S erie sELf-sTudy sERiEs - HPN Online

1 sELf-sTudy Serie sELf-sTudy sERiEs Sponsored by March 2012 Blanket and fluid warming cabinet basics The sELf-sTudy lesson on this central service topic was developed by STERIS. The lessons are administered by KSR Publishing, Inc. Earn CEUs The sERiEs can assist readers in maintaining their CS. for Spd professionals certification. After careful study of the lesson, com- by Martha Page, RN. plete the examination at the end of this section. Mail the complete examination and scoring fee to Health- care Purchasing News for grading. We will notify you I. if you have a passing score of 70 percent or higher, t may not seem obvious that know chamber cabinet. Shortly after that, a dual and you will receive a certificate of completion within ledge about blanket and fluid warm cabinet with separate controls was avail.

2 30 days. Previous lessons are available on the Internet ing technology is relevant for the SPD. able to healthcare providers, although in at However, in my encounters with various some models the upper cabinet had a fixed hospitals and health centers I have noted temperature. However, the fourth and Certification that there are a variety of healthcare pro fifth generation cabinets were not cleared The CBSPD (Certification Board for Sterile Processing fessionals assigned the responsibility for for intravenous fluid warming. and Distribution) has pre-approved this in-service for these patient related perioperative tools, As innovation continues for warming one (1) contact hour for a period of five (5) years from for two reasons. Facilities are doing more cabinets, digital technology is being incor.

3 The date of original publication. Successful completion with less and are trying to achieve LEAN porated. The newest systems offer digital of the lesson and post test must be documented by initiatives, so personnel may be participat controls with more precise temperature facility management and those records maintained ing in multiple roles to reduce operational control and monitoring. Some systems by the individual until re-certification is required. DO expenses. In addition, in small facilities also offer USB connectivity to download NOT SEND LESSON OR TEST TO CBSPD. such as ambulatory surgery centers and and report data (Figure 1). For additional information regarding certification con- rural hospitals, employees may wear tact CBSPD - 148 Main Street, Suite B-1, Lebanon, NJ different hats than in the conventional Conditions impacting 08833 For more infor- hospital setting.

4 SPD staffs are perform hypothermia mation direct any questions to Healthcare Purchasing ing multiple tasks, monitoring and testing The Association of PeriOperative Regis . News (941) 927-9345, ext 202. the sterilizers in all of the departments, tered Nurses (AORN) recommends that delivering supplies (which can include the temperature of surgical suites be kept Learning the intravenous fluids) to multiple areas between 20 C (68 F) and C (73 F). and monitoring the inventory. As with It has been noted that for some specialties any technology that comes under SPD (orthopedic and neurological procedures, Objectives purview, a good basic understanding of the purpose, mechanics and proper for example) the temperatures can vary from C (62 F) to 20 C (68 F).

5 In 1. Describe current industry operation of these systems will optimize addition to the traditional surgical suite, recommendations and guidance for their efficient use and management, for there are other hospital areas where tem . warming cabinet temperatures the ultimate benefit of patients. peratures may be maintained at lower 2. Discuss the possible causes and levels. These include preoperative areas, complications of hypothermia A little history post anesthesia care units, cardiac cath . Blanket /solution warming cabinets have eterization units, radiology departments, 3. Explain the factors related to been in existence since the 1930's. The obstetrics and nursery areas, emergency selecting optimal warming cabinets early models used steam technology for rooms, gastrointestinal procedure rooms heating; constant high pressure steam was and other areas where patients may needed for optimal heating.

6 The tempera undergo procedures. The recommended Sponsored by: tures were controlled with temperature temperature range for cardiac catheter . knobs rather than with a thermometer ization and post anesthesia care units, or thermostat. A thermometer had to be for example, is C (70 F) to . placed within the chamber to measure C (75 F). actual temperature, and the temperature These low ambient room temperatures then could be increased or decreased are set for medical/procedural reasons, manually. or to offset the heat generated by equip . Improvements have been made with ment in these rooms that can impact each new generation of cabinets. By the staff's ability to work comfortably. The third and fourth generations, analog low temperatures can have adverse effects controls were available that offered low, on the surgical patient and can require a medium and high settings for a single method for maintaining normothermia (a 30 March 2012 HEALTHCARE PuRCHA sing nEWs Sponsored by sELf-sTudy sERiEs condition of normal body temperature).

7 All phases of patient A warm blanket can be the first line of procedures, begin . defense for keeping the patient at a normal ning preoperatively, thermal level. continuing through In addition to the room temperature, the procedure, when patients enter the surgical suite Figure 1: Warming cabinet digital control panel and extending into they may have a decreased body tem the post operative perature for other reasons: long waiting of body heat from the body's core to its phase. Although there are a number of periods in the preoperative area, anxiety, periphery occurs during the first hour warming modalities available depending fewer layers of clothing, or cooler, room after the induction of regional or general on the patient setting (warm blankets, temperature intravenous fluids being in anesthesia, resulting in a core temperature warming fluids or forced warm heat), fused into a warmer, normal temperature drop of approximately C ( F).

8 There is always a role for a warm blanket. human body. The linear phase occurs during the sec The direct benefit of a warmed blanket A patient's age, weight, height, and ond and subsequent hours of anesthesia; may last for only a few minutes, but the physical condition can also affect body during this time the heat loss declines perception of comfort and psychological temperatures. For example, older adults steadily because the body is not able to well being can last much longer and is the are particularly prone to reduced body metabolically produce enough heat to beginning of healing. temperature for several reasons. Older maintain temperature while under anes . persons lose heat more rapidly due to thesia. After three to five hours of anes Warming cabinet temperature decreased fat and muscle mass.

9 In ad thesia the patient's core temperature often recommendations dition, changes in vascular tone in older plateaus and remains constant (thermal There are no national standards for blan . adults inhibit vasoconstriction and thus plateau phase). General anesthesia also ket and fluid warming cabinet tempera . decrease heat production. Furthermore, causes heat loss from the lungs via inhaled ture settings. However, in 2006 the ECRI. general or major regional anesthesia im gases, medication induced vasodilatation, Institute issued a warning that fluid and pairs the thermoregulatory mechanisms of decreased metabolic rate, and a decrease blanket warmers should be limited to a older people more than it affects younger in tissue perfusion.

10 Temperature no higher than 43 C (110 F). people. to decrease the risk of thermal injuries to In contrast, infants and neonates are patient and facility patients. In 2009, ECRI published a hazard at an increased risk of developing hypo consequences report update, raising their previous rec . thermia because of their increased ratio of Hypothermia is one of the most common ommendation for a safe blanket warming body surface area to body mass. Infants complications a patient can experience in temperature limit to C (130 F), with also are unable to shiver to generate heat the surgical or procedural setting. Hypo the provision that IV fluids should not be in response to hypothermia. thermia increases the risk of surgical site warmed in the same cabinet.