ta cs jed v3

Preventing inadvertent perioperative hypothermia in elective

arthroscopic shoulder surgery: A protocol for a randomised

controlled trial

By Renatta DiStaso and Kerry-Anne Cobbe

Research Team Nicole Draper (NUM)

Professor Kim Walker (NRI)

Kerry-Anne Cobbe (CNS)

Renatta Di Staso (CNS)

Jed Duff (Research Fellow)

Professor Sandy Middleton (NRI)

Dr. Simon Tan (Orthopaedic

surgeon)

Dr. Emma Halliday (Anaesthetist)

Associate Professor Lawrence

Lam (Statistician)

Todd Allen (Research Assistant)

DSU Staff

Session Overview Background

Inadvertent perioperative hypothermia

Literature review

Time line: research process

Temperature and Comfort Study (TaCS): protocol

Ethical Issues

Stumbling blocks

Context St Vincent’s Private is a 25o bed acute care private hospital catering for

all major specialities excluding maternal and paediatric care

Day Surgery

5 operating theatres

1 lithotripsy suite

2 treatment rooms

Approximately 10,000 cases with 1/3 planned overnight stay

Background Research all starts with an idea...How can nurses better

care for patients to see better outcomes and improve

recovery time.

As clinicians the easiest way to become involved in research

in your own practice is to answer your own clinical

problems.

Literature Review Perioperative hypothermia is core temperature below 36°C

Contributing factors:

Reduced metabolic heat production due to anaesthetic

Cold perioperative environment

Impaired thermoregulation.

Linked to poorer postoperative outcomes, extended recovery stay &

increased resource use.

Literature review Literature says that active and passive measures for

preventing perioperative hypothermia are as follows:

Warm blankets

Forced air warming gowns and blankets

Space blankets

Warm irrigation fluids

Time line July 2009: Initial Idea

July- October 2009: Development of idea, study proposal

October 2009: Application for Research Grant

January 2010: Nursing Research grant approved

March 2010: Ethics Approval Application

May 2010 Feasibility study : Forced Air Warming Study (FAWS)

Time line....July 2010:

Ethics Approval

Commenced staff education

Australian and New Zealand Clinical Trials Register

September 3rd 2010: 1st patient recruited

January 31st 2011: 40 patients

Purpose The effects of pre-warming and/or warmed irrigation fluids on

elective arthroscopic shoulder surgery patients’

Temperature

Thermal comfort

Total recovery time

Study Design Randomised 2x2 factorial

design

Study groups: 4

Participants: 12o

Duration: 12-16 months

Preoperative warming

No preoperative

warming

Warmed irrigation

fluidsT1 T2

No warmed irrigation

fluidsT3 T4

Participant SelectionInclusion Criteria Exclusion Criteria

Elective arthroscopic

shoulder surgery

>/=18years

ASA grade 1-111

Willing & able to give consent

BMI <18.5 or >40

Preop temperature >37.5

Unable to speak or

understand English

Randomisation in Clinical Trials Randomisation is the process of assigning

clinical trail participants to treatment

groups.

Allocation is carried out using a chance

mechanism so that neither the

participant nor the investigator will know

in advance which will be assigned.

Ethical Issues

Consent

Blinding and un-blinding

Data collection and storage

Stumbling Blocks

Research: terminology, literature review, critiquing

Computer skills: excel, designing data collection forms,

statistics

Time

Thank youWe would like to acknowledge:

St Vincent’s & Mater Health Sydney Research Grants (2010-2011)

SV&MHS Nursing Research Institute (NRI)

NUM – Nicole Draper

Professor Kim Walker, Professor Sandy Middleton and Research

Fellow Jed Duff for their ongoing support and encouragement.