Inadvertent perioperative
hypothermia
Implementing NICE guidance
2nd.edition August 2011
NICE clinical guideline 65
What this presentation covers
Background
Definitions
Key priorities for implementation
Costs and savings
Discussion
Related guidance
Find out more
Background
Surgical patients are at risk of developing
hypothermia at any stage of the perioperative
pathway.
Inadvertent perioperative hypothermia is a common
but preventable complication, which is associated
with poor outcomes for patients.
Definitions
• Preoperative - 1 hour before induction of anaesthesia
• Intraoperative - the total anaesthesia time
• Postoperative - 24 hours after entry into the
recovery area in the theatre suite
• Hypothermia - a patient core temperature of
below 36.0°C.
• Comfortably warm - the expected normal
temperature range of adult patients
• Temperature - used to denote core temperature
Advice for patients
Patients (and their families and carers) should be
informed before and on admission that:
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staying warm before surgery will lower the risk of
postoperative complications
the hospital environment may be colder than their
own home
they should bring additional clothing to help them
keep comfortably warm
they should tell staff if they feel cold at any time
during their hospital stay.
Measuring patient temperature
When using any device to measure patient temperature,
healthcare professionals should:
• be aware of, and carry out, any adjustments that
need to be made in order to obtain an estimate of
core temperature from that recorded at the site of
measurement
• be aware of any such adjustments that are made
automatically by the device used.
Preoperative phase
Each patient should be assessed for their risk of
inadvertent perioperative hypothermia and potential
adverse consequences before transfer to the theatre
suite.
Patients at higher risk of
perioperative hypothermia
Some patients are at higher risk of inadvertent
perioperative hypothermia; they should be managed
accordingly if any two of the following apply:
• ASA grade II to V
• preoperative temperature below 36.0°C
• undergoing combined general and regional
anaesthesia
• undergoing major or intermediate surgery
• at risk of cardiovascular complications.
Preoperative warming
If the patient’s temperature is below 36.0°C in the hour
before they leave the ward or emergency department:
•
forced air warming should be started preoperatively
on the ward or in the emergency department
(unless there is a need to expedite surgery
because of clinical urgency)
•
forced air warming should be maintained
throughout the intraoperative phase.
Intraoperative phase
The patient’s temperature should
be measured and documented
before induction of anaesthesia and
then every 30 minutes until the end
of surgery.
Induction of anaesthesia should not
begin unless the patient’s
temperature is 36.0°C or above.
Intraoperative warming
The following patients should be warmed intraoperatively
from induction of anaesthesia using a forced air warming
device:
•
those at higher risk of inadvertent perioperative
hypothermia and who are having anaesthesia for
less than 30 minutes
•
those who are having anaesthesia for longer than 30
minutes
Warming intravenous fluids
Intravenous fluids (500 ml or more) and blood
products should be warmed to 37°C using a fluid
warming device.
Postoperative phase
The patient’s temperature should be measured and
documented on admission to the recovery room and
then every 15 minutes
• Ward transfer should not be arranged unless the
patient’s temperature is 36.0°C or above.
• If the patient’s temperature is below 36.0°C,
they should be actively warmed using forced air
warming until they are discharged from the
recovery room or until they are comfortably
warm
Costs and savings
per 100,000 population
Recommendations with significant costs
Costs
(£ per year)
Increased use of forced air warming blankets
43,000
Increased warming of IV fluids and blood products
23,000
Estimated cost of implementation
66,000
Recommendations with significant savings
Savings
(£ per year)
Expected reduction in surgical site infections
–43,000
Estimated annual net cost of implementation
23,000
Costs correct at April 2008. Costs
not updated for 2nd edition
Discussion
•
Which key areas of local practice differ from the
guideline?
•
To ensure effective implementation:
- what equipment is needed?
- what are staff training needs?
•
What will the impact be on the average length of
patient stay if the guideline is implemented fully?
•
How should Risk and Safety Managers be involved
in the implementation of the guideline?
Related NICE guidance - NICE
medical technology guidance – Inditherm
Mattress
•
NICE medical technology guidance addresses ‘case for
adoption’ for specific technologies
•
Recommendations are not intended to limit use of other
relevant technologies
•
Inditherm patient warming mattress medical technology
guidance published August 2011
•
The inditherm patient warming mattress should be
considered for use in patients undergoing operations
carrying a risk of inadvertent hypothermia
This medical technology guidance does not supersede NICE clinical guideline 65’s
recommendations on pre- or peri-operative warming
NHS Evidence
Visit NHS Evidence for the best available evidence on
perioperative hypothermia
Click here to go to
the NHS Evidence
website
Find out more
Visit www.nice.org.uk/guidance/CG65 for:
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Other guideline formats
Costing report and template
Audit support
Implementation advice
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