Normothermia Made Easy: Why Temperature Management is More Than Just a Blanket

In the fast-paced environment of the operating room, some vital signs demand immediate attention—blood pressure, heart rate, oxygen saturation. But one critical sign is often overlooked: temperature.

For Jennifer Rose, MSML, BSN, RN, CNOR, CV-BC, a perioperative nurse at Houston Methodist Hospital The Woodlands, temperature management is more than a routine check—it’s an essential factor in patient safety, surgical outcomes, and post-op recovery.

"Temperature is just as vital as any other sign we monitor, but it's often dismissed unless the patient has a fever. Yet, in the OR, it can significantly impact bleeding, infection risk, and pain. If you don’t get ahead of it, you’re already behind,” she said. 

And the data suggests it: Inadvertent perioperative hypothermia (IPH)—when a patient’s core body temperature drops below 96.8°F (36°C)—can triple the risk of surgical site infections, prolong recovery, and increase blood loss.

So why do many facilities still treat hypothermia prevention as an afterthought? And what can nurses do to change the narrative?

The Myth of "Just a Blanket"

Many surgical teams assume a warm blanket is enough to prevent hypothermia. While comforting, a blanket alone won’t maintain normothermia throughout surgery.

"I’ve heard nurses say, ‘It’s a short procedure, they won’t get that cold.’ But even brief periods of temperature drop can have serious consequences."

At Rose’s facility, compliance with temperature management protocols hovered at only 51%. That realization drove her to lead an initiative to improve normothermia outcomes—but the process proved far more complex than expected.

Why Short Surgical Procedures Still Require Temperature Management

A common misconception is that shorter procedures don’t require active warming. Many providers assume hypothermia only occurs in long surgeries, but research shows that the biggest drop in core temperature happens within the first hour after induction of general anesthesia and then tapers. Because of this, shorter procedures may not allow enough time for active warming to fully offset heat loss.

"We tend to think, ‘It’s a quick case, the patient will be fine.’ But hypothermia happens fast. And even mild cases can impact recovery," Rose said. 

Prewarming should be standard for all surgical patients. Even 10 minutes of prewarming can reduce heat redistribution after anesthesia induction, setting the patient up for a safer intraoperative course.

Building a Better Approach to Normothermia

Preventing perioperative hypothermia takes more than awareness—it requires proactive, multidisciplinary collaboration.

Many patients associate surgery with feeling cold, which can add to preoperative anxiety. But warming before surgery isn’t just about comfort—it prevents heat loss before it starts.

• Active warming should be applied preoperatively, not just in the OR.

"Patients remember that first cold touch when they get on the OR table," Rose said. "We can prevent that moment entirely."

      2. Use a Multimodal Warming Strategy

A one-size-fits-all approach won’t work. Different procedures require different warming tools, and relying on a single method is often ineffective.

• Warm IV & Irrigation Fluids – Using a fluid-warming system prevents cold fluids from rapidly cooling the patient.
• Water Circulating Blankets – Ideal for long, complex cases like plastic or cardiovascular surgery.
• Heated OR Environments – Even small temperature increases can reduce heat loss, though this can be met with resistance.
• Reducing the amount of time the patient is exposed to the environment while prepping for draping – Keep the patient covered as long and as much as possible to reduce heat loss from the laminar air flow and evaporative loss from surgical skin prep. 

Despite clear benefits, many surgical teams push back on raising OR temperature. Surgeons and staff, dressed in surgical gowns and standing under the intense OR spotlights, often prefer cooler environments for their own comfort.

"Surgeons and staff get hot in PPE, so they don’t want the room warmer. But for the patient, those few degrees make a big difference," Rose said. 

Even when facilities have the right tools, inconsistent protocols and lack of training often undermine appropriate care practices.

"Some hospitals have all the right tools, but they sit unused because nurses aren’t confident in how to apply them," Rose added. 

To drive consistent normothermia compliance, hospitals must: