Unplanned Perioperative Hypothermia and Evidence-Based Nursing Care

Year 2024, Volume: 6 Issue: 3, 596 - 611, 25.12.2024

Gamze Bozkul , Gülay Altun Uğraş

Abstract

Unplanned perioperative hypothermia is a decrease in body temperature below 36 0C during the period from the preoperative period to the postoperative period. Various risk factors related to the patient and the surgical process pave the way for this situation. Unplanned perioperative hypothermia occurs in approximately 70% of patients. Unplanned perioperative hypothermia leads to various complications such as surgical site infections, blood loss, increased transfusion requirements, prolonged wound healing, chills, and cardiac problems for patients. It is associated with adverse patient outcomes, prolonged hospital stay and increased costs. Active or passive heating methods are used to prevent this situation. During the surgical process, nurses play a key role in the care and follow-up of patients. Nurses' awareness of unplanned perioperative hypothermia should be increased, their education should be maintained, and the guidelines developed should be integrated into clinical practice skills. The National Institute for Health and Care Excellence, the Association of periOperative Registered Nurses and the American Society of PeriAnesthesia Nurses have prepared guidelines for health professionals with evidence-based practices for this topic. It is necessary to make plans in order to disseminate interventions for the prevention of hypothermia in surgical nurses and to reflect evidence-based guide recommendations into practice.

Keywords

Unplanned Perioperative Hypothermia, Evidence-Based Practices, Nursing Care

Project Number

-

İstenmeyen Perioperatif Hipotermi ve Kanıt Temelli Hemşirelik Bakımı

Abstract

İstenmeyen perioperatif hipotermi, ameliyat öncesi dönemden ameliyat sonrası döneme kadarki süre içinde vücut sıcaklığının 36 0C’nin altına düşmesidir. Hastaya bağlı ve cerrahi süreçle ilgili çeşitli risk faktörleri bu duruma zemin hazırlamaktadır. İstenmeyen perioperatif hipotermi hastaların yaklaşık %70’inde meydana gelmektedir. Hastalarda cerrahi alan enfeksiyonları, kan kaybı, artan transfüzyon gereksinimleri, uzamış yara iyileşmesi, titreme ve kardiyak sorunlar gibi çeşitli komplikasyonlara yol açmaktadır. Olumsuz hasta çıktıları, uzamış hastanede kalış süresi ve artan maliyetlerle ilişkilidir. Bu durumu önlemek için ise aktif ya da pasif ısıtma yöntemleri kullanılmaktadır. Cerrahi süreç içerisinde hemşireler, hastaların bakımında ve izleminde kilit roldedirler. Hemşirelerin istenmeyen perioperatif hipotermiye yönelik farkındalıklarının arttırılması, eğitimlerinin sürekliliğinin sağlanması ve geliştirilen rehberlerin klinik uygulama becerilerine entegrasyonu sağlanmalıdır. İngiltere Ulusal Sağlık ve Klinik Bakım Mükemmelliği Enstitüsü, PeriOperatif Kayıtlı Hemşireler Derneği ve Amerikan PeriAnestezi Hemşireleri Derneği tarafından sağlık profesyonellerine yönelik bu konu için kanıt temelli uygulamaların yer aldığı rehberler hazırlamıştır. Cerrahi hemşirelerinde hipoterminin önlenmesine yönelik girişimlerin yaygınlaştırılması ve kanıta dayalı rehber önerilerin uygulamaya yansıtılabilmesi amacıyla planlamaların yapılması gerekmektedir.

Keywords

İstenmeyen perioperatif hipotermi, Kanıt Temelli Uygulamalar, Hemşirelik Bakımı.

Project Number

-

References

• Akers, J. L., Dupnick, A. C., Hillman, E. L., Bauer, A. G., Kinker, L. M., & Hagedorn Wonder, A. (2019). Inadvertent perioperative hypothermia risks and postoperative complications: A retrospective study. AORN Journal, 109(6), 741–747. https://doi.org/10.1002/aorn.12696
• Association of Surgical Technologist (AST). (2019). AST Guidelines for Best Practice in Maintaining Normothermia in the Perioperative Patient. 1-26. Erişim: https://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/ASTGuidlinesNormothermia.pdf, Erişim Tarihi: 14.12.2022.
• Aygin D., & Yaman Ö. (2019). Ameliyat sonrası vücut sıcaklığı komplikasyonları ve hemşirelik bakımı. Türkiye Klinikleri Cerrahi Hastalıkları Hemşireliği-Özel Konular, 5 (2), 59-65. https://l24.im/x2Ldqh
• Bindu, B., Bindra, A., & Rath, G. (2017). Temperature management under general anesthesia: Compulsion or option. Journal of Anaesthesiology, Clinical Pharmacology, 33(3), 306–316. https://doi.org/10.4103/joacp.JOACP_334_16
• Boddu, C., Cushner, J., & Scuderi, G. R. (2018). Inadvertent perioperative hypothermia during orthopedic surgery. American Journal of Orthopedics (Belle Mead, N.J.), 47(7), 10.12788/ajo.2018.0056. https://doi.org/10.12788/ajo.2018.0056
• Brandt, S., Oguz, R., Hüttner, H., Waglechner, G., Chiari, A., Greif, R., Kurz, A., & Kimberger, O. (2010). Resistive-polymer versus forced-air warming: comparable efficacy in orthopedic patients. Anesthesia and Analgesia, 110(3), 834–838. https://doi.org/10.1213/ANE.0b013e3181cb3f5f
• Bu, N., Zhao, E., Gao, Y., Zhao, S., Bo, W., Kong, Z., Wang, Q., & Gao, W. (2019). Association between perioperative hypothermia and surgical site infection: A meta-analysis. Medicine, 98(6), e14392. https://doi.org/10.1097/MD.0000000000014392
• Campbell, G., Alderson, P., Smith, A. F., & Warttig, S. (2015). Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. The Cochrane database of systematic reviews,4, CD009891. https://doi.org/10.1002/14651858.CD009891.pub2
• Centers for Disease Control and Prevention. (2019). Prevent hypothermia & frostbite. Erişim adresi: https://www.cdc.gov/disasters/winter/staysafe/hypothermia.html Erişim tarihi: 3 Kasım 2022.
• Chataule, S. M., Hazarika, A., Jain, K., Chauhan, R., Luthra, A., Meena, S., Aggarwal, S., & Sethi, S. (2022). Preoperative forced-air warming strategy: ıs it effective in averting intraoperative hypothermia in elderly trauma surgical patients?. Cureus, 14(9), e29305. https://doi.org/10.7759/cureus.29305
• Chen, H. Y., Su, L. J., Wu, H. Z., Zou, H., Yang, R., & Zhu, Y. X. (2021). Risk factors for inadvertent intraoperative hypothermia in patients undergoing laparoscopic surgery: A prospective cohort study. PLoS ONE 16(9): e0257816. https://doi.org/10.1371/journal.pone.0257816
• Cumin, D., Fogarin, J., Mitchell, S. J., & Windsor, J. A. (2022). Perioperative hypothermia in open and laparoscopic colorectal surgery. ANZ Journal of Surgery, 92(5), 1125–1131. https://doi.org/10.1111/ans.17493 Demirarslan, E. (2017). Ameliyat sonrası hipotermi kontrolü. Sağlık Akademisi Kastamonu, 2(1) , 51-70. https://doi.org/10.25279/sak.284277
• Emmert, A., Gries, G., Wand, S., Buentzel, J., Bräuer, A., Quintel, M., & Brandes, I. F. (2018). Association between perioperative hypothermia and patient outcomes after thoracic surgery: A single center retrospective analysis. Medicine, 97(17), e0528. https://doi.org/10.1097/MD.0000000000010528
• Giuliano, K. K., & Hendricks, J. (2017). Inadvertent perioperative hypothermia: Current nursing knowledge. AORN Journal, 105(5), 453–463. https://doi.org/10.1016/j.aorn.2017.03.003
• Gozubuyuk, E., Aygun, E., Basaran, I., Canbolat, N., Cavdaroglu, B., Akgul, T., & Buget, M. I. (2022). Effects of changes in body temperature on perioperative bleeding in adolescent ıdiopathic scoliosis surgery. Therapeutic Hypothermia and Temperature Management, 12(3), 146–154. https://doi.org/10.1089/ther.2021.0016
• Hooper, V. D., Chard, R., Clifford, T., Fetzer, S., Fossum, S., & Godden, B. (2010). ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition. Journal of PeriAnesthesia Nursing 25(6), 346-365. https://doi.org/10.1016/j.jopan.2010.10.006
• Jallow, O., & Bayraktar, N. (2022). Nurses' awareness and practices of unintentional perioperative hypothermia prevention: a cross-sectional study. Therapeutic Hypothermia and Temperature Management, https://doi.org/10.1089/ther.2022.0030
• Keskin, H. G. (2021). Postoperatif hipotermi ve hemşirelik bakımı. Necmettin Erbakan Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 4(1), 20-24. https://dergipark.org.tr/tr/pub/neufhsj/issue/63161/689731
• Link T. (2020). Guidelines in practice: Hypothermia prevention. AORN Journal, 111(6), 653–666. https://doi.org/10.1002/aorn.13038
• Lopez, M. B. (2018). Postanaesthetic shivering - from pathophysiology to prevention. Romanian Journal of Anaesthesia and Intensive Care, 25(1), 73–81. https://doi.org/10.21454/rjaic.7518.251.xum
• Lynch, S., Dixon, J., & Leary, D. (2010). Reducing the risk of unplanned perioperative hypothermia; AORN Journal, 92, 553-565. https://doi.org/10.1016/j.aorn.2010.06.015
• McSwain, J. R., Yared, M., Doty, J. W., & Wilson, S. H. (2015). Perioperative hypothermia: Causes, consequences and treatment. World Journal of Anesthesiology, 4(3), 58-65. https://doi.org/10.5313/wja.v4.i3.58
• National Institute for Health and Care Excellence (NICE). (2016). Hypothermia: prevention and management in adults having surgery. Erişim adresi: https://www.nice.org.uk/guidance/cg65. Erişim tarihi: 10.12.2022
• Osilla, E. V., Marsidi, J. L., & Sharma, S. (2022). Physiology, Temperature Regulation. In StatPearls. StatPearls Publishing.
• Öner Cengiz, H., Uçar, S., & Yilmaz, M. (2021). The role of perioperative hypothermia in the development of surgical site infection: a systematic review. AORN Journal, 113(3), 265–275. https://doi.org/10.1002/aorn.13327 Pan, P., Song, K., Yao, Y., Jiang, T., & Jiang, Q. (2020). The impact of intraoperative hypothermia on blood loss and allogenic blood transfusion in total knee and hip arthroplasty: a retrospective study. Biomed Research İnternational, 1096743. https://doi.org/10.1155/2020/1096743
• Perlman, R., Callum, J., Laflamme, C., Tien, H., Nascimento, B., Beckett, A., & Alam, A. (2016). A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients. Critical Care (London, England), 20(1), 107. https://doi.org/10.1186/s13054-016-1271-z
• Pu, J., Zhao, W. J., Xie, X. F., & Huang, H. P. (2022). A systematic review and meta-analysis of risk factors for unplanned intraoperative hypothermia among adult surgical patients. Journal of Perianesthesia Nursing, 37(3), 333– 338. https://doi.org/10.1016/j.jopan.2021.08.013
• Rajagopalan, S., Mascha, E., Na, J., & Sessler, D. I. (2008). The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology, 108(1), 71–77. https://doi.org/10.1097/01.anes.0000296719.73450.52
• Rauch, S., Miller, C., Bräuer, A., Wallner, B., Bock, M., & Paal, P. (2021). Perioperative hypothermia—a narrative review. International Journal of Environmental Research and Public Health, 18(16), 8749. https://doi.org/10.3390/ijerph18168749
• Reynolds, L., Beckmann, J., & Kurz, A. (2008). Perioperative complications of hypothermia. Best Practice & Research Clinical Anaesthesiology, 22(4), 645–657. https://doi.org/10.1016/j.bpa.2008.07.005
• Ribeiro, J. C., Bellusse, G. C., Martins de Freitas, I. C., & Galvão, C. M. (2021). Effect of perioperative hypothermia on surgical site infection in abdominal surgery: A prospective cohort study. International Journal of Nursing Practice, 27(4), e12934. https://doi.org/10.1111/ijn.12934
• Rightmyer, J., & Singbartl, K. (2016). Preventing perioperative hypothermia. Nursing, 46(9), 57-60. https://doi.org/10.1097/01.NURSE.0000482266.09262.a9
• Riley, C., & Andrzejowski, J. (2018). Inadvertent perioperative hypothermia. BJA Education, 18(8), 227–233. https://doi.org/10.1016/j.bjae.2018.05.003
• Ruetzler, K., & Kurz, A. (2018). Consequences of perioperative hypothermia. Handbook of Clinical Neurology, 157, 687–697. https://doi.org/10.1016/B978-0-444-64074-1.00041-0
• Sagiroglu, G., Ozturk, G. A., Baysal, A., & Turan, F. N. (2020). Inadvertent perioperative hypothermia and ımportant risk factors during major abdominal surgeries. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP, 30(2), 123–128. https://doi.org/10.29271/jcpsp.2020.02.123
• Sari, S., Aksoy, S. M., & But, A. (2021). The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors. International Journal Of Clinical Practice, 75(6), e14103. https://doi.org/10.1111/ijcp.14103
• Siddiqiui, T., Pal, K. M. I., Shaukat, F., Mubashir, H., Akbar Ali, A., Malik, M. J. A., & Shahzad, N. (2020). Association between perioperative hypothermia and surgical site ınfection after elective abdominal surgery: A prospective cohort study. Cureus, 12(10), e11145. https://doi.org/10.7759/cureus.11145
• Simegn, G. D., Bayable, S. D., & Fetene, M. B. (2021). Prevention and management of perioperative hypothermia in adult elective surgical patients: A systematic review. Annals of Medicine and Surgery, 72, 103059. https://doi.org/10.1016/j.amsu.2021.103059
• Soysal, G. E. & İlçe, A. (2018). Ameliyat döneminde istenmeyen hipotermide kanıta dayalı uygulamalar. Bozok Tıp Dergisi, 8(2), 72-79. https://dergipark.org.tr/en/pub/bozoktip/issue/38108/440050
• Tamer, F., & Karadağ, M. (2020). Cerrahi hemşirelerinin istenmeyen perioperatif hipotermi bakımına yönelik bilgi ve uygulamalarının belirlenmesi. Türkiye Klinikleri Hemşirelik Bilimleri Dergisi, 12(1), 19-29. https://doi.org/10.5336/nurses.2019-70341
• Torossian, A., Bräuer, A., Höcker, J., Bein, B., Wulf, H., & Horn, E. P. (2015). Preventing inadvertent perioperative hypothermia. Deutsches Arzteblatt İnternational, 112(10), 166–172. https://doi.org/10.3238/arztebl.2015.0166
• Türk Anesteziyoloji ve Reanimasyon Derneği. (2013). The Turkish Anaesthesiology and Reanimation Society Guidelines for the prevention of inadvertent perioperative hypothermia. (2013). Turkish Journal of Anaesthesiology and Reanimation, 41(5), 188–190. https://doi.org/10.5152/TJAR.2013.64
• Vural, F., Çelik, B., Deveci, Z., & Yasak, K. (2018). Investigation of inadvertent hypothermia incidence and risk factors. Turkish Journal of Surgery, 34(4), 300-305. https://doi.org/10.5152%2Fturkjsurg.2018.3992
• Yüksel, S. & Altun Uğraş, G. (2016). Cerrahi hastasında hipotermi gelişimini önlemede hemşirenin rolü. Mersin Üniversitesi Sağlık Bilimleri Dergisi, 9(2), 113-121. Retrieved from https://dergipark.org.tr/tr/pub/mersinsbd/issue/24537/259943