Regulating Temperature Using an Overhead Radiant Warmer

Skill 2-2

Regulating Temperature Using an Overhead Radiant Warmer

Neonates, infants who are exposed to stressors or chilling (e.g., from undergoing numerous procedures), and infants who have an underlying condition that interferes with thermoregulation (e.g., prematurity) are highly susceptible to heat loss. Therefore, radiant warmers are used for infants who have trouble maintaining body temperature. In addition, use of a radiant warmer minimizes the oxygen and calories that the infant would expend to maintain body temperature, thereby minimizing the effects of body temperature changes on metabolic activity.

An overhead radiant warmer uses infrared light to warm the infant. The infant's skin is warmed, causing an increase in blood flow, which heats both the underlying blood and tissue surfaces. The warmer is adjusted to maintain an anterior abdominal skin temperature of 95.9° to 97.7°F (35.5° to 36.5°C) using an automatic thermostat (Bell, n.d.; Silbert-Flagg & Pillitteri, 2018).

Delegation Considerations

Measurement of body temperature for an infant in a radiant warmer is not delegated to assistive personnel (AP). Depending on the state's nurse practice act and the organization's policies and procedures, the measurement of body temperature for an infant in a radiant warmer may be delegated to a licensed practical/vocational nurse (LPN/LVN). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Overhead warmer
Temperature probe
Aluminum foil probe cover
Axillary or rectal thermometer, based on facility policy
PPE, as indicated

Assessment

Assess the patient's temperature using the route specified in facility policy, and assess the patient's fluid intake and output.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or needs may require the use of this skill as part of related interventions. An appropriate health problem or need may include:

Hyperthermia
Hypothermia
Impaired Thermoregulation

Outcome Identification and Planning

The expected outcome to achieve when using an overhead warmer is that the infant's temperature is maintained within normal limits without injury. Other outcomes may be appropriate, depending on the specific diagnosis or patient problem identified for the patient.

Implementation

Action	Rationale
1. Check the prescribed interventions or plan of care for the use of a radiant warmer.	Provides for patient safety and appropriate care.
2. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient.	Identifying the patient ensures the right patient receives the intervention and helps prevent errors.
4. Close curtains around the bed and close the door to the room, if possible. Discuss the procedure with the patient's family/caregivers.	This ensures the patient's privacy. Explanation reduces the family's/caregiver's apprehension and encourages cooperation.
5. Plug in the warmer. Turn the warmer to the manual setting. Allow the blankets to warm before placing the infant under the warmer.	By allowing the blankets to warm before placing the infant under the warmer, you are preventing heat loss through conduction. By placing the warmer on the manual setting, you are keeping the warmer at a set temperature no matter how warm the blankets become.
6. Insert probe securely into the heater unit. Switch the warmer setting to automatic. Set the warmer to the desired abdominal skin temperature, usually 95.9° to 97.7°F (35.5° to 36.5°C) (Bell, n.d.; Silbert-Flagg & Pillitteri, 2018).	The automatic setting ensures that the warmer will regulate the amount of radiant heat, depending on the temperature of the infant's skin. The temperature should be adjusted so that the infant does not become too warm or too cold.
7. Place the infant under the warmer. Attach the probe to the infant's abdominal skin at mid-epigastrium, halfway between the xiphoid and the umbilicus. Cover with a foil-backed shield (Figure 1). If the infant is prone, attach the probe to the skin over either flank (not between the scapulae) (Bell, n.d.; Silbert-Flagg & Pillitteri, 2018).	The foil-backed shield prevents direct warming of the probe, allowing the probe to read only the infant's temperature.
8. When the abdominal skin temperature reaches the desired set point, check the patient's temperature using the route specified in facility policy to be sure it is within the normal range (Figure 2).	By monitoring the infant's temperature, you are watching for signs of hyperthermia or hypothermia.
9. Adjust the warmer's set point slightly, as needed, if the patient's temperature is abnormal. Do not change the set point if the temperature is normal.	By monitoring the infant's temperature, you are watching for signs of hyperthermia or hypothermia. This prevents the infant from becoming too warm or too cool.
10. Remove additional PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene deters the spread of microorganisms.
11. Check the position of the probe frequently to ensure the probe maintains contact with the patient's skin. Continue to monitor temperature measurement and other vital signs.	Poor contact will cause overheating. Entrapment of the probe under the arm or between the infant and mattress will cause a falsely high reading and underheating (Bell, n.d.; Silbert-Flagg & Pillitteri, 2018). Poor contact with skin will cause overheating (Bell, n.d.). Monitoring of vital signs assesses patient status.

Evaluation

The expected outcomes have been met when the infant has been placed under the radiant warmer, the infant's temperature was well controlled, and the infant experienced no injury.

Documentation

Guidelines

Document initial assessment of the infant, including body temperature; the placement of the infant under the radiant warmer; and the settings of the radiant warmer. Document infant's skin and axillary (or rectal) temperatures, and other vital sign measurements.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

The infant becomesfebrile under the radiant warmer: Do not turn the warmer off and leave the infant naked. This could cause cold stress and even death. Leave the warmer on automatic and lower the set temperature. Notify the primary care provider.
The warmer's temperature is fluctuating constantly or is inaccurate: Change the probe cover. If this does not improve the temperature variations, change the probe as well.

Special Considerations

Infant and Child Considerations

Radiant warmers result in increased insensible water loss. This water loss needs to be taken into account when daily fluid requirements are calculated.

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Skill 2-2