getting to the core: considerations for perioperative ...€¦ · •non-invasive •proper...

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3M Health Care Academy

Getting to the core: Considerations for Perioperative Temperature Monitoring

Disclosure

Sponsored by 3M Health Care

Presented by: Jamie Dougherty, BSN, RN

Clinical Specialist – OR Solutions

Medical Markets Division

© 3M 2017. All Rights Reserved 3

Learning Objectives

1. Discuss the importance of monitoring core body temperature in

perioperative patients.

2. Identify methods of monitoring body temperature during the

perioperative journey and the benefits and drawbacks associated

with each method.

3. Describe zero-heat-flux technology and summarize associated

clinical studies.

4. Outline guidelines and recommended practices for perioperative

temperature monitoring.

4

Why temperature monitoring?Temperature is one of the four main vital signs that is monitored to help provide

safe and effective care.

1. Temperature

2. Pulse

3. Respiratory rate

4. Blood pressure

© 3M 2017. All Rights Reserved

TemperatureAn important vital sign for the surgical patient• Accurate core body temperature monitoring is vital and will

identify if the patient is hypothermic, normothermic, or

hyperthermic

• Patients undergoing anesthesia are at risk for inadvertent

perioperative hypothermia

• Fever detection is critical and can warn of infection, allergic

reactions, mismatched blood transfusions or other complications

• Accurate temperature monitoring will indicate whether warming

interventions are effective

• Important to ensure that temperatures post operatively are

accurate as they have patient care implications and potential

financial consequences


Malignant Hyperthermia (MH)

•Rare but serious risk of general anesthesia

•Failure to detect and treat MH increases the

likelihood of complications, including cardiac arrest

and death4

•Changes in core temperature can assist in diagnosis

4. Larach MG, et al. Cardiac arrests and deaths associated with malignant hyperthermia in North America from 1987 to 2006: a report from the North American Malignant Hyperthermia Association of the

United States. Anesth 2008; 108:603-11.


1. Young V, Watson M. Prevention of Perioperative Hypothermia in Plastic Surgery. Aesthetic Surgery Journal. 2006;551-571.

Inadvertent Hypothermia

Occurs in up to 90% of patients, unless treated1 and is considered a frequent, preventable complication of surgery.


Increased Rate of

Wound Infection5,6

Increased

Mortality Rates7

Coagulopathy7-9 Prolonged &

Altered Drug

Effect10

Myocardial Ischemia

& Cardiac

Disturbance11

Shivering &

Thermal

Discomfort2,3,5,12,13

Delayed

Emergence from

Anesthesia14

Perioperative hypothermia is defined as core temperature less than 36.0°C1-4

Research shows that even mild hypothermia can result in significant negative outcomes including:

1. Young V, Watson M. Prevention of Perioperative Hypothermia in Plastic Surgery. Aesthetic Surgery Journal. 2006;551-571. 2. Sessler, DI. Perioperative Heat Balance. Anesth. 2000;92:578-596. 3. Sessler DI. Current concepts: Mild Perioperative Hypothermia. New Engl J Med. 1997; 336(24):1730-1737. 4. Sessler DI, Kurz A. Mild Perioperative Hypothermia. Anesthesiology News. Oct 2008: 17-28. 5. Kurz A, Sessler DI, et al. Perioperative Normothermia to Reduce the Incidence of Surgical-Wound Infection and Shorten Hospitalization. New Engl J Med. 1996;334:1209-1215. 6. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after a clean surgery: a randomized controlled trial. Lancet. 2001;358(9285):876-880. 7. Bush H Jr., Hydo J, Fischer E, et al. Hypothermia during elective abdominal aortic aneurysm repair: The high price of avoidable morbidity. J Vasc Surg. 1995;21(3): 392-402. 8. Schmied H, Kurz A, et al. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. The Lancet. 1996;347(8997):289-292. 9. Rajagopalan S, et al. The Effects of Mild Perioperative Hypothermia on Blood Loss and Transfusion Requirement. Anesth. 2008; 108:71-7. 10. Heier T, Caldwell JE, Sessler DI, et al. Mild Intraoperative Hypothermia Increases Duration of Action and Spontaneous Recovery of Vecuronium Blockade during Nitrous Oxide-Isoflurane Anesthesia in Humans. Anesth. 1991;74(5):815-819. 11. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. JAMA. 1997;277:1127-1134. 12. Fossum S, Hays J, Henson MM. A Comparison Study on the Effects of Prewarming Patients in the Outpatient Surgery Setting. J PeriAnesth Nurs. 2001;16(3):187-194. 13. Wilson L, Kolcaba K. Practical Application of Comfort Theory in the Perianesthesia Setting. J PeriAnesth Nurs. 2004;19(3):164-173. 14. Lenhardt R, Marker E, Goli V, et al. Mild Intraoperative Hypothermia Prolongs Postanesthetic Recovery. Anesth. 1997; 87(6):1318-1323.

Negative outcomes of inadvertent perioperative hypothermia


Core temperature• The temperature of vital organs deep within

the body, as opposed to peripheral

temperature of the limbs

• Single best indicator of thermal status1

• Measured in perioperative patients to

monitor inadvertent perioperative

hypothermia, response to warming, detect

malignant hyperthermia, surgical site

infection or transfusion reaction

• Anesthesia impairs ability to regulate core

temperature

1. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology 2008; 109:318-38.

37oC

© 3M 2017. All Rights Reserved1. Sessler DI. Mild Perioperative Hypothermia. New Engl J Med. 1997;336(24):1730-1737.

2. Sessler DI. Temperature Monitoring. In: Miller RD, ed. Anesthesia. 3rd ed. New York: Churchill/Livingstone 1990.

The body’s normal response to temperature (°C)

32 33 34 35 36 37 38 39 40 41

0.2°C Interthreshold Range

Vasoconstriction

Shivering

NST

Vasodilation

Sweating

Thermoregulation: Under Normal Circumstances

Adapted from: Sessler DI.

Temperature Monitoring.

In: Miller RD, ed.

Anesthesia. 3rd ed. New York:

Churchill/Livingstone 1990.


Thermoregulation: Under Anesthesia

32 33 34 35 36 37 38 39 40 41

4.0°C Interthreshold Range

Vasoconstriction

NST

Vasodilation

Sweating

Hypothermia :

< 36.0°C

Anesthesia-impaired response to temperature (°C)

1. Sessler DI. Mild Perioperative Hypothermia. New Engl J Med. 1997;336(24):1730-1737.

2. Sessler DI. Temperature Monitoring. In: Miller RD, ed. Anesthesia. 3rd ed. New York: Churchill/Livingstone 1990.

Adapted from: Sessler DI.

Temperature Monitoring.

In: Miller RD, ed.

Anesthesia. 3rd ed. New York:

Churchill/Livingstone 1990.


Heat redistribution during anesthesia

Warmer blood from the core moves to the periphery

Cooler blood in the periphery mixes with warmer blood from the core

This mixture and flow of blood reduces core body temperature

Sessler DI. Mild Perioperative Hypothermia. New Engl J Med. 1997;336(24):1730-1737.


Characteristic Patterns of General Anesthesia-Induced Hypothermia

Elapsed Time (h)0 2 4 6

DECREASECORE TEMP

1hr

0

-1

-2

-3

CoreTemp(C°)

1. Sessler DI. Perioperative Heat Balance. Anesth. 2000;92:578-596.

2. Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, Cheng C. Heat Flow and Distribution During Induction of General Anesthesia. Anesth. 1995;82(3):662-673.

Adapted from: Sessler DI, Anesth. 2000; 92(2): 578-96.

➢ Core temperature can drop 1.6°C in the first hour of general anesthesia1, 2

➢ 81% of this temperature decrease is due to core-to-peripheral heat redistribution2


Regional Anesthesia

• Patients undergoing regional anesthesia are also at risk for

hypothermia5,7,8

• Temperatures often are not routinely monitored7,9

• Patient may be asymptomatic

• Patients often feel warmer due to incorrect perceptions

in blocked areas5

• Hypothermia often undetected9

5. Sessler DI, Kurz A. Mild Perioperative Hypothermia. Anesthesiology News. October 2008: 17-28.

7. Frank SM, et al. Temperature monitoring practices during regional anesthesia. Anesth Analg 1999;88:373.7.

8. Matsukawa T, et al. Heat flow and distribution during epidural anesthesia. Anesthesiology 1995; 83(5):961-67.


How is temperature monitoring being done today?


Numerous temperature monitoring methods

Less Accurate,Invasive

Most Accurate,Most Invasive

Axilla

Esophageal Oral (Sublingual)

Temporal Artery ScannerTympanic MembraneLiquid Crystal Display

Pulmonary Artery

Infrared Tympanic

Suitable for OR use, typically compatible with general anesthesia

Suitable for regional anesthesiapre-op and PACU, estimates body temperature

Most AccurateLeast Accurate

Skin Sensor Probe

Nasopharyngeal

Bladder

Rectal

Least Accurate,Least Invasive


Choosing Methods of Temperature Measurement

✓Accurate, reliable and precise across all

possible temperature ranges

✓Not sensitive to outside influences

✓Safe

✓Determined by accessibility of site, ease

of use and patient comfort



Temperature monitoring devices

• Wide variations can exist due to method and technique

• Several things can affect the accuracy of a temperature

reading:

• Improper technique

• Reliability of the instrument

• Not using the proper thermometer in the proper place

• Not following the manufacturers instructions for use


Oral

1. Frank SM, et al. Temperature monitoring practices during regional anesthesia. Anesth Analg. 1999;88:373–7.2. Langham GE, et al. Noninvasive temperature monitoring in postanesthesia care units. Anesth. 2009; 111:90-6.3. Hooper VD, Andrews JO. Accuracy of noninvasive core temperature measurement in acutely ill adults: the state of the science. Biol Res Nurs. 2006; 8(1): 24-344. Lawson L, et al. Accuracy and precision of noninvasive temperature measurement in adult intensive care patients. Am J Crit Care. 2007; 16(5): 485-96.

•Quick, easy, familiar to patients

•Reasonable estimation of core body temperature1-4

•Accuracy impacted by technique, probe placement

•Not ideal for all surgical patients, unconscious or restless patients

•Intermittent readings

Limitations Advantages


Bladder

•No variation due to technique

•Reasonable estimation of core temperature

•Continuous

•Invasive

•Accuracy diminishes with core temperature changes1, hypothermia3, and is influenced by urine output2


1. Frank SM, et al. Temperature monitoring practices during regional anesthesia. Anesth Analg. 1999;88:373–7.2. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008; 109:318-38.3. Holtzclaw BJ Monitoring body temperature. AACN Clin Issues Crit Care Nurs. 1993;4:44–55.


Axillary

•Non-invasive, safe

•Somewhat protected from ambient air with proper placement

•Consistently varies from core temperature1

•Placement of probe highly variable; decreases precision of measurement1,3

•Not an accurate reflection of core temperature with hypothermia or vasoconstriction2


1. Lawson L, et al. Accuracy and precision of noninvasive temperature measurement in adult intensive care patients. Am J Crit Care. 2007; 16(5): 485-96.

2. Holtzclaw BJ Monitoring body temperature. AACN Clin Issues Crit Care Nurs. 1993;4:44–55.

3. Lefrant JY, et al. Termperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulomnary artery core method. Intensive Care Med. 2003;29:414-18.


Rectal

•Accurate reflection of core temperature at steady state

•Continuous

•Insertion can be uncomfortable for awake patient •Positioning patient can be difficult •Accuracy may be impacted by presence of stool3

•May not be appropriate for patients with thrombocytopenia•Lag behind with thermal change1-3

•Poor at detecting malignant hyperthermia1



2. Holtzclaw BJ Monitoring body temperature. AACN Clin Issues Crit Care Nurs. 1993;4:44–55.

3. Lefrant JY, et al. Termperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med 2003;29:414-18.


Infrared Aural Canal (Tympanic)

•Quick•Easy•Non-invasive

•Proper placement difficult to achieve consistently•Errors in measurement technique may contribute to accuracy and reliability of measurements1,2

•Not in close enough proximity to tympanic membrane to obtain and evaluate the infrared signal •Numerous studies have evaluated the accuracy and variability of this monitoring method and have deemed infrared tympanic thermometers insufficient for clinical use1,3-7


1. Hooper VD, Andrews JO. Accuracy of noninvasive core temperature measurement in acutely ill adults: the state of the science. Biol Res Nurs. 2006; 8(1): 24-34


3. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008; 109:318-38.

4. Langham G, Maheshwari, A, et al. Noninvasive temperature monitoring in post-anesthesia care units. Anesth. 2009;111(1):90-6.


6. Modell JG, Katholi CR, et al. Unreliability of the infrared tympanic thermometer in clinical practice? A comparative study with oral mercury and oral electronic thermometers. South Med J 1998;91:649-54.

7. Frommelt T, Ott C, Hays V. Accuracy of different devices to measure temperature. MedSurg Nursing June 2008;17(3):171-82.


Skin Probes


1. Vaughan MS, et al. Inaccuracy of Liquid Crystal Thermometry to Identify Core Temperature Trends in Postoperative Adults. Anesth Analg. 1982; 61(3):284-87.

2. Larach MG, et al. Clinical presentation, treatment and complications of malignant hyperthermia in North America from 1987 to 2006. Anesth Analg. 2010; 110(2):498-507.

3. Langham GE, et al. Noninvasive temperature monitoring in postanesthesia care units. Anesth. 2009; 111:90-6.

4. Holtzclaw BJ Monitoring body temperature. AACN Clin Issues Crit Care Nurs. 1993;4:44–55.5. Brull SJ, et al. Liquid crystal skin thermometry: an accurate reflection of core temperature? Can J

Anaesth. 1993;40:375-81.6. Marsh ML, et al. Failure of intraoperative liquid crystal temperature monitoring. Anesth Analg. 1996;

82:1102-04.7. Ikeda T, et al. Influence of thermoregulatory vasomotion and ambient temperature variation on the

accuracy of core-temperature estimates by cutaneous liquid-crystal thermometers. Anesth 1997; 86:603-12.

8. Fiedler MA. Thermoregulation:Anesthetic and perioperative concerns. AANA J 2001;69(6):485-91.9. Cattaneo CG, et al. The accuracy and precision of body temperature monitoring methods during

regional and general anesthesia. Anesth Analg 2000; 90(4):938-45. 10. Boetcher SKS, et al. Characteristics of direct-contact, skin-surface temperature sensors. International

Journal of Heat and Mass Transfer 2009;52:3799-3804.

LCD•Found to be inadequate for measuring trends in core temperature1,5-8

•Accuracy may be impacted by ambient temperature, air flow at sensor4,7-9

•Not recommended for detection of MH2

•Unsuitable for clinical use3

LCD & Thermocouple/Thermistor• Easy to use and observe,

convenient to place, noninvasive, single patient use

Thermocouple/Thermistor•Sensitive to ambient temperature and airflow4,9-10

•Accuracy decreases as core temperature decreases3

•Unsuitable for clinical use3


Temporal Artery

•Quick•Easy•Non-invasive

•Technique significantly impacts accuracy and precision of measurements1,2

•Diaphoresis and airflow near the face may affect temporal artery measurements1

•Improper cleaning of the lens can result in interference from buildup of oil and impact accuracy of readings2

•Poor at detecting fever5,6 and hypothermia4,7

•High reproducibility error6

•Numerous studies found it insufficient for use in perioperative patients6,7 and clinical practice3-5,8


1. Lawson L, et al. Accuracy and precision of noninvasive temperature measurement in adult intensive care patients. Am J Crit Care 2007; 16(5): 485-96.

2. Carroll D, et al. A Comparison of Measurements From a Temporal Artery Thermometer and a Pulmonary Artery Catheter Thermistor. Am J Crit Care 2004; 13(3):258.

3. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesth 2008;109:318-38.

4. Hannenberg AA, Sessler Di. Improving Perioperative Temperature Management. Anesth Analg2008;107(5):1454-56.

5. Suleman MI, et al. Insufficiency in a new temporal-artery thermometer for adult and pediatric patients. Anesth Analg 2002;95:67-71.

6. Kimberger O, et al. Temporal artery versus bladder thermometry during perioperative and intensive care unit monitoring. Anesth Analg 2007; 105(4):1042-47.

7. Winslow EH, et al. Unplanned perioperative hypothermia and agreement between oral, temporal artery, and bladder temperatures in adult major surgery patients. J Perianseth Nurs 2012; 27(3):165-80.

8. Greenes DS, et al. Accuracy of a noninvasive temporal artery thermometer for use in infant.s. Arch Pediatr Adolesc Med 2001;155:376-81.


Zero-Heat-Flux Thermometry

• Non-invasive, accurate reflection of core temperature1

• Continuous• Easy to use• Consistent (data travels with patient) • Displays two hour temperature trend• Electronic health record (EHR)

compatible• Reduces variability of multiple devices

and techniques

•Placement limited to forehead•May not be appropriate for all patients and procedures


1. Eshraghi Y, Sessler D. (2012), Exploratory Method-Comparison Evaluation of a Disposable Non-Invasive Zero Heat Flow Thermometry System. 2012 American Society of Anesthesiologists Annual Meeting; A63.

How does Zero-Heat-Flux technology work?

28

3M Health Care AcademySM

How does it work?

Under normal conditions, heat moves from the warmer core out to the cooler periphery where it

dissipates from our skin into the environment.

29

3M Health Care AcademySM

How does it work?

Zero-heat-flux creates a zone of perfect insulation allowing the warmer temperature to rise to the

skin surface where the core temperature can be measured noninvasively.


How does it work?

• Consists of a single-use patient

sensor applied to the forehead and

control unit that displays temperature

•Accurate and precise in clinical

studies

Clinical Studies


Clinical Studies

Observational study comparing core temperatures measured with a

pulmonary artery catheter and non-invasive zero-heat-flux sensor

• 105 patients undergoing nonemergent cardiac surgery, excluding the period

of cardio pulmonary bypass (CPB)

Results:

• 36,000 data pairs

• Mean error (TZHF-TPA) = -0.23˚C;

95% LOA= ±0.8˚C

Eshraghi Y, Nasr V, Parra-Sanchez I, et al. An evaluation of a zero heat flux cutaneous thermometer in cardiac surgical patients. AnesthAnalg. 2014;119(3);543-549.

-3

-2

-1

0

1

2

3

33 34 35 36 37 38 39 40T

ZH

F -

TP

A (

°C)

(TZHF + TPA)/2 (°C)


Conclusion

Core temperature can be measured non-invasively

with zero-heat-flux technology.


Clinical StudiesProspective, observational study

Temperatures measured simultaneously

• Lower Extremity Vascular Surgery: Non-invasive zero heat flux (ZHF) temperature

sensor and esophageal

• Cardiac Surgery: Non-invasive ZHF temperature sensor and nasopharyngeal and

pulmonary artery

Mäkinen M, Pesonen A, Jousela I, et al. Novel zero-heat-flux deep body temperature measurement in lower extremity vascular and cardiac surgery. J Cardiothorac vas Anesth. 2016;30:973-978.

+0.08⁰CVascular Surgery

-0.05 ⁰CCardiac Surgery

(Off CBP)

-0.12 ⁰CCardiac Surgery (On & Off CBP)

Mean Difference (⁰C)

(95% limits of agreement -0.25 to +0.40⁰C)



ZHF vs. Esophageal

ZHF vs. Pulmonary Artery

ZHF vs. Nasopharyngeal

Results


Conclusion

This study demonstrated agreement with core body

temperatures measured using the non-invasive zero-

heat-flux temperature sensor comparable to

esophageal, nasopharyngeal and pulmonary artery

with temperatures ≥34˚C.


Clinical StudiesProspective study

Compared zero-heat-flux (ZHF) thermometry to esophageal and arterial

temperature using a femoral artery catheter in ICU and Neuro ICU patients.

Dahyot-Fizelier C, Lamarche S, Kerforne T, et al. Accuracy of Zero-Heat-Flux Cutaneous Temperature in Intensive Care Adults. Critical Care Medicine. 2017;45:e715-e717.

92.6% 99.8% 99.8%

ZHF vs. Esophageal

ZHF vs. Arterial

Arterial vs. esophageal

(95% CI, 91.9-93.4) (95% CI, 95.3-100.0) (95% CI, 95.3-100.0)

Results:

>62,000 pairs of temperature were collected

Absolute Difference of Temperature Pairs ≤ 0.5⁰C (% [95% CI])


Conclusion

The core temperature measured by the ZHF method

provides a comparable reliability to esophageal or

arterial temperatures in ICU patients.


Clinical StudiesComparative study

Pediatric patients undergoing non-emergent urology, orthopedic or

general abdominal surgery

Evans M, Davis P, McCarthy D, Van Duren A, Morse DJ, Strom C. 3M™ SpotOn™ Temperature Monitoring System versus Nasopharyngeal Temperature Monitoring in Pediatric Surgical

Patients. Presented at the 2014 PostGraduate Assembly of Anesthesiology.

Results:

Average bias between the ZHF and nasopharyngeal temperatures was small at 0.28°C.

Bia

s

Average Temperature

Side of forehead Left Lateral Right Lateral

Bland-Altman Results


Conclusion

The non-invasive method helps to reduce or eliminate

the disadvantages associated with nasopharyngeal

temperature monitoring including placement

technique, patient discomfort, risk of injury, cross-

contamination and inconsistent methodologies across

departments.

Guidelines and Recommended Practices


American Society of Anesthesiologists (ASA)Basic Anesthetic Monitoring

• “During all anesthetics, the patient’s oxygenation, ventilation, circulation and

temperature shall be continually evaluated.”1

• “Every patient receiving anesthesia shall have temperature monitored when

clinically significant changes in body temperature are intended, anticipated or

suspected.”1

Postanesthetic Care

• “Routine assessment of patient temperature detects complications, reduces

adverse outcomes, and should be done during emergence and recovery”2

• “Patient temperature should be periodically assessed during emergence and

recovery.”2

1. ASA Standards for Basic Anesthetic Monitoring, 2015. http://www.asahq.org/quality-and-practice-management/standards-guidelines-and-related-resources/standards-for-basic-anesthetic-monitoring. Revised October 28, 2015. Accessed January 29, 2018.

2. Apfelbaum JL, Silverstein JH, Chung FF, et al. Practice guidelines for postanesthetic care: an updated report by the American society of anesthesiologists task force on postanesthetic care. Anesthesiology. 2013;118(2):291-307. doi: 10.1097/ALN.0b013e31827773e9.

http://www.asahq.org/quality-and-practice-management/standards-guidelines-and-related-resources/standards-for-basic-anesthetic-monitoring


AANA - American Association of Nurse Anesthetists

Standard V – Thermoregulation

• “When clinically significant changes in body temperature are intended,

anticipated, or suspected, monitor body temperature in order to

facilitate the maintenance of normothermia.”

AANA Standards for Nurse Anesthesia Practice, 2013.


ASPAN - American Society of PeriAnesthesia Nurses

Temperature Measurement Recommendations Supported by Strong Evidence

• “Near-core measures of oral temperature best approximates core” (Class I,

Level B)

• “The same route of temperature measurement should be used throughout the

perianesthesia period for comparison purposes” (Class I, Level C)

• “Caution should be taken in interpreting extreme values from any site with near-

core instruments” (Class I, Level C)

Hooper VD, et al. ASPAN’s Evidence-Based Clinical Practice Guideline for the Promotion of Perioperative Normothermia: Second Edition. Journal of PeriAnesthesia Nursing. 2010; 25(6):346-65.


AORN - Association for periOperative Registered Nurses

Recommendation II

• The same method of temperature measurement should be used throughout

the perioperative period when clinically feasible (High Evidence)

• The method of temperature monitoring should be selected based on the

requirements of the procedure such as accessibility of the route,

invasiveness of the route, anesthesia type, anesthesia delivery method.

• Temperature may be measured using core temperature sites: tympanic

membrane (via thermistor), distal esophagus, cutaneous (via zero-heat-flux

thermometry), nasopharynx, pulmonary artery or “near-core” sites: mouth,

axilla, bladder, rectum, skin, tympanic membrane (via infrared sensor)

1. AORN. Guideline for Prevention of Unplanned Patient Hypothermia. AORN, Inc. 2015.


Malignant Hyperthermia Association of the U.S.

• “MHAUS recommends core temperature monitoring

for all patients given general anesthesia lasting more

than 30 minutes.”

Malignant Hyperthermia Association of the United States. Temperature During Surgical Procedures Web site. https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/temperature-monitoring-during-surgical-procedures/ Accessed January 26, 2018.

https://www.mhaus.org/healthcare-professionals/mhaus-recommendations/temperature-monitoring-during-surgical-procedures/


1.1.5 Temperature should be measured from a site that produces a direct

measurement of core temperature or a direct estimate of core temperature

• These sites include: pulmonary artery catheter, distal esophagus, urinary bladder, zero

heat-flux (deep forehead), sublingual, axilla, rectum

1.1.6 Do not use indirect estimates of core temperature in adults having surgery.

National Institute for Health and Care Excellence. (2016). https://www.nice.org.uk/guidance/cg65/chapter/Recommendations#preoperative-phase. Retrieved on January 12, 2018

Preoperative Temperature Intraoperative TemperaturePostoperative Temperature

• The patient's temperature should be measured and documented in the hour before they leave the ward or emergency department.

• The patient’s temperatures should be measured before induction of anesthesia and every 30 minutes until the end of surgery

The patient’s temperature should be measured and documented on admission to the recovery room and then every 15 minutes.

NICE - National Institute for Health and Care Excellence


Summary

• Accurate temperature measurement is critical to the assessment and management of

perioperative patients

• Most of the invasive devices that accurately report core body temperature are

limited to operating room use

• Most instruments are unable to accurately and noninvasively measure core temperature

• Improved accuracy with a consistent method may help compliance with quality measures and

improve temperature management utilization

• Deep tissue thermometry utilizing zero heat flux technology can improve quality by

noninvasively monitoring core temperature consistently and accurately throughout the

perioperative journey, regardless of the type of anesthesia

Questions

Thank You

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