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- Assess the patient's condition, and explain the procedure to him. Provide privacy, and make sure the room is warm and free of drafts. Check facility policy and, if necessary, make sure the patient or a responsible family member has signed a consent form.
- Wash your hands thoroughly. If the patient isn't already wearing a patient gown, ask him to put one on. Use a gown with cloth ties rather than metal snaps or pins to prevent heat or cold injury.
- Take the patient's temperature, pulse, respirations, and blood pressure to serve as a baseline, and assess his level of consciousness, pupil reaction, limb strength, and skin condition.
- Keeping the bottom sheet in place and the patient recumbent, roll the patient to one side and slide the rolled blanket halfway underneath him, so that its top edge aligns with his neck. Then roll the patient back, and pull and flatten the blanket across the bed. Place a pillow under the patient's head. Make sure his head doesn't lie directly on the blanket because the blanket's rigid surface may be uncomfortable and the heat or cold may lead to tissue breakdown. Use a sheet or bath blanket as insulation between the patient and the blanket.
- Apply lanolin or a mixture of lanolin and cold cream to the patient's skin where it touches the blanket to help protect the skin from heat or cold sensation.
- In automatic operation, insert the thermistor probe in the patient's rectum and tape it in place to prevent accidental dislodgment. If rectal insertion is contraindicated, tuck a skin probe deep into the axilla, and secure it with tape. If the patient is comatose or anesthetized, insert an esophageal probe. Plug the other end of the probe into the correct jack on the unit's control panel.
- Place a sheet or, if ordered, the second hyperthermia-hypothermia blanket over the patient. This increases the thermal benefit by trapping cooled or heated air.
- Wrap the patient's hands and feet if he wishes to minimize chilling and promote comfort. Monitor vital signs and perform a neurologic assessment every 5 minutes until the desired body temperature is reached and then every 15 minutes until temperature is stable or as ordered.
- Check fluid intake and output hourly or as ordered. Observe the patient regularly for color changes in skin, lips, and nail beds and for edema, induration, inflammation, pain, and sensory impairment. If they occur, discontinue the procedure and notify the physician.
- Reposition the patient every 30 minutes to 1 hour, unless contraindicated, to prevent skin breakdown. Keep the patient's skin, bedclothes, and blanket cover free of perspiration and condensation, and reapply cream to exposed body parts as needed.
- After turning off the machine, follow the manufacturer's directions. Some units must remain plugged in for at least 30 minutes to allow the condenser fan to remove water vapor
from the mechanism. Continue to monitor the patient's temperature until it stabilizes because body temperature can fall as much as 5Â° F (2.8Â° C) after this procedure.
- Remove all equipment from the bed. Dry the patient and make him comfortable. Supply a fresh patient gown, if necessary. Cover him lightly.
- Continue to perform neurologic checks and monitor vital signs, fluid intake and output, and general condition every 30 minutes for 2 hours and then hourly or as ordered.
- Return the equipment to the central supply department for cleaning, servicing, and storage.
- If the patient shivers excessively during hypothermia treatment, discontinue the procedure and notify the physician immediately. By increasing metabolism, shivering elevates body temperature.
- Avoid lowering the temperature more than 1 degree every 15 minutes to prevent premature ventricular contractions.
- Don't use pins to secure catheters, tubes, or blanket covers because an accidental puncture can result in fluid leakage and burns.
- With hyperthermia or hypothermia therapy, the patient may experience a secondary defense reaction (vasoconstriction or vasodilation, respectively) that causes body temperature to rebound and thus defeat the treatment's purpose.
- If the patient requires isolation, place the blanket, blanket cover, and probe in a plastic bag clearly marked with the type of isolation so that the central supply department can give it special handling. If the blanket is disposable, discard it, using appropriate precautions.
- To avoid bacterial growth in the reservoir or blankets, always use sterile distilled water and change it monthly. Check to see if facility policy calls for adding a bacteriostatic agent to the water. Avoid using deionized water because it may corrode the system.
- To gradually increase body temperature, especially in postoperative patients, the physician may order a disposable warming system. (See Using a warming system.)