What a difference a degree makes

Healthcare Purchasing News, Dec, 2005 by Jeannie Akridge

Clearly many facilities are still lacking in their temperature management techniques and increased attention to the subject will bring great rewards.

"Patient warming seems to be used selectively for surgical procedures. It's something that needs to become commonplace for all surgical procedures," said Arizant's Bergstrom.

References:

(1.) "Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten Hospitalization", Andrea Kurz, M.D., Daniel I. Sessler, M.D., and Rainer Lenhardt, M.D., for the Study of Wound Infection and Temperature Group, The New England Journal of Medicine, Vol. 334, No. 19, May 9, 1996.

(2.) "Active Thermoregulation Improves Outcome of Off-Pump Coronary Artery Bypass", Y. Joseph Woo, M.D., Pavan Atluri, M.D., Todd J. Grand, BS, Vivian M. Hsu, BA, Albert Cheung, M.D., Division of Caridothoracic Surgery, Dpeartment of Surgery, University of Pennsylvania, Asian Cardiovascular & Thoracic Annals, 2005, Vol. 13, No. 2.

(3.)"Pressure Management Study Comparing Standard Table Pads to a Multi-Layer Pressure Relief Pad in the Operating Room," Suzy Scott-Williams, RN, MSN, CWOCN, VA Medical Center, Memphis, Allan C. Lummus, PhD, Department of Preventive Medicine University of TN Health Science Center. Memphis.

Warm patients, cool surgeons

While a warm operating room can provide an added boost as part of an aggressive protocol to keep patients at normothermia, the discomfort afforded an already stressed surgical staff working for long periods under hot lights makes it an inconvenient option at best.

There are now some alternatives that help keep surgeons happy while promoting better patient outcomes. One such solution is a surgeon's cooling vest available from Game Ready (Berkeley, CA). The Game Ready Active Cooling Vest delivers active cold therapy and adjustable compression to the upper torso and back to aggressively pull heat away from the body. Connected to a microprocessor control unit, the vest circulates ice water around the surgeon's chest to lower his/her core temperature. The vest is designed with four compression levels to ensure a tight fit and promote optimum cooling.

Another company that provides a surgeons' cooling vest is Cincinnati Sub-Zero with its Maxi-Therm Lite Surgeon's Cooling Vest that connects to its Blanketrol II conductive warming system.

Preventing pressure ulcers

In addition to hypothermia, another complication of surgery is the development of pressure ulcers. These can occur in as little as 20 or 25 minutes, and pads and positioning products can go a long way to preventing them--if they provide adequate support for pressure points and are made of a material that reduces shear, a factor that can compromise skin and leave it vulnerable to the development of sores.

"You need to manage pressure on anyone that is immobile," said Laura Grisanti of Gaymar Industries. "When you have a patient that can't move you need to reposition them at least every two hours. That is the standard of care anywhere. When you're in the O.R. and you have a person that's immobile, they're not going anywhere. You can't move them, you can't reposition them every two hours. So you need to do something up front to avoid that pressure ulcer as much as you possibly can ... and protect those bony prominences."