Thermoregulation protocol implementation for newborns in surgical procedures

An experimental report, conducted at a neonatal unit in Salvador, Bahia, from January 2016 to January 2017. The Plan, Do, Check, Action cycle guided the construction, implementation and applicability of the protocol.

RESULTS

Implementation of the protocol that allowed the reduction of adverse events due to thermal instability during surgical procedures and introduction of new technologies.

CONCLUSION

The protocol could improve and strengthen the care practices related to safe surgery in newborns.

Keywords:
Patient safety. Infant; newborn. Body temperature regulation. Nursing.

Actions	Recommendations / Routines
To ensure environment temperature of the NICU or operating room between 23-26 ºC.	To control temperature with an ambient thermometer in the morning, afternoon and evening, and check it one hour before the procedure.
To keep the NB with temperature sensor attached to the skin for monitoring.	Before the surgical procedure, to keep sensor adhered to the skin in the right hypochondrium region and monitor thermal curve.
To keep the NB engaged in previously heated culls when removing him from the incubator or heated crib for transport.	To transport in previously heated incubator with temperature between 30-36 ºC and later adjusted according to the need of the NB.
To initiate surgical procedure only when the NB has normothermic state.	To check temperature before the surgical procedure, guaranteeing normothermia (temperature of 36.5 - 37.4 ºC).
To insert esophageal thermometer before surgical procedure for temperature monitoring.	To monitor thermal curve every 30 minutes until the end of surgery.
To use thermal blanket during large surgical procedures.	To monitor thermal blanket temperature according to the NB needs.
To administer solutions and blood products at a suitable temperature of 36.5 ºC to 37 ºC.	To check temperature of solutions and blood products with infrared thermometer.
To monitor the temperature of the NB in the NICU after the postoperative return, with a digital thermometer.	- To continue with multi-parameter monitoring at 01-hour intervals in the first 06 postoperative hours; - Every 02 hours in the first 12 hours postoperatively; - Every 03 hours after the first 12 hours after surgery.
To monitor NB temperature at 15-minute intervals in situations where the condition presents hyper or hypothermia.	- In episodes of hypothermia, to adjust incubator parameter or heated crib, increasing 0.5 ºC every 60 minutes. - In episodes of hyperthermia, to adjust parameter of incubator or heated crib, reducing 0.5 ºC every 60 minutes and assess the needs of administering antipyretics.

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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