Cooling blanket placement

[javajunkie]

I am reviewing the policy regarding cooling blankets at my hospital and I am unable to find an article about the proper placement of cooling blankets. Usually, I see that they are placed posteriorly, which provides more surface area, but wouldn't you think that anterior placement makes more sense? Cool air 'sinks' and anterior placement is better for skin integrity.

So, I will take a poll. What is the usual placement in your facility?

[gwenith, BSN, RN]

Okay - here I go - I worked in areas that do both some units will only place the balnket under the patient other only on top. - Just a personal experience - it is more effective under the patient for although it is true that cold air sinks it does not seem to work as well. Perhaps when it is under the patient it is closer to major vessles - I don't know. I will be watching this poll.

[Magic99]

We orginally placed the blankets under the patient and I still think they worked a little better that way, however, we made the change to placing the blanket on top to protect the patient from skin breakdown. When you have a patient laying on the blanket and the reponse of you blood vessels to cold is to clamp down, you are taking blood flow away from tissue that is under a great deal of pressure laying in the bed, placing the patient at great risk for bed sores.

[renerian, BSN, RN]

WE did posterior. I cannot get to the poll though for some reason it is not giving me an option to vote?

renerian

[rileygrl11, BSN, RN]

We place them posteriorly. Then put ice packs under the arms, groin , etc.

[Carol T.]

In our facility, we place them posterior. This is where I have a few questions. We also turn them on and off instead of leaving them to work. My understanding is that they will help to regulate the core temp. According to an article on Cardiosource at

http://www.cardiosource.com/library/journals/journal/article/fulltext?acronym=AJM&uid=PIIS0002934399000686&kwhighligh=Cooling%20Blanket ,

"We conclude that active cooling should be avoided in unsedated patients with moderate fever, because it does not reduce core temperature but does increase metabolic rate, activate the autonomic nervous system, and provoke thermal discomfort."

I can see where this is true. Today, a patient had a rectal Temp of 101.8. I turned the cooling blanket back on and it immediatly went to 40 degrees F. That would be like lying on Ice water. This poor lady feels bad enough without us torturing her! (How long can you leave the ice pack on your twisted ankle?)

I would think that Anterior, if at all, would be better, for the simple fact- even a weak, dying patient can at least wiggle out from under it.

[NurseStyles]

We do not use cooling blankets on our floor. I have never used one.

[Tweety, BSN, RN]

Cooling blankets are overrated and I'm sure they are uncomfortable. I use them posteriorly only for uncontrolled very high fevers. I let moderate fevers run their course.

If I'm in charge and a cooling blanket is in use, I check the temp. of the patient. Some nurses I've noticed are notorious for leaving them on until the person gets to be 98.6. I usually turn them off around 101 range.

[Carol T.]

I started reading more about the model we use, and I found other settings. So, with the blanket posterior, I set the blanket temp to 90 degrees F. It helped to keep her temp from going up, and actually brought her down into the 99's. After a day of that, I set the blanket temp to maintain a 99 degree temp in the patient. The blanket temp never went below 70 degrees F. To me, this has got to be more comfortable than 40 degrees F., Anytime! Today, her temp stayed between 98.7 and 99.0 rectally. To me, that is what should be going on. I also think she was much more comfortable, and, her body was allowed to try to regulate on it's own. I would have liked to have just used Tylenol... but orders read... greater than 101.4....

Now, if we can just keep her K+ up and her Na+ down!