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/