Change Process: Warm Fluids vs.

Room Temperature Fluids

By: Angie Wetli RN

Introduction Explanation of Project Implementation

Preop needs a fluid warmer
The current practice in the preoperative area of St Francis
Eastside is to use room temperature IV fluids on each
surgical patient in the preop area. There is a fluid warmer on
the unit, but it is located in the center OR core. It not
convenient for the preop nurses. In order to retrieve the fluids,
the nurse must dress out for the OR each time a fluid is
needed.
Researchers found that warmed intravenous fluids kept the
core temperature of study participants about a half degree
warmer than that of participants given room temperature
intravenous fluids at 30, 60, 90, and 120 minutes, and at the
end of surgery (Campbell, Alderson, Smith, & Warttig, p. 3).
Unplanned hypothermia can be a serious adverse event for
perioperative patients. In addition to causing discomfort for
the patient, hypothermia may contribute to complications,
including myocardial events, incision-site infection, and
slower healing time, among others, and may result in a longer
hospital stay (Bashaw, 2016, p. 305).
There are several recommended interventions to help
maintain a normal body temperature for surgical patients
including administering warm IV fluids to the patients.
Currently the St Francis Eastside does not have a fluid
warmer in the preop unit. The goal of this change project is to
prove that a fluid warmer is needed in preop in order to
administer warm IV fluids to surgical patients rather than
room temperature fluids.
OBJECTIVES
1) Warm IV fluids will help decrease
hypothermia postoperative for
hysterectomy patients.
This change project will show the need to update the Eight patients were chosen based on the scheduled
current process of administering room temperature IV surgery time. Temperatures were taken by the preop
fluids to surgical patients. There is a need to purchase nurses and recorded. Warm IV fluids were were
a fluid warmer for the preop area in order to provide given to each of these patients. Each preop nurse
warm IV Fluids for every surgical patient. had to prepare the warm fluids from the OR fluid Conclusion
warmer for each individual patient. This process
The current process to administer warm IV fluids is
makes the preop team less efficient.
very time consuming and decreases the preop nurses Using warm fluids on the preop patients did improve
efficiency The change did lead to an improvement, however it the percentage of patients with hypothermia. The
did not achieve the predicted goal. The goal was to prediction before the test was that 100% of the
It has been calculated that the administration of 1
have 100% of the patients entering recovery room patients would have a normal temperature following
liter intravenous fluid at room temperature (21C) surgery. This was not the case since two of the
without any signs of hypothermia. There were still
decreases core body temperature by .25C (John, patients still had a low temperature, but the overall
two patients that were too cold after surgery.
Ford, & Harper, 2014, p. 624). percentage did improve.
Following surgery the each of the patients
The temperatures of 8 patients were taken using The change in process will be implemented by the
temperatures were taken by the recovery room staff
room temperature fluids. The patients temperature nurses in preop and the managers of the department
and recorded. The temperatures were recorded as
preop and then the temperature following the surgery. have approved the change. The process will begin
follows in the following table.
Four of the eight patients in the study were once the fluid warmer is in the preop are a.
hypothermic upon entering the recovery room. This Of all of the patients reported only 1 patient had
process currently needs improvement. significant postoperative shivers in the recovery The preop charge nurse was able to find a fluid
warmer in another department that was not being
room. None of the patients that were monitored
have reported any postoperative infections used. Engineering was called to the department to
according to the Infection Control nurse at St approve placement of the fluid warmer and an
Francis Eastside. equipment check was done on the actual warmer.
The engineering staff concluded that a new electrical
outlet needs to be added to the area where the
warmer will be placed. An estimate will be given to
management regarding the cost of the electrical
outlet and approval is pending.
Table 1 Patient temperature using room temperature Table 2 Patient temperatures using warm fluids
fluids
Surgery Type Length of Preop Temp Postop Temp Postop Infectiom Surgery Type Length of Preop Temp Postop Temp Postop Infection
Surgery Surgery
References
Hysterectomy 1.5 hours 98.1 97.0 None reported
Gallbladder 1.5 hours 97.8 98.0 None reported
Hysterectomy 1.5 hours 97.3 98.5 None reported
D&C Ablation 1.25 hours 99.2 98.5 None reported Bashaw, M. (2016, March). Guideline implementation:
D&C
Laparoscopic
1.75hours 98.7 97.8 None reported Diagnostic
Laparoscopy
2 hours Surgery Type 98.3 None reported
Preventing hypothermia. AORN Journal, 103, 305-
Salpingectomy 313. http://dx.doi.org/10.1016/j.aorn.2016.01.009

2) There will be no patients that enter Sleeve 2 hours 97.5 97.1 None reported
ENT 1.5hours 97.3 97.0 None reported
Campbell, G., Alderson, P., Smith, A. F., & Warttig, S.
Gastrectomy
PACU with a temperature of <97.5 A&P repair 2 hours 97.7 97.8 None reported Warming of intravenous and irrigation fluids for
Breast 1 hour 97.9 96.1 None reported preventing inadvertent perioperative hypothermia.
degrees Farenheit. Lumpectomy Robotic 2 hours 98.2 100.3 None reported
myomectomy Cochrane Database of Systemic Reviews, 2015,
3) Warm IV fluids will decrease patient
Abdominal 1.5 hours 98.6 97.0 None reported Issue 4. Art.No.:CD009891. DOI:
Laparoscopy
10.1002/14651858.CD009891.pub2
shivers postoperatively. Total Knee 1.75hours 98.3 98.8 None reported ENT 1.75hours 98.0 97.8 None reported
Arthroplasty

4) Warm IV fluids will decrease postop D&C 1 hour 98.6 97.1 None reported John, M., Ford, J., & Harper, M. (2014, February 1).
Peri-operative warming devices: performance and
infections.
clinical application. The Association of Anaesthetists
of Great Britain and Ireland, 69, 623-638.
http://dx.doi.org/10.1111/anae.12626