU nurses until the individuals normal body temperature is
established.
 The time after service user has undergone surgical process and being admitted to ICU or
PACU.
The research has also implemented varied exclusion to the consequent population-
 Service users going through trauma specially those facing chronic injuries related to head
(John et.al. 2016).
 Patients taking care or diagnosis related to therapeutic hypothermia
 Individuals facing shivering without facing the disease.
The result of the research were examined and segregated into primary and secondary basis. A
evidence of both these components obtained as an outcome of the literature review are as
follows:
Primary result:
 The time taken to establish and attain body temperature which can be measured as
normal
 The temperature difference which can be noted after providing the intervention to
patients (Yi et.al. 2015).
 Rate of rewarming.
 Cardiovascular problem like heart stroke, cardiac muscle infarction and death.
Secondary results:
 Deferred healing of wound and infection caused after surgery.
 Breakdown of skin.
 High loss of blood and imbalance in transfusion.
 Feedback taken from patient like level of depression faced by patient suffering from
hypothermia
 Mortality rate recording while doing the research.
 Amount of time the patient stayed in the PACU and extended hospitalisation.
 Total number of patient admitted in the intensive care unit unexpectedly.
 Trembling Overheating the service user ( where temperature is high than 37.5 degree Celsius.)
Evidence based care
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To improve the effect of postoperative hypothermia, it was found that nurses have to do
the keen analyses and understanding of the patients' situation. They should be able to understand
the signs and symptoms faced by the service users and change in their behaviour due to this
disease. All the practices followed by them should be based on ethical principles like honesty,
autonomy, and beneficence. They should respect patients-value and treat them with respect. This
can support nurses in building a relationship of trust with the service user. They can also make
use of multi-disciplinary team in order to provide preventive care to the patient. It will also
improve the quality of services provided by health-care professionals (Madrid et.al. 2016).
Results
It has been found that after conducting a total of 14,588 searches, it was cut short to a
total of 15 articles which were involved and reviewed in the research. All these studies have
helped in improving the knowledge and learning related to the postoperative hypothermia. It was
also seen that there exists a statistically considerable difference between interventions which
were developed and maintained as enumerated (Torossian et.al. 2015). All these searches has
also supported in early detection and prevention of the diseases which can assist in improving the
patients' health outcomes.
Interventions used by nurses
Active warming methods
In this review of literature, the most of the samples which were involved had been
examined and evaluated active warming techniques which lays keen emphasis on the forced-air
system of warming. The advantages linked with the utilization of forced-air warming tools are
consequently more which results into the best outcomes such as increase in body temperature.
Decrease in trembling of patient and fall in heart related issues, increase in comfort of patient,
fall in bleeding related issues, reduce in infection caused by surgery, and decrease in hospital
admission. These methods help in improving the health outcome of service users.
For overcoming normothermia, active warming methods can be used in order to gain a
positive outcome or result (Singh 2014). The evaluation of subgroups has shown a consequently
differences between active warming and control groups in favour of active warming. By
evaluating and analysing it was noted that there exists a huge difference among active and
unheated blankets than for active and heated blankets. In connection to relaxation, an experiment
was conducted which was also one of the basis of study. The rewarming can also be provided to
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patients by using hot water bottles and heating pads. Also, nurses can make use of new method
such as arteriovenous anastomose. When it has been opened and heated, the organs underlying
the skin transfer warmed substances blood to the core of body which support in increasing body
temperature of the service user (Mehta & Barclay 2014).
The major issue which can be faced by using active warming methods is core temperature
afterdrop that can be seen when cold blood turns back to the heart. It has been analysed that this
process of blood going back has lead to many unexpected and unwarranted deaths. This problem
can only be reduce by using invasive core rewarming before active rewarming.
In order to prevent hypothermia nurses should be involved in providing all the clinical-
aid which is being related to the disease. They can impart patients with survival kit, blanket, first
aid kit, water and necessary amount of medications which can support them in overcoming the
disease. They can also help service users by covering them with multiple layers of clothing,
which can reduce loss of heat. Nurses must ask patients to remain indoor or in their home if they
are facing problem related to inadvertent postoperative hypothermia. Patients suffering from
mild hypothermia can be asked to go home but individuals facing high hypothermia should be
keenly analysed and observed until the temperature of their body is normal.
Active warming method includes various types of mechanism like electrical blanket,
water mattress, radiant heating, warmed blankets and heating gel pad. These elements helped in
regaining the body temperature of the service users. It helped in solving there problem which
were faced after undergoing the surgical process such as feeling sick, weak, restless and irritated.
Often service users are also seen with issues like nausea, fatigue, vomit, due to inadvertent
postoperative hypothermia. It also makes individuals immune system weak and deployed. They
are not able to perform daily routine task properly (Nieh & Su 2016).
The impact and efficiency of active air warming method was evaluated in handling
postoperative hypothermia. The researchers suggested that this technique should be immediately
implemented in the PACU or intensive care unit. It has been analysed that, it very common for
service user to adopt this disease after going through surgical process, so nurses should
frequently make use of active air warming methods. It has been seen that old or elderly aged
service users often faces this type of problem. For improving their health nurses should make use
of these methods.
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Passive Warming methods
The patients suffering from inadvertent postoperative hypothermia faces many problem
related to health. This method imparts efficient ways to reduce the effect of the disorder.
According to Shaw et.al. 2017 traditional warming methods are more effective than the new
methods in handling the situation of the patient facing hypothermia. Passive warming technique
helps in reducing the impact of disease in patients body. It supports in increasing the temperature
of the body. The equipments used in this method are head covers, hand gloves, aluminium
blankets and unwarned blankets with the main objective of reducing the loss of body heat. A
research was organised which shows that the cotton blankets have less effect than the warm
blankets. It does not hold the patients body temperature effectively. Service users may face
severe consequences while utilising cotton blankets (Diagnosis and Treatment of Hypothermia,
2015). Furthermore, the study suggested that the passive warming methods are more cost
efficient than any other method. It helps in achieving better outcome of the service user and
improving comfort and relaxation of patients. It suggests that nurses should place blankets
directly in contact with service users skin in order to reduce the loss of heat which can be
occurred in body. This can improve the well-being of patients.
CONCLUSION
From the entire literature review it has been summarised that for conducting the study 15
articles were analysed and examined which shows the main reason behind the occurrence of the
postoperative inadvertent hypothermia. The research includes the study design like using of
cross-sectional data, controlled randomized trials which were being used in order to conduct the
study. Also evidence based care and intervention like active and passive warming methods used
by nurses to treat patients admitted in the PACU are also being discussed in the report. Further,
assignment shows that the for overcoming the disease early detection of it is very necessary.
Several strategies like observing the vital sign of changes by health-care professionals are
also been discussed in the study. The literature review was made in order to know the reason
behind deterioration in health outcome of patients and improving their well-being. Furthermore,
the study also lays emphasis on using cost effective method like active warming in order to
enhance the health of service users. This also improve the quality of treatment given by PACU
nurses and establish a relationship between patients and them.
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REFERENCES
Books and journals
Belayneh, T., Gebeyehu, A. & Abdissa, Z., 2014. Post-operative Hypothermia in Surgical
Patients at University of Gondar Hospital, Ethiopia. J Anesth Clin Res.5(461).p.2.
Campbell, G. & et.al. 2015. Warming of intravenous and irrigation fluids for preventing
inadvertent perioperative hypothermia.
Feldheiser, A. & et.al., 2016. Enhanced Recovery After Surgery (ERAS) for gastrointestinal
surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiologica
Scandinavica.60(3). pp.289-334.
Frisch, N.B & et.al. 2017. Intraoperative hypothermia in total hip and knee
arthroplasty. Orthopedics. 40(1). pp.56-63.
Giuliano, K.K. & Hendricks, J., 2017. Inadvertent perioperative hypothermia: Current nursing
knowledge. AORN journal.105(5). pp.453-463.
Han, S.B. & et.al. 2014, April. Risk factors for inadvertent hypothermia during adult living-
donor liver transplantation. In Transplantation proceedings (Vol. 46, No. 3, pp. 705-
708).
Horn, E.P. & et.al. 2016. Warming before and after epidural block before general anaesthesia for
major abdominal surgery prevents perioperative hypothermia: a randomised controlled
trial. European Journal of Anaesthesiology (EJA).33(5).pp.334-340.
John, M. & et.al. 2016. Comparison of resistive heating and forced-air warming to prevent
inadvertent perioperative hypothermia. BJA: British Journal of Anaesthesia.116(2).
pp.249-254.
Madrid, E. & et.al. 2016. Active body surface warming systems for preventing complications
caused by inadvertent perioperative hypothermia in adults. Cochrane Database of
Systematic
Mehta, O.H. & Barclay, K.L., 2014. Perioperative hypothermia in patients undergoing major
colorectal surgery. ANZ journal of surgery.84(7-8). pp.550-555.
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Nieh, H.C. & Su, S.F., 2016. Meta‐analysis: effectiveness of forced‐air warming for prevention
of perioperative hypothermia in surgical patients. Journal of advanced
nursing.72(10).pp.2294-2314.
Shaw, C.A. & et.al. 2017. Effectiveness of active and passive warming for the prevention of
inadvertent hypothermia in patients receiving neuraxial anesthesia: a systematic review
and meta-analysis of randomized controlled trials. Journal of clinical anesthesia.38.
pp.93-104.
Singh, A., 2014. Strategies for the management and avoidance of hypothermia in the
perioperative environment. Journal of perioperative practice. 24(4). pp.75-78.
Torossian, A. & et.al. 2015. Preventing inadvertent perioperative hypothermia. Deutsches
Ärzteblatt International. 112(10).p.166.
Yi, J. and et.al. 2015. Incidence of inadvertent intraoperative hypothermia and its risk factors in
patients undergoing general anesthesia in Beijing: a prospective regional survey. PloS
one.10(9). p.e0136136.
Online
Diagnosis and Treatment of Hypothermia. 2015. [ONLINE] Available through:
<https://www.aafp.org/afp/2004/1215/p2325.html>
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