cooling blankets

[dfk, RN, CRNA]

just looking to see other's thoughts on using cooling blanket (sepsis/shock for discussion purposes). i was 'educated' on the use of cooling blankets by putting them under a patient, as this was supposed to be more effective.. where i am at now, large level I sicu, no one practices this.. they all put a sheet over the pt. then put the cooling blanket on top of that.. what gets me, is that our nurse's aid said that's not how to do it. well, i was a bit taken aback at the moment she said that, like, excuse me? she told me she was inserviced that using it under the pt will cause blisters. anyone's thoughts on this?? also, any evidenced based cases to know of? thanks in advance.

[Phishininau]

The cooling blanket can actually be placed above and below the patient. When we use the bottom one, we place a fitted sheet over the blanket. Protocol requires that the patient be turned every fifteen minutes when the blanket under them is used and currently on. I also use a setpoint about a degree or two above where I want them so they dont get too cool.

[dfk, RN, CRNA]

i understand what u are saying, and i'm looking for those who have used both and have experienced any negative effects from back vs. front.. this could be frostbite to whatever.. i don't know. that's why medicine and nursing are ever evolving.

[wtbcrna, MSN, DNP, CRNA]

I have always used the cooling blanket under the patient. We put the cooling blanket then a sheet and usually a draw-sheet between the cooling blanket and the patient. I have never had any ill effects from doing it this way.

[Phishininau]

I havent had any adverse effects from leaving the patient with the cooling balnket under them. I would advise you these two things:

1. Turn them often.

2. Avoid cooling them too quickly. This can cause shivering which increases ICP. You never want that on a head case.

From my experience, though, using the bottom cool method is more effective in decreasing the core body temp.