Preventing Hypothermia in the Perioperative Setting
This course will cover the importance of maintaining normothermia and how the nurse plays a role in preventing hypothermia in the perioperative setting.
Start
Learning Objectives
By the end of this learning module, learner will be able to:
identify and implement different interventions to prevent perioperative hypothermia.
list at least 3 adverse effects of perioperative hypothermia.
define perioperative hypothermia.
recognize patient populations who are at a greater risk for periop hypothermia.
identify different mechanisms of heat loss in the perioperative setting.
differentiate between active and passive warming measures.
Next
Hypothermia Overview
All patients having surgery are at risk for developing inadvertent hypothermia.
Perioperative hypothermia is defined as a core body temperature below 36°C (<96.8°F).
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Patients in the following catgeories are at a higher risk for experiencing perioperative hypothermia:
Hypothermia Overview
Patients of older age
Patients with a higher ASA Classification
Patients with a lower body weight or BMI
Patients with a low pre-operative core body temperature
Patients undergoing major surgery
Patients under general anesthesia for a prolonged time
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Why does hypothermia commonly occur in the perioperative setting?
- anesthetic drugs can impair the patient's ability to thermoregulate
- exposure to a cold enviornment
- surgical factors (large open wounds, cold irrigants, IV fluids, etc.)
Methods of Heat Loss
Convection
Convection
Evaporation
Heat transfer caused by evaporation of liquid from skin. Accounts for 8-10% of heat loss in surgical patients.
Heat transfer caused by air circulation or drafts. Accounts for 30% of heat loss in surgical patients.
Conduction
Radiation
Heat transfer from hot to colder space. Accounts for 40% of heat loss.
Heat transfer caused by contact with another object
Next
Guruswamy, J., & Omosule, A. J. (2021). 13 - Temperature Monitoring. In Anesthesia Equipment (Third Edition, pp. 287–303). Elsevier Inc. https://doi.org/10.1016/B978-0-323-67279-5.00013-3
Knowledge Check
Next
Knowledge Check
Next
Anesthesia and Thermoregulation
- Anesthesia impedes thermoregulatory control.
- Under normal circumstances, when we are cold our bodies will naturally vasoconstrict and even shiver.
- When our bodies are hot, we may sweat and vasodilate.
- The brain will even adjust our metabolic rate to help compensate.
- Anesthesia interferes with this proces in the hypothalmus.
Anesthesia increases the natural thermoregulatory response range by 20 times, meaning there is delayed response in these natural correction methods.
Next
Saad H, Aladawy M. Temperature management in cardiac surgery. Glob Cardiol Sci Pract. 2013 Nov 1;2013(1):44-62. doi: 10.5339/gcsp.2013.7. PMID: 24689001; PMCID: PMC3963732.
What's the risk?
Inadvertent hypothermia can have negative impacts on the surgical patient.
Increases risk of SSI
Increases risk of myocardial events
Impairs coagulation cascade
Next
Can cause post-op shivering
Can alter drug metabolism
Patient discomfort
Info
Fischer, L. (2025). Guideline for Patient Temperature Management. AORN Journal, 121(2), P4–P6. https://doi.org/10.1002/aorn.14288
Passive Warming
Passive warming measures can help insulate and prevent further heat loss, but do not warm the patient.
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Active Warming
Active warming involves application of heat to the patient.
These measures are preferred and more effective than passive methods. .
Info
Info
Info
Info
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Inadvertent Perioperative Hypothermia Prevention
- Perioperative nurses should prioritize maintaining patient normothermia, through all phases of periop.
- Patient assessment should start in pre-op with a baseline temperature.
- Temperature should continue to be monitored through the perioperative trip
- Temperatures out of normal parameters should be communicated and addressed.
- Active warming methods should be initiated on patients preoperatively to maintain normothermia and prevent heat loss
- Passive methods can be used along with active methods, but are not as effective on their own.
- Active warming measures should continue through periop until patient is normothermic and maintains their body temperature.
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Post Quiz
Next
Thank you for COmpleting the Course
IV Fluid Warmers
IV fluids and blood products can be warmed while being administered to the patient. While they cannot be heated above normal body temperature, they can be brought to normal core body temperature to prevent ambient temperature fluids from decreasing core temperature. Blood products that are administered cold can drop core body temperature by 0.25°C for every unit given.
How can post-op shivering be harmful?
- Shivering uses a lot of energy, and when patients shiver post-operatively their oxygen demands can increase by 300% - 400%.
- This can strain patients who are already at risk, like the elderly or those with heart or lung comorbidities.
- Some medications and pain can cause shivering in the recovery period, but hypothermia is most commonly the cause.
- Shivering can be treated with medications to help preserve patient energy.
Lopez MB. Postanaesthetic shivering - from pathophysiology to prevention. Rom J Anaesth Intensive Care. 2018 Apr;25(1):73-81. doi: 10.21454/rjaic.7518.251.xum. PMID: 29756066; PMCID: PMC5931188.
Shivering
While common, postoperative shivering can increase oxygen demand on patients by 135% - 468%. This can place unnecessary strain on a patient in recovery. Medications can be given to manage the shivering, but it is best if it can be prevented.
Ambient Room Temperature
Operating rooms are notorious for being cold. Some patients will need to have much of their body exposed and uncovered for the surgical procedure, so when we cannot apply forced air blankets or other active/passive warming measures, increasing room temperature can help warm the patient.
Forced Air Warmers
Forced air warmers are commonly used in surgery, and work by blowing warmed air through special blankets with air channels. These blankets come in multiple sizes and shapes to allow for surgical exposure. These blankets can be applied in pre-op and travel with the patient through their perioperative journey. They also come in gowns.
Irrigation Fluid Warmers
Fluid warmers are used to warm irrigation fluids that will be flushed into the patient's body.
Using cold or ambient fluids as surgical irrigations can quickly decrease core temperature, so fluid warmers help combat that.
Preventing Hypothermia in the Perioperative Setting
Lydia Esham
Created on February 27, 2026
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Transcript
Preventing Hypothermia in the Perioperative Setting
This course will cover the importance of maintaining normothermia and how the nurse plays a role in preventing hypothermia in the perioperative setting.
Start
Learning Objectives
By the end of this learning module, learner will be able to:
identify and implement different interventions to prevent perioperative hypothermia.
list at least 3 adverse effects of perioperative hypothermia.
define perioperative hypothermia.
recognize patient populations who are at a greater risk for periop hypothermia.
identify different mechanisms of heat loss in the perioperative setting.
differentiate between active and passive warming measures.
Next
Hypothermia Overview
All patients having surgery are at risk for developing inadvertent hypothermia.
Perioperative hypothermia is defined as a core body temperature below 36°C (<96.8°F).
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Patients in the following catgeories are at a higher risk for experiencing perioperative hypothermia:
Hypothermia Overview
Patients of older age
Patients with a higher ASA Classification
Patients with a lower body weight or BMI
Patients with a low pre-operative core body temperature
Patients undergoing major surgery
Patients under general anesthesia for a prolonged time
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Why does hypothermia commonly occur in the perioperative setting?
Methods of Heat Loss
Convection
Convection
Evaporation
Heat transfer caused by evaporation of liquid from skin. Accounts for 8-10% of heat loss in surgical patients.
Heat transfer caused by air circulation or drafts. Accounts for 30% of heat loss in surgical patients.
Conduction
Radiation
Heat transfer from hot to colder space. Accounts for 40% of heat loss.
Heat transfer caused by contact with another object
Next
Guruswamy, J., & Omosule, A. J. (2021). 13 - Temperature Monitoring. In Anesthesia Equipment (Third Edition, pp. 287–303). Elsevier Inc. https://doi.org/10.1016/B978-0-323-67279-5.00013-3
Knowledge Check
Next
Knowledge Check
Next
Anesthesia and Thermoregulation
Anesthesia increases the natural thermoregulatory response range by 20 times, meaning there is delayed response in these natural correction methods.
Next
Saad H, Aladawy M. Temperature management in cardiac surgery. Glob Cardiol Sci Pract. 2013 Nov 1;2013(1):44-62. doi: 10.5339/gcsp.2013.7. PMID: 24689001; PMCID: PMC3963732.
What's the risk?
Inadvertent hypothermia can have negative impacts on the surgical patient.
Increases risk of SSI
Increases risk of myocardial events
Impairs coagulation cascade
Next
Can cause post-op shivering
Can alter drug metabolism
Patient discomfort
Info
Fischer, L. (2025). Guideline for Patient Temperature Management. AORN Journal, 121(2), P4–P6. https://doi.org/10.1002/aorn.14288
Passive Warming
Passive warming measures can help insulate and prevent further heat loss, but do not warm the patient.
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Active Warming
Active warming involves application of heat to the patient.
These measures are preferred and more effective than passive methods. .
Info
Info
Info
Info
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Inadvertent Perioperative Hypothermia Prevention
Next
Guideline Quick View: Patient Temperature Management. (2025). AORN Journal, 121(4), 312–315. https://doi.org/10.1002/aorn.14340
Post Quiz
Next
Thank you for COmpleting the Course
IV Fluid Warmers
IV fluids and blood products can be warmed while being administered to the patient. While they cannot be heated above normal body temperature, they can be brought to normal core body temperature to prevent ambient temperature fluids from decreasing core temperature. Blood products that are administered cold can drop core body temperature by 0.25°C for every unit given.
How can post-op shivering be harmful?
Lopez MB. Postanaesthetic shivering - from pathophysiology to prevention. Rom J Anaesth Intensive Care. 2018 Apr;25(1):73-81. doi: 10.21454/rjaic.7518.251.xum. PMID: 29756066; PMCID: PMC5931188.
Shivering
While common, postoperative shivering can increase oxygen demand on patients by 135% - 468%. This can place unnecessary strain on a patient in recovery. Medications can be given to manage the shivering, but it is best if it can be prevented.
Ambient Room Temperature
Operating rooms are notorious for being cold. Some patients will need to have much of their body exposed and uncovered for the surgical procedure, so when we cannot apply forced air blankets or other active/passive warming measures, increasing room temperature can help warm the patient.
Forced Air Warmers
Forced air warmers are commonly used in surgery, and work by blowing warmed air through special blankets with air channels. These blankets come in multiple sizes and shapes to allow for surgical exposure. These blankets can be applied in pre-op and travel with the patient through their perioperative journey. They also come in gowns.
Irrigation Fluid Warmers
Fluid warmers are used to warm irrigation fluids that will be flushed into the patient's body. Using cold or ambient fluids as surgical irrigations can quickly decrease core temperature, so fluid warmers help combat that.