Preoperative warming

Preoperative warming

posted by Kathleen Flessa on Jan 11, 2018 8:01 am

Good morning. My hospital is implementing an ERAS program and we want to start pre-warming select patients in our "holding area". Does anyone have any information regarding this? We will be using the paper warming blankets attached to the warming machine (Bair Hugger). I'm curious who is applying these blankets in your units and what are the moitoring requirements?
Thank you,
Kathy Flessa BSN, RN, CNOR

Re: Preoperative warming

posted by Jean Cacopardo on Jan 12, 2018 11:28 am

We have been doing ERAS cases for over a year with the Bair Paws gown which is started in our preop admiting area.  The nurses explain the purpose of the gown but the temperature is controlled by the patient.  It has been successful here.
Jeanie Cacopardo, BSN, RN, SLE

Re: Preoperative warming

posted by Anna Baraniewski on Jan 12, 2018 2:43 pm

Our hospital is doing ERAS protocol also but it involved drinking gatorade morning of procedure and some other criteria..was not aware of prewarming the patient 

Re: Preoperative warming

posted by Leah Bezzo on Jan 13, 2018 4:18 pm

Our hospital began this a bit ago.  The pre-op nurses started them, the patients controlled them, and the OR nurses disconnected them when it was time to take the patient to the OR.

We had a couple of minor issues:
1) The gown can be used pre-op and then intra-op, but we found that we were often opening another bair hugger blanket for intra-op use.  For many of our cases, and for our smaller patients, we preferred underbody bair huggers.
2) The hose size for the pre-op warmers with the patient controller and the traditional bair hugger are different, so it caused a lot of confusion about where to plug in the bair hugger intraoperatively.  Proper training can alleviate this issue, but we were ruining a lot of the gowns intraop trying to plug the hose into the wrong hole, rending the gown useless.
3) The ENT ORs were generally faster paced, but the pre-op nurses would still apply these gowns if the cases were scheduled for more then 2 hours.  Unfortunately, the patients would only be in pre-op for a very short period of time and often didn't even have the chance to hook up the gowns, and then the OR nurses would rip them once the patient was anesthetized in favor of an underbody blanket.  We were big fans of the underbody blankets and would put these on the bed during room set-up, not always expecting the patient to have one of the bair hugger gowns on.  Agreeing on specific patient types would help this issue.

Re: Preoperative warming

posted by Kathleen Flessa on Jan 13, 2018 5:01 pm

Thank you for all of your replys. I am also looking for a related policy. Specifically regarding documentation. The current proposal is that the nursing assistant in the holding area will apply the blanket and attach the hose. I am concerned that this is not a nursing assistant function and want to make sure that we are doing what is right. Our patients may be in the holding area for a period of time prior to entering the OR. We had the patient controlled bear paws and gowns awhile ago but had the same problem with the gowns being ripped off and replaced by the regular uppper or lower body blankets (increasing costs). So this time they will be using the regular units that have no patient control. I have a concern regarding overheating and the potential for burns.
Thoughts,
Kathy

Re: Preoperative warming

posted by ARMAN ALI on Jan 14, 2018 11:40 am

Great

Re: Preoperative warming

posted by Pat Guzzo on Jan 14, 2018 12:40 pm

I strongly agree that the preop NURSE should be involved in application--especially educating patients and families.

One circumstance I've run into: the gowns were provided for same-day-admit patients (as a PR thing--and patients DO love them!).  But when I asked for one for an 80+  - year- old patient having hip fracture repair, was told that they weren't available for 'inpatients.'  An elderly patient having a surgery requiring extended 'naked' time before the procedure starts could benefit the MOST from prewarming! 

Re: Preoperative warming

posted by Kathy Pate on Jan 15, 2018 8:04 am

Our hospital has chosen the paper Bair Hugger gowns and begin the warming process in the preoperative area.  These can alos be used for the intraoperative phasse but they are a bit cumbersome so mostly we use the blankets intra op.

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