heating during op

Re: heating during op

Siobhan Steven — Mon, 14 Feb 2011 10:34:07 GMT

Just read what I wrote re catching on fire due to too much alcohol, I meant when diathermy is used in the Sx, (also if a diffibrilator is used...hard to explain to the owners.)

Re: heating during op

Vicky RVN — Mon, 14 Feb 2011 08:05:39 GMT

I also use drip bags with food colouring in after seeing it as a top tip on here! When we get locum vets in they wonder what on earth are in the bright green drip bags lol!

Re: heating during op

Siobhan Steven — Sun, 13 Feb 2011 22:41:39 GMT

I get the nurses to check the temp of our 'hotties' (warmed fluid bags that we dye with Diff Quick stain and flurostain to make pretty colours), if they are over 40 degrees Celcius they are too hot and they should still be wrapped in a light hand towel. The diathermy plate we use is a metal one which we wrap in a abdo/ lap sponge dampened with NaCl (better conductivity than LRS, we have adhesive single use ones but the patient has to be clipped for it = more heat loss and they supposedly can only be used once. Also, be careful to not overdose on the alcohol...prep that is, tales of patients catching on fire are a bit scary!! We have heated Sx tables and Bair Huggers with disposble blankets as well. I was told 60% of the total heat loss a patient will experience happens between premed and Sx commencing, don't know how true it is.

Re: heating during op

Phrin Vernon RVN — Sun, 13 Feb 2011 22:11:22 GMT

[quote user="Bronwyn Hayward"]

You can use regular 1L fluid bags as hot water bottles - we dye them using food dye so there's no chance they get mistaken for IV fluids, and for safety we make fleece covers for them. You heat them in the microwave - they're soft and pliable and can easily be slid in alongside the patient's thorax or under their inguinal folds/axillae. I think running the IV line through a hot water bath helps too - put it as close as possible to the patient and refresh the water regularly. And yes, BAIR huggers are the bomb!

[/quote]

We do that with fluid bags too! Got the idea off a 'top tip' on here, and it is a great way to try and keep the patient warm. For very small or skinny patients (ie thyroidectomy cat!), we use the fluid bags to make a cradle, and the cover with towels, bubble wrap and incontinence sheets to stop local overheating.

I also use bubble wrap and space blankets for extremities - usually legs, but we had a chinchilla in the other week and he got space blanket ear covers!!

I agree that warming the IV line as close as poss to the patient is a good idea too, although take care not to overwarm the fluids going IV. I tend to aim for bood temp - ie they don't feel either hot nor cold to me when I touch the giving set. I have seen some people just place a warmer over the IV fluid bag, which IMO is futile, as by the time the fluid has travelled down the giving set, any warmth will have been lost to the atmosphere.

Oh, and I would LOVE a bair hugger!!

Re: heating during op

Bronwyn Hayward — Sun, 13 Feb 2011 22:01:02 GMT

Re: heating during op

Kerry Brennand DipAVN (Surgical) RVN A1 MBVNA — Sun, 13 Feb 2011 21:01:15 GMT

Generally I dont think pre and post op temps are taken often enough.....where i am working at the moment they cover all the op tables with two layers of bubble wrap with a heat pad under the first layer.......bair huggers are used as required......in kennels use the 5L plastic bottles that had hibiscrub in.....filled with hot water....good at keeping the kennel walls warm...... blankets placed on top of patient pre warm in the tumble dryer.

Re: heating during op

Susan Jackson — Sun, 13 Feb 2011 18:41:11 GMT

[quote user="Sarah Southworth RVN"]

Could also try bubble wrap around the toes, and im sure you already do it. but have the theatre nice and warm. Or you can get those blankets, the ones that look like tin foil. We normally cut one up into different sizes and wrap them up.

[/quote]

I've done the bubble wrap and when you take them off they are usually warm and sweaty so think they do help with some heat loss. Just cover and blanket what you can.

Would love a bear hugger but again we don't have the money to spend.

Re: heating during op

chris beasley — Sat, 12 Feb 2011 17:52:52 GMT

Thank you nick!!

Re: heating during op

Laura Ringsell — Sat, 12 Feb 2011 07:13:00 GMT

Nick - you rock!!!!

Re: heating during op

Nick Shackleton — Fri, 11 Feb 2011 07:11:16 GMT

I have a Pdf if anyone is interested. It's aimed at human nurses but the principals remain the same

Re: heating during op

Juliet Drummond DAVN (med) RVN D32/33 — Fri, 11 Feb 2011 01:08:55 GMT

plat= plate - grr doh

Re: heating during op

Juliet Drummond DAVN (med) RVN D32/33 — Fri, 11 Feb 2011 01:08:20 GMT

as ever- nick is correct on this, if you do use monopolar diathermy, please ensure the plat is directly below the area the diathermy is used on.

Re: heating during op

Nick Shackleton — Thu, 10 Feb 2011 22:49:30 GMT

Mono polar diathermy: the hand piece only has one pole (see pic) The current is earthed through the patient and into the plate. I would like to point out now you must have direct contact with patient to earth plate. if not then current will arc from patient to plate and cause a burn

Bi-polar diathermy: Two poles usually in the form of forceps. the current only passes between the tips and therefore does not get earthed through the patient therefore the plate is not required.

Generally with bipolar only coagulation can be performed but with monopolar you can use both cut and coagulation function.

^^^^^^ Bi-polar diathermy hand piece ^^^^

^^^^^ Mono Polar Diathermy with cut and coagulation buttons ^^^^^^^^

Re: heating during op

chris beasley — Thu, 10 Feb 2011 22:22:21 GMT

please explain re diathermy. I thought you have to use it in both modes. Sure the directions which came with it said that?

Re: heating during op

Juliet Drummond DAVN (med) RVN D32/33 — Thu, 10 Feb 2011 22:15:56 GMT

[quote user="sazzle RVN"]

I love bair huggers!

also, i didnt think you needed an earth plate for bi polar diathermy, only mono polar

[/quote]

bair hugger's rock

you are completly correct re the diathermy.

Re: heating during op

bongo — Thu, 10 Feb 2011 22:12:10 GMT

I love bair huggers!

also, i didnt think you needed an earth plate for bi polar diathermy, only mono polar

Re: heating during op

Juliet Drummond DAVN (med) RVN D32/33 — Thu, 10 Feb 2011 22:07:21 GMT

we never use cradels for op's, only electric heat pads, ties and sandbags to support them in dorsal recumbancy.

in the past i have found the buster op pads great for both positioning and for head preservation, as they are filled with polystyrene balls.

just a thought

Re: heating during op

chris beasley — Thu, 10 Feb 2011 22:00:36 GMT

Thanks for that Emma - I must admit while we were trying out hot hands under the cradle and ascess the heat with our own hands, I was a little worried about how they would be with an animal on the plastic for a long time.

Re: heating during op

Emma Purnell — Thu, 10 Feb 2011 17:38:27 GMT

Always be super careful with any incidence of direct heat when trying to warm patients during the op. Not longer after I started in practice we have a dog suffer a horrible burn post op from a heat pad, the skin began to slough 2 days later and it took almost 2 years to fully heal the wound after referral.

Obviously heating them is so so important and I am always working on ways to improve it but just a little re-warning to all

Re: heating during op

Nicola Smith — Thu, 10 Feb 2011 16:30:15 GMT

You can get 2nd hand bair huggers reasonable from some of the 2nd hand medical equipment places - and can get washable blankets for them too - we love ours and loads less probs with cold patients after. We got the unit for about £300 which is loads cheaper tha new!!

Re: heating during op

Sally Howe — Thu, 10 Feb 2011 16:11:09 GMT

I also warm up a towel/vet bed for in the cradle and another for back in the kennel in addition to hot hands/ bubble wrap (stopping the temptation of popping them) etc. We don't have a bear hugger... wish we did. I keep theatre toasty warm too.

Re: heating during op

chris beasley — Thu, 10 Feb 2011 15:04:49 GMT

Thanks for your inputs. I do use hot hands but this cat was too small once in cradle. Have been experimenting with hot hands underneath cradle today. It does get very hot but with practice we could get it right.

Re: heating during op

Sarah Southworth RVN CertVNECC — Thu, 10 Feb 2011 12:52:30 GMT

Re: heating during op

Kim Buckley — Thu, 10 Feb 2011 09:49:58 GMT

It's important to keep them warm pre op and post premed so wrap them up if possible in their kennel and provide some sort of warmth such as heat pads. My friend did her dissertation on heat loss and this is what she found.

Re: heating during op

Royalsuper_fairy — Thu, 10 Feb 2011 09:28:36 GMT

I bandage up limbs and if possible I line the cradle as suggested. Some thing I also do is to use hot hands at the bottom of the cradle or instead of the cradle.