The Essential Role of Perioperative Nurses in Preventing Hypothermia: Strategies and Guidelines for Maintaining Normothermia

Perioperative Nurses: Guardians of Patient Temperature

Perioperative nurses, along with the entire perioperative team, are responsible for managing patient temperature and preventing hypothermia during surgery. Hypothermia, defined as a core body temperature below 36°C (96.8°F), can lead to serious complications, including increased blood loss, higher infection rates, delayed wound healing, and prolonged recovery times. The Association of periOperative Registered Nurses (AORN) emphasizes the importance of maintaining normothermia—keeping the patient's body temperature within the normal range—throughout the perioperative period to ensure optimal surgical outcomes.

Perioperative Nurses’ Role in Temperature Management

From the moment a patient enters the surgical pathway, perioperative nurses are responsible for collaboratively assessing and managing temperature-related risks. During the preoperative phase, nurses perform a thorough evaluation to identify patients at higher risk for hypothermia, such as those with low body mass index, older adults, or those undergoing procedures longer than two hours. This assessment guides the development of individualized temperature management plans, tailored to each patient's needs.

In the intraoperative phase, perioperative nurses collaborate with anesthesia professionals to actively monitor and maintain patient temperature. They ensure that the operating room environment is conducive to maintaining normothermia, adjusting room temperatures as necessary and minimizing patient exposure to cold environments. Perioperative nurses are also responsible for applying active warming devices, such as forced air or conductive warming blankets, to keep the patient's core temperature stable.

Strategies to Prevent Perioperative Hypothermia

The AORN Guideline for Prevention of Hypothermia recommends evidence-based strategies to prevent adverse patient outcomes. One method is prewarming patients with forced air warming systems for at least 30 minutes before anesthesia induction. This practice helps reduce the redistribution of body heat that often occurs after beginning anesthesia, which can lead to a rapid drop in core temperature.

During surgery, perioperative teams use multiple warming techniques to maintain normothermia, including:

• Active warming devices: Warming blankets or gowns, which are placed on the patient during surgery, as well as other devices like heating pads, warming mattresses, resistive fabric warming devices and radiant warmers, are essential tools in preventing temperature drops.
• Warming intravenous fluids and surgical irrigants: Administering warmed fluids helps prevent the introduction of cold substances into the patient's body, which can lower core temperature.

Recommendations for Maintaining Normothermia

Maintaining normothermia requires a coordinated effort among the surgical team, with perioperative nurses playing a central role. AORN recommends that perioperative teams establish and adhere to a comprehensive temperature management protocol. This protocol should include:

• Preoperative warming: As previously mentioned, prewarming patients is a critical step. The literature recommends that prewarming begins at least 10 to 30 minutes before anesthesia induction to maximize its effectiveness.
• Intraoperative warming: Perioperative teams should use a combination of active warming devices and warmed fluids to maintain temperature during surgery. This multi-modal approach is more effective than relying on a single method.
• Postoperative monitoring: Temperature management doesn’t end when the surgery is complete. Perioperative nurses continue to monitor and manage patient temperature in the recovery room to ensure normothermia is maintained and to prevent any delayed hypothermia.

Perioperative nurses play an indispensable role in preventing hypothermia and ensuring patient safety during surgery. By following AORN’s guidelines and employing a combination of prewarming, active intraoperative warming, and vigilant temperature monitoring, perioperative teams can effectively maintain normothermia and improve surgical outcomes. Their expertise and diligence are key to minimizing the risks associated with hypothermia and enhancing the overall quality of perioperative care.

When and where are the AORN Guidelines Workshops?

AORN Guidelines Workshops are in-person, interactive educational events designed to provide perioperative team members with a deep understanding of the latest AORN Guidelines for Perioperative Practice.

These workshops offer:

• In-depth exploration of recent updates to the AORN Guidelines
• Practical tips for implementing evidence-based best practices in the OR
• Hands-on demonstrations of the newest OR technologies
• Networking opportunities with fellow perioperative professionals

By attending an AORN Guidelines Workshop, participants can enhance their knowledge, skills, and confidence in delivering optimal patient care.

Guidelines Workshops event information