The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Nursing and Supportive Care (NCC NSC) have issued guidance to the NHS in England and Wales on preventing hypothermia in patients before, during and up to 24 hours after surgery.
Patients may be at increased risk if any two of the following apply:
• They have a condition that affects their general health, such as high blood pressure, asthma, diabetes or angina.
• Their temperature is already below 36°C (and it is not possible to warm them up before surgery because they need to be operated on urgently).
• The patient is undergoing a combined general and regional (such as an epidural) anesthetic.
• The patient is undergoing major or intermediate surgery.
• The patient is at risk of heart complications.
Healthcare professionals should ensure that patients are kept comfortably warm while waiting for surgery by giving them at least one cotton sheet plus two blankets, or a duvet. If the patient’s temperature is below 36°C, they should be warmed using “forced air warming”.
This treatment should be started pre-operatively on the ward or in the emergency department (unless this is not possible because they need to be operated on urgently). Forced air warming should be maintained throughout surgery.
During surgery patients should not be given an anaesthetic until their temperature is 36°C or above (unless this is not possible because they need to be operated on urgently). Intravenous fluids (500 ml or more) and blood products should be warmed to 37°C using a fluid warming device. If the patient’s operation lasts longer than 30 minutes, or if their operation is shorter than this but they are at higher risk of hypothermia or its complications, they should be kept warm throughout the operation using forced air warming (and their temperature measured throughout surgery).
After surgery (i.e. 24 hours after the patient has entered the recovery area), the patient’s temperature should be measured and documented on admission to the recovery room and then every 15 minutes. The patient should not be transferred to the ward unless their temperature is 36°C or above. If their temperature is below 36°C, they should be actively warmed using forced air warming.
Andrew Dillon, NICE chief executive, said: “There is a great deal of misunderstanding about the risks associated with perioperative hypothermia but equally there is a huge amount that can be done to prevent hypothermia happening. Prevention begins with simple measures, such as providing sufficient bedding to keep patients comfortably warm before surgery. More active interventions to warm patients should be used during surgery when patients are at most risk of becoming hypothermic.
“Providing patients with the right information is also very important – an issue that this guideline seeks to address. Implementation of this guideline is likely to have significant benefits for patients and the NHS, including a reduction in rates of surgical site infection and shorter hospital stays.”
The guideline is available at www.nice.org.uk/CG065
