Letters to the Clinical Editor

Dear Dr. Kern, I just came across a great article about unintentional hypothermia as it relates to the OR environment. It seems to me this article should apply to the cath lab environment as well. The article, “Unintentional hypothermia: Using evidence to keep your patient warm,” by Burns et al, states that hypothermia puts the patient at risk for MI, dysrrhythmias, coagulopathies and infection. Patient comfort was not mentioned! The Surgical Care Improvement Project (SCIP) measure 10 requires that all patients under anesthesia or regional for >1 hour maintain normothermia. Most of our cath cases are short; however, our EP cases are much longer and some interventions also exceed 1 hour. Our lab now has the x-ray generator, which produces the heat, in a separate, ventilated, cool room, making the notion to keep the procedure room cool absolute. However, due to staff/MD comfort, rooms remain very cool. We do have a blanket warmer, but not all staff is in tune with utilizing it. Should we in the cath lab area provide warming tools for those cases >1 hour for at least patient comfort and/or the above-mentioned risk factors? Thank you, Martine De Vriendt RN, CCT, RCIS, Clinical Educator Cardiac Catheterization Laboratory Clarian Health Partners Indianapolis, Indiana Email mdevrien@clarian.org

References

1. Burns S, Zoltan L. Unintentional hypothermia: Using evidence to keep your patient warm. OR Nurse 2011 Jan; 5(1):12-15. doi: 10.1097/ 01.ORN.0000390910.27625.8f

Dear Ms. DeVriendt, Thank you for your letter. I was unfamiliar with this issue in the cath lab since, as you stated, most of our procedures are short and the patients are under conscious sedation. I am not sure the same holds for the EP lab cases, where patients may be under general anesthesia for several hours. There is no reason to think this does not apply to these patients, but since they are under the care of anesthesia, these care providers should be monitoring body temperature and treat them accordingly. As to the issue of warm blankets in the cath lab, these are a great idea for patient comfort for all both before and after the procedure. Sincerely, Morton J. Kern, MD