Tuesday, October 30, 2012

Using a Cooling Blanket

Goal: The patient maintains the desired body temperature.

1. Review the medical order for the application of the hypothermia blanket. Obtain consent for the therapy per facility policy.

2. Gather the necessary supplies and bring to the bedside stand or overbed table.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient. Determine if the patient has had any previous adverse reaction to hypothermia therapy.

5. Close curtains around 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.

6. Check that the water in the electronic unit is at the appropriate level. Fill the unit two thirds full with distilled water, or to the fill mark, if necessary. Check the temperature setting on the unit to ensure it is within the safe range.

7. Assess the patient’s vital signs, neurologic status, peripheral circulation, and skin integrity.

8. Adjust bed to comfortable working height, usually elbow height of the care giver (VISN 8 Patient Safety Center, 2009).

9. Make sure the patient’s gown has cloth ties, not snaps or pins.

10. Apply lanolin or a mixture of lanolin and cold cream to the patient’s skin where it will be in contact with the blanket.

11. Turn on the blanket and make sure the cooling light is on. Verify that the temperature limits are set within the desired safety range.

12. Cover the hypothermia blanket with a thin sheet or bath blanket.

13. Position the blanket under the patient so that the top edge of the pad is aligned with the patient’s neck.

14. Put on gloves. Lubricate the rectal probe and insert it into the patient’s rectum unless contraindicated. Or tuck the skin probe deep into the patient’s axilla and tape it in place. For patients who are comatose or anesthetized, use an esophageal probe. Remove gloves. Attach the probe to the control panel for the blanket.

15. Wrap the patient’s hands and feet in gauze if ordered, or if the patient desires. For male patients, elevate the scrotum off the cooling blanket with towels.

16. Place the patient in a comfortable position. Lower the bed. Dispose of any other supplies appropriately.

17. Recheck the thermometer and settings on the control panel.

18. Remove any additional PPE, if used. Perform hand hygiene.

19. Turn and position the patient regularly (every 30 minutes to 1 hour). Keep linens free from condensation. Reapply cream, as needed. Observe the patient’s skin for change in color, changes in lips and nail beds, edema, pain, and sensory impairment.

20. Monitor vital signs and perform a neurologic assessment, per facility policy, usually every 15 minutes, until the body temperature is stable. In addition, monitor the patient’s fluid and electrolyte status.

21. Observe for signs of shivering, including verbalized sensations, facial muscle twitching, hyperventilation, or twitching of extremities.

22. Assess the patient’s level of comfort.

23. Turn off blanket according to facility policy, usually when the patient’s body temperature reaches 1 degree above the desired temperature. Continue to monitor the patient’s temperature until it stabilizes.

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