Monitoring Temperature Using an Overhead Radiant Warmer

Neonates, infants who are exposed to stressors or chilling (e.g., from undergoing numerous procedures), and infants who have an underlying condition that interferes with thermoregulation (e.g., prematurity) are highly susceptible to heat loss. Therefore, radiant warmers are used for infants who have trouble maintaining body temperature. In addition, use of a radiant warmer minimizes the oxygen and calories that the infant would expend to maintain body temperature, thereby minimizing the effects of body temperature changes on metabolic activity.

An overhead radiant warmer warms the air to provide a neutral thermal environment, one that is neither too warm nor too cool for the patient. The incubator temperature is adjusted to maintain an anterior abdominal skin temperature of 36.5°C (97.7°F), but at least 36°C (96.8°F), using Servocontrol (automatic thermostat) (Sinclair, 2002).

Equipment                                                                        

• Overhead warmer

• Temperature probe

• Aluminum foil probe cover

• Axillary or rectal thermometer, based on facility policy

• PPE, as indicated

Assessment

Assess the patient’s temperature using the axillary or rectal route, based on facility policy, and assess the patient’s fluid intake and output.

Nursing Diagnosis

Determine the related factors for the nursing diagnoses based on the patient’s current status. Appropriate nursing diagnoses may include:

• Hyperthermia       

• Hypothermia

• Risk for Imbalanced Body Temperature

• Ineffective Thermoregulation

Outcome Identification and Planning

The expected outcomes to achieve when using an overhead warmer are that the infant’s temperature is maintained within normal limits without injury.

Implementation

1. Check medical order or nursing care plan for the use of a radiant warmer
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Close curtains around bed and close the door to the room, if possible. Discuss the procedure with the patient’s family.
5. Plug in the warmer. Turn the warmer to the manual setting. Allow the blankets to warm before placing the infant under the warmer.
6. Switch the warmer setting to automatic. Set the warmer to the desired abdominal skin temperature, usually 36.5°C.
7. Place the infant under the warmer. Attach the probe to the infant’s abdominal skin at mid-epigastrium, halfway between the xiphoid and the umbilicus. Cover with a foil patch.
8. When the abdominal skin temperature reaches the desired set point, check the patient’s axillary or rectal temperature, based on facility policy, to be sure it is within the normal range.
9. Adjust the warmer’s set point slightly, as needed, if the axil- lary or rectal temperature is abnormal. Do not change the set point if the axillary or rectal temperature is normal.
10. Remove additional PPE, if used. Perform hand hygiene.
11. Check frequently to be sure the probe maintains contact with the patient’s skin. Continue to monitor temperature measurement and other vital signs.

Evaluation

The expected outcomes are met when the infant is placed under a radiant warmer, the temperature is well controlled, and the infant experiences no injury.

Documentation

Document initial assessment of the infant, including body temperature; the placement of the infant under the radiant warmer; and the settings of the radiant warmer. Document the incubator air temperatures, as well as subsequent skin and axillary or rectal temperatures, and other vital signs measurements.

Sample documentation: 19/03/18 @19:15 Infant placed under radiant warmer. Warmer on automatic setting 36.7°C (98°F), baby’s skin temperature 36.8°C (98.2°F), rectal temperature 37°C (98.6°F), warmer air temperature 36.7°C (98°F).

_HSN, RN

Unexpected situations and associative interventions

• The infant become febrile under the radiant warmer: Do not turn the warmer off and leave the infant naked. This could cause cold stress and even death. Leave the warmer on automatic and dial the set temperature. Notify the physician.

•  The warmer’s temperature is fluctuating constantly or is inaccurate: Change the probe cover. If this does not improve the temperature variations, change the probe as well.

Infant and Child consideration

• Radiant warmers increase insensible water loss in low-birth-weight babies in the newborn period. This water loss needs to be taken into account when daily fluid requirements are calculated.

Reference: Lynn, P., & Taylor, C. (2011). Taylors clinical nursing skills: A nursing process approach. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.