Fluid warming across care areas:
perioperative care
Keeping surgical patients at a normal body temperature is a daily struggle for those in the medical field. Among
the more than 45 million inpatient and 34.7 million ambulatory surgeries occurring annually in the United States,
an estimated 50 to 90 percent result in patient hypothermia.1,2,3 Hypothermia, defined as a core temperature
below 36 ºC, has a significant impact on postoperative outcomes, which are almost exclusively undesirable.
In addition to clinical and financial impact, patient hypothermia also affects both clinician and patient satisfaction.
Adverse effects of hypothermia
Temperature management techniques are especially
Hypothermia in the perioperative environment
important for patients at high risk of perioperative
is caused by a variety of factors including low
operating room temperature, large surgical
incisions, a core-to-peripheral redistribution of
body heat as a result of anesthetics, chilled IV
solutions, surgical procedure length, and more. 4
Prevention of perioperative hypothermia and
hypothermia, particularly patients undergoing body
cavity surgery, and surgery greater than one hour in
duration; also at risk are patients who are elderly and
who receive combined general-epidural anesthesia.6
Benefits of pre-operative warming
post-anesthetic shivering, which should be
Hypothermia is one of the most preventable
considered and managed as two components
complications resulting from an operative procedure,
of the same syndrome, may improve post-surgical
and prevention is most effective when warming
outcomes including:
begins preoperatively. Pre-warming before surgery
• Reduced cardiac mortality5
increases patient body temperature and allows patients
• Improved wound healing and shorter hospital stays 6
to conserve heat, which significantly minimizes the
reduction in core temperature caused by anesthesia
• Less tendency to bleed due to platelet dysfunction7
induction and other factors in the OR. Key data points
• Improved immune function decreasing the risk
to pre-operative warming include:
of infection
7
• Studies have shown that one to two hours of
• Quicker awakening and recovery room stays due
to faster drug metabolism
4
prewarming prevents intraoperative hypothermia,
even in patients who are not warmed in the OR
when undergoing prolonged abdominal surgery.8
• Laboratory studies suggest that as little as 30 minutes
of pre-warming should provide clinical benefit.
9
• According to the Association of Registered
Nurses (AORN), a patient who receives
preoperative continuous warming before the
• Post-anesthetic shivering is a common complication
of modern anesthesia, affecting five to 65 percent
of patients after general anesthesia and 33 percent
of patients during epidural regional anesthesia. 6
• Apart from discomfort, shivering is associated with a
induction of anesthesia will be more likely to
number of dangerous outcomes including increased
remain normothermic throughout the care
oxygen consumption and carbon dioxide production,
journey because actively warmed patients do
catecholamine release, increased cardiac output,
not need to do as much core-to-peripheral
hypertension, and raised intraocular pressure.
redistribution of body heat.
Additionally, it may decrease mixed venous oxygen
10
The enFlow® IV fluid/blood warming system allows
preoperative nurses to take proactive temperature
saturation as well as interfere with monitoring. 6
• Mild hypothermia triples the incidence of surgical-wound
management measures at the start of a case.
infection, and impacts important recovery steps
Early warming helps prevent the occurrence of
including wound healing, drug metabolism, and more.4,7,11
patient hypothermia.9,10
Benefits of operating room warming
During surgery, all general anesthetic agents impair
thermoregulatory responses and decrease the
vasoconstriction and shivering threshold.6 Anesthetic
agents, however, are not the only culprits. Cold OR
rooms, chilled IV solutions, surgical procedure length,
and more all bring greater compromise to body
temperature during surgical procedures. Supportive
• Maintaining core normothermia decreases the duration or
post-anesthetic recovery and may, therefore, reduce costs
of care.13 In one study, hypothermia averaging only 1.5 °C
less than normal resulted in cumulative adverse outcomes
adding between $2,500 and $7,000 per surgical patient in
hospitalization costs.14
The enFlow IV fluid/blood warming system allows the
PACU staff to continue warming post-surgery when
patients are at a vulnerable state to help ensure core
statements for OR warming include:
temperature is maintained.
• Each liter of intravenous fluids infused into adult
enFlow for the perioperative care continuum
surgical patients at ambient temperature, or each
unit of blood infused at 4 °C, decreases the mean
body temperature approximately 0.25 °C.11
• According to one study, the combination of
The enFlow cartridge’s ability to move with the patient
allows caregivers an easy, efficient, and cost effective way
to start the warming process early, increasing the likelihood
of maintaining normothermia across the perioperative
convective and fluid warming was associated
workflow. On other fluid warming devices, warming
with a decreased likelihood of patients leaving
across care areas can be difficult and expensive, requiring
the operating room hypothermic.12
either multiple disposables or compromising infection
Benefits of post-operative warming
control protocols. With enFlow, the disposable cartridge
attaches in-line to standard IV fluid/blood delivery sets at
Even with the best planned procedures and
the start of procedures. When it is time to move to the
implementation of evidence-based interventions,
next area of the surgical workflow, the user simply removes
patients coming out of the OR may still suffer from
the cartridge from the enFlow warming unit, allowing the
hypothermia. To ensure normothermia is maintained
IV set in its entirety to be moved with the patient when
throughout the perioperative continuum of care,
transported. Once the patient arrives at the next area, the
patients should be warmed before surgery, during, and
cartridge is easily inserted into an enFlow warming unit
again in recovery. Additional facts relative to postoperative
stationed in that area and is back to heating within several
outcomes associated with hypothermia include:
seconds. Continuous warming can mean less hypothermia
and less patient complications.
Contact us
To learn more about the enFlow IV fluid/blood warming
system and the impact it can have on the perioperative care
continuum, please contact Customer Service at 800.323.9088
or visit carefusion.com/VitalSigns.
References
1 Centers for Disease Control and Prevention, FastStats, Inpatient Surgery. Retrieved on November 29,
2011 from: http://www.cdc.gov/nchs/fastats/insurg.htm. 2 Centers for Disease Control and Prevention,
U.S. Outpatient Surgeries on the Rise. Retrieved on November 29, 2011 from: http://www.cdc.gov/media/
pressrel/2009/r090128.htm. 3 Young, V., Watson, M. Prevention of Perioperative Hypothermia in Plastic
Surgery. Aesthetic Surgery Journal, 2006, 551-571. 4 Kurz, A., Sessler, D., Lenkhardt, R. Perioperative
normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J
Med, 1996, 334:1209-15. 5 Frank, S., Fleisher, L., Breslow, M., Higgins, M. et al. Perioperative maintenance
of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. Department of
Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Md., USA.JAMA,
April 1997, 277(14):1127-34. 6 Buggy, D., Crossley, A. Thermoregulation, Mild Perioperative Hypothermia
and Post-Anaesthetic Shivering. BMJ, 2000, 84(5):615-28. 7 Schmied, H., Kurz, A., Sessler, D. et al. Mild
hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet, 1996,
347:289-92. 8 Just, B., Tre´vien, V., Delva, E. et al. Prevention of intraoperative hypothermia by preoperative
skin-surface warming. Anesthesiology, 1993, 79:214–8. 9 Sessler, D., Schroeder, M., Merrifield, B. et al.
Optimal duration and temperature of pre-warming. Anesthesiology, 1995, 82:674–81. 10 Paulikas, C.
Prevention of Unplanned Perioperative Hypothermia. AORN J., 2008, 88(3):358-365. 11 Sessler, D. Mild
Perioperative Hypothermia. New England Journal of Medicine, June 1997, 336(24):1730-1737. 12 Smith, C.,
Desai, R., Glorioso, V., Cooper, A, et al. Preventing hypothermia: convective and intravenous fluid warming
versus convective warming alone. Department of Anesthesiology, MetroHealth Medical Center, Case Western
Reserve University, Cleveland, OH. J Clin Anesth, August 1998, 10(5):380-5. 13 Lenhardt, R., Marker, E., Goll,
V., Tschernich, H., et. al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Department
of Anesthesia, University of California, San Francisco. Anesthesiology, December 1997, 87(6):1318-23. 14
Mahoney, C., Odum, J. Maintaining intraoperative normothermia: A metaanalysis of outcomes with costs.
AANA Journal, April 1999, 67(2):155-164.
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