Warming Devices, Use of



Warming Devices, Use of







CLINICAL GUIDELINES



  • Use of selected warming devices to maintain the child’s temperature may be implemented by the registered nurse (RN) or licensed practical nurse (LPN). Use of some warming devices require a healthcare prescribers orders; follow institutional protocols.


  • Use of hypothermia blanket may only be implemented by the RN or LPN by the order of a healthcare prescriber.


  • Child’s temperature is maintained between 97.7°F and 99.5°F (36.5°C and 37.5°C).


  • Preterm infant’s temperature is maintained between 97.3°F and 98.9°F (36.3°C and 36.9°C).


  • Hypothermia is considered to be a core body temperature less than 97.7°F (36.5°C) or a skin temperature less than 96.8°F (36°C) and may occur in premature infants and in children with intracranial birth injury, shock, or critical illness or in those under heavy sedation.


  • All preterm infants are maintained under a radiant warmer or in an isolette until they are able to maintain their body temperature within normal ranges without adjunct therapy.


  • Warming measures are initiated when a child’s core temperature is less than or equal to 97.2°F (36.2°C).


  • Child’s temperature is closely monitored during warming measures and until it has returned to within normal parameters.


  • Profoundly hypothermic children are placed on a cardiorespiratory monitor.




EQUIPMENT



  • Temperature measurement device (see Chapter 123 for types of temperature measurement devices)


  • Blankets


  • Head covers


  • Foot coverings

For radiant warmer:



  • Radiant warmer


  • Servo temperature probe

For isolette:



  • Double-walled isolette (use of porthole sleeves, when available, decreases the amount of ambient heat loss)


  • Servo temperature probe

For chemically heated mattress:



  • Chemically heated mattress


  • Linen to cover mattress

For hypothermia blanket:



  • Electronic warming blanket


  • Hypothermia machine with thermometer probe


  • Protective sheets


  • Distilled water (to fill machine if needed)

Forced-air warming blanket:



  • Forced-air warming blanket


  • Linen to cover warming blanket

For heat lamp:



  • Heat lamp


  • Measuring device


CHILD AND FAMILY ASSESSMENT AND PREPARATION



  • Assess child’s clinical history and related symptoms to determine reasons for hypothermia:



    • Injury to or disease of the hypothalamus or pituitary gland, which can produce changes in the child’s ability to thermoregulate


    • Lack of clothing or covers


    • Cold environment (e.g., crib placed near a window or air-conditioning vent)


    • Diagnosis related or recent surgery


    • Dehydration


    • Hypoglycemia


    • Sepsis


    • Wet linen and covers


    • Pooling of secretions under the body


    • Ventilation with cold, dry oxygen


    • Failure to thrive or starvation

imageCold-stressed children may have electrolyte and cardiac disturbances that require close observation.



  • Explain to the child and the family what you will be doing to moderate or alter the child’s temperature
    and make the child more comfortable. Include the following in discussion:



    • Measures used to provide warmth to the child


    • Manner in which the family can assist with the child’s care while maintaining the child’s temperature such as swaddling


    • Explanation of all equipment to be used to assist in warming the child


    • Measures to be used to monitor the child’s temperature


    • Providing skin-to-skin contact (“kangaroo care”) to the infant


  • Encourage the family to be present in the room and to participate in measures to warm the child.


  • Use diversionary techniques with the child if needed to ensure their cooperation while undergoing warming procedures.



PROCEDURE
Preintervention Measures
































Steps

Rationale/Points of Emphasis


1 Perform hand hygiene and gather the necessary supplies to assess child’s temperature.

Reduces the transmission of microorganisms. Promotes efficient time management and provides an organized approach to the procedure.


2 Determine child’s temperature (see Chapter 123 ), compare with normal temperature, and observe the child for clinical manifestations of hypothermia.

Evaluates degree of hypothermia. Signs of hypothermia include pallor, acrocyanosis or central cyanosis, mottling of the skin, and signs of respiratory distress. Consistently cold-stressed neonates exhibit poor weight gain, metabolic acidosis, apnea, and bradycardia.

caREminder

Avoid rectal temperatures in infants because they can cause tissue damage.


3 Notify healthcare prescriber of child’s temperature and if there is evidence of dehydration, hypoglycemia, or diagnosis-related condition that would impact thermoregulation.

Alerts healthcare prescriber to order laboratory tests to determine causative agent. Orders for implementing warming measures can also be acquired at this time. Heat transfer between the child and the environment is altered by thickness of the body (amount of subcutaneous fat) and degree of dilation and blood flow through the skin blood vessels. Hypoglycemia and hypothermia are early signs of sepsis in neonates and infants.


4 Select intervention method to warm the child. Gather needed equipment to proceed with intervention measures. Follow manufacturer’s instructions for prewarming selected equipment (e.g., radiant warmer, isolette). (See Chapter 76 for additional information on selected warming devices for the newborn.)

Prevents or treats hypothermia, which can increase oxygen consumption and cause respiratory distress. Warming measures are selected based on child’s temperature, age, diagnosis, healthcare setting (emergency department, intensive care unit, general care unit), and resources available.


5 Perform hand hygiene before initiating interventions with the child.

Reduces transmission of microorganisms when initiating contact with the child.




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Jul 9, 2020 | Posted by in NURSING | Comments Off on Warming Devices, Use of

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