Cooling Blankets

No set protocol at my hospital. Doctor's order not needed either. Nursing judgment. We have found that placing the blanket UNDER the patient is more effective, but if unable to turn patient at that specific moment, we will place on top temporariliy. We use the manual mode and adjust according to patient tolerance and response.

Linda

I was wondering if you guys could give me input on the use of cooling blankets in your ICUs. Our clinical practice committe has been trying to come up with standard guidelines and I have had tough time finding literature of the uses of colling blankets. What I wonder is do you place the blanket on the patient anterior or postior? Also do you use the automatic mode or manual mode and if the manual mode is used what tempature do you set the machine to cool at? Any input will be appreciated.

Thanks,

Karen

We also try to put the blanket under the patient but with a sheet between the blanket and the patient. Ours has a thermometer probe that can be used for manual or automatic use. We usually use the automatic and set the temperature around 99F if the doctor didn't specify. I've never really checked a protocol for this. Not sure if we do have one.

We usually put the blanket under the patient with a sheet in between the patient and cooling blanket. We also put mineral oil on the back of the patient where the skin will come into contact with the blanket. I was told this helps to minimize burns (freezer burns?). We usually set the temperature as tolerated, but many times we set it pretty cold as we usually only use the blankets when temperatures are dangerously high. I once had a patient who's temperature was over 106 degrees farenheight.

We do the same as Moonpie...cooling blanket on the bed under a sheet...with q1 hour mineral oil on body surface closest to the blanket

Coming from a slightly different angle, we use cooling blankets for our patients on the hypothermia protocol (cardiac arrest with reperfusion, but remains comatose). We use a cooling blanket underneath the patient covered with a sheet and also apply cooling vests that pretty much cover the entire trunk. If we don't cool to target temp fast enough, we'll add ice packs and do gastric lavage with slush. We also place Foley caths with temp capabilities as this gives us an accurate body temp. I know this is kinda trends away from the original posts but thought I'd share anyway.

B.

Our cooling blanket protocol was for anyone over 104F. Most of the time these people had a swan ganz to get a temp from or a temp sensing foley. When their temp reached 104 we paralyzed them (dr's order needed), put the blanket under them with a sheet between them and the blanket and turned the blanket to a temp to drop the patients temp slowly. Hope it helps.

Our hypothermia protocol uses the "Artic Sun" cooling machine: vest for pt. and also wraps on both legs, cools automatically the first 24 hours and then rewarms patient,and we use a foley with temp. capabilities, but this is reserved only for Cardiac Arrests, comatose patients: like BlakeS stated above.

For Neuro trauma patients with high fever: (40C area) we do not have a written protocol, but with doc permission we expose pt. (loin cloth used for privates) get a box fan to blow across the patient and "spritz" the pt. like a plant.......I tell you the first time I did this I felt like I was working in a greenhouse!.....the water is such a "fine mist" that the pt. doesn't shiver (preventing a rise in their temp) But you have to keep "up the spritz" it is very labor intensive to continually keep the pt. moist, but if the pt. is a one-to-one you can do it. It can work!

We used to use the big old cooling blanket under the pt. but ....one bad experience, ruined that and we can only use it over the pt. which is not very effective, better luck with ice packs on groins and axillary area. Hope this info. helps!

Our hypothermia protocol uses the "Artic Sun" cooling machine: vest for pt. and also wraps on both legs, cools automatically the first 24 hours and then rewarms patient,and we use a foley with temp. capabilities, but this is reserved only for Cardiac Arrests, comatose patients: like BlakeS stated above.

For Neuro trauma patients with high fever: (40C area) we do not have a written protocol, but with doc permission we expose pt. (loin cloth used for privates) get a box fan to blow across the patient and "spritz" the pt. like a plant.......I tell you the first time I did this I felt like I was working in a greenhouse!.....the water is such a "fine mist" that the pt. doesn't shiver (preventing a rise in their temp) But you have to keep "up the spritz" it is very labor intensive to continually keep the pt. moist, but if the pt. is a one-to-one you can do it. It can work!

We used to use the big old cooling blanket under the pt. but ....one bad experience, ruined that and we can only use it over the pt. which is not very effective, better luck with ice packs on groins and axillary area. Hope this info. helps!

What was the bad experience that ended the use of the cooling blanket at your facility? I'm asking because I'd like to prevent it from happening at ours. Thanks for sharing.

We use an very large cooling blanket machine that is older than I am, but it still gets the job done. It connects to a rectal temp probe. Our policy is to always use auto mode (never manual) & set the temp 2-3 degrees below core temp, & adjust as it comes down to avoid thermal injury. We put the blanket under the pt w/ a sheet between. I'll pass on the mineral oil idea. Thanks.

ive seen nurses who puts it under the patient as oppose to on top, i dont really know what the exact rationale of it at least from my standpoint, working in a unit where u can break ur back from turning patient's by urself i think it's just as easy to cool a patient off when it's on top, but i use auto mode i mean i set it at a temp, some of those cooling blankets can get pretty ice cold if u use manual and u just set it to cool, u dont wanna run the chance of arterial clamping of the lower extremities cuz it happens sometimes, id rather cool someone slowly rather than see blue feet and have to wrap a ton blanket to rewarm

No set protocol at my hospital. Doctor's order not needed either. Nursing judgment. We have found that placing the blanket UNDER the patient is more effective, but if unable to turn patient at that specific moment, we will place on top temporariliy. We use the manual mode and adjust according to patient tolerance and response.

Linda

no set protocol for me either. we use our own judgement. we usually pu the blanket posterior w/ sheet between pt amd bed. the other day my pt's temp was 104.5 and we put one on bottom and on top and packed him in ice.

Hey guys. I'm a new comer here on allnurses.com. So, I had a patient once with a temp of 106. I place a cooling blanket. His temp decreased to 103 by day shift. During report the day shift nurse felt it was not a good idea to cool a patient with a blanket. The logic that she gave me was that our Infectious Disease Docs do not like them because the cold acutally shunts the blood to the core thereby actually increasing the temp to the core and upping the chances of brain damage. Side note: the patient did not have an Infectious Disease consult yet, so I went off another MDs order. This make any sense to any body or is that a ridiculous point?