Applying a Forced-Air Warming Device

Skill 6-6

Applying a Forced-Air Warming Device

Patients are at risk for altered body temperature related to the surgical procedure, length of the procedure, anesthetic agents, a cool surgical environment, age, and use of cool irrigating or infusion fluids. Inadvertent hypothermia (temperature below 96°F [36°C]) can lead to complications of poor wound healing, hemodynamic stress, cardiac disturbances, coagulopathy, delayed emergence from anesthesia, and shivering and its associated discomfort (AORN, 2019). Warming methods intra- and postoperatively are tailored to the individual patient and may include a combination of modalities (Link, 2020). Warmed blankets and forced-air warming devices are used for rewarming postoperatively. Forced-air warming devices are placed over the patient and circulate warm air around the patient. Covering the patient with the device acts to reduce heat loss from the skin (through convective and radiant loss) and in combination with the transfer of heat to the patient's body from the forced-air acts to raise the patient's body temperature and/or prevent hypothermia (Spruce, 2020c). It is important to monitor the patient's body temperature and circulatory status during use of these devices. Follow the manufacturer's directions and facility policies for use.

Delegation Considerations

Application of a forced-air warming device is not delegated to assistive personnel (AP). Application of a forced-warm air device may be delegated to licensed practical/vocational nurses (LPN/LVNs). 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

Forced-air warming device
Forced-air blanket
Electronic thermometer
PPE, as indicated

Assessment

Assess the patient's temperature and skin color and perfusion. Patients who are hypothermic are generally pale to dusky and cool to the touch and have decreased peripheral perfusion. Inspect nail beds and mucous membranes of patients with darker skin tones for signs of decreased perfusion. Measure the patient's body temperature and assess the patient's vital signs.

Actual or Potential Health Problems and Needs

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

Impaired thermoregulation
Perioperative injury risk
Thermal injury risk

Outcome Identification and Planning

The expected outcome to achieve when applying a forced-air warming device is that the patient will return to and maintain a temperature of 97.7° to 99.5°F (36.5° to 37.5°C). Other outcomes that may be appropriate include the following: the skin will become warm, capillary refill will be less than 2 to 3 seconds, and the patient will not experience shivering.

Implementation

Action	Rationale
1. Check the patient's health record for the prescribed use of a forced-air warming device. Gather the necessary supplies.	Reviewing the order validates the correct patient and correct procedure. Organization facilitates performance of the task. Preparation promotes efficient time management and an organized approach to the task.
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 the curtains around the bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient or significant other. Place necessary supplies on the bedside stand, overbed table, or other surface within easy reach.	Closing the curtains and door ensures the patient's privacy. Explanation relieves anxiety and facilitates engagement. Bringing everything to the bedside conserves time and energy. Arranging items nearby is convenient, saves time, and avoids unnecessary stretching and twisting of muscles on the part of the nurse.
5. Assess the patient's temperature. Temperature measurement should be obtained using the same site and method of measurement (AORN, 2019).	Baseline temperature validates the need for use of the device and provides baseline information for future comparison. Temperature measurement can vary significantly when temperatures are measured at different sites or by different methods; the same site and method of temperature measurement should be used throughout the perioperative phases when clinically feasible (AORN, 2019).
6. Plug forced-air warming device into electrical outlet. Place forced-air blanket over the patient, with plastic side up (Figure 1). Keep air-hose inlet at foot of bed.	Blanket should always be used with the device. To avoid causing burns, do not place air hose under lightweight blankets with airflow blanket.
7. Securely insert the air hose into the inlet. Place a lightweight fabric blanket over the forced-air blanket, according to the manufacturer's instructions. Turn the machine on and adjust temperature of air to desired effect.	The air hose must be properly inserted to ensure that it will not fall out. The blanket will help keep warmed air near the patient. Adjust air temperature, depending on desired patient temperature. If the blanket is being used to maintain an already stable temperature, it may be turned down lower than if needed to raise patient's temperature.
8. Remove PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents transmission of microorganisms.
9. Monitor the patient's temperature at least every 30 minutes while using the forced-air device.	Monitoring the patient's temperature ensures that the patient does not experience too rapid a rise in body temperature, resulting in vasodilation.
10. Discontinue use of the forced-air device once the patient's temperature is adequate and the patient can maintain the temperature without assistance.	The forced-air device is not needed once the patient is warm and stable enough to maintain temperature.
11. Remove device and clean according to facility policy and manufacturer's instructions.	Proper care of equipment helps to maintain function of the device.

Evaluation

The expected outcomes have been met when the patient's temperature returned to the normal range of 97.7° to 99.5°F (36.5° to 37.5°C), the patient maintained this temperature, the patient's skin was warm, and patient was free from shivering.

Documentation

Guidelines

Document the patient's temperature and the route used for measurement. Record that the forced-air warming device was applied to the patient. Document appearance of the skin and that the patient did not experience any adverse effects from the warming device. Record that the patient's temperature was monitored every 30 minutes, as well as the actual temperature measurements.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

Patient's temperature is increasing too quickly: Decrease temperature of air-warming device. If air is down to lowest setting, turn device off. If patient's temperature increases too rapidly, it can lead to a vasodilation effect that will cause the patient to become hypotensive.

Special Considerations

Use of forced-air warming devices has been associated with thermal injuries (Feil, 2017; John et al., 2014). Monitor for correct assembly of warmer hose to the blanket and accidental disconnection to avoid hot air being blown directly on the patient's skin; do not position patients on top of blankets designed to cover patients (Feil, 2017; John et al., 2014).
Preoperative warming with forced-air warming blanket can help prevent unintended perioperative hypothermia (Broback et al., 2018).

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Skill 6-6