Prevention of Hypothermia

Publication Date: July 1, 2019
Last Updated: March 14, 2022

Guideline Essentials


  • Measure and monitor the patient’s temperature during all phases of perioperative care.
  • Select the temperature measurement site and method in collaboration with the perioperative team and based on:
    • anesthesia type
    • anesthesia delivery method
    • accessibility of the body site for measurement
    • invasiveness of the method
  • Use the same site and method of temperature measurement throughout the perioperative phases when clinically feasible.
  • Determine the frequency of patient temperature measurement based on the individual patient assessment and the health care organization’s policies and procedures.
  • Calibrate the selected temperature-monitoring device according to the manufacturer’s written instructions for use.
  • Document the site and method of temperature measurement and the value of the patient’s temperature in the patient’s record.
  • Communicate the patient’s most recent temperature during transitions of care (eg, preoperative to intraoperative, intraoperative to postoperative).
  • Communicate the patient’s temperature to the perioperative team when it is outside the normothermic range.

Clinical practice guidelines recommend using the same site and method for temperature measurement. Measurements can vary significantly when temperatures are measured at different sites or by different methods. When team members are aware that the patient’s temperature is outside of the normothermic range, they can institute the hypothermia treatment measures specific to their role.



  • Implement methods for preventing or treating hypothermia for all patients during all phases of perioperative care.
  • Select the method for preventing hypothermia in collaboration with the perioperative team members and based on the following criteria:
    • age (eg, premature and other low-birth-weight infants, older than 65 years)
    • sex (ie, female)
    • low body-surface area or weight
    • congestive heart failure
    • previous cardiac surgery
    • other preexisting medical conditions
    • hypotension
    • history of organ transplantation
    • type and duration of the surgical procedure
    • type and duration of the planned anesthesia
    • patient positioning
    • use of a pneumatic tourniquet
    • use of an intermittent pneumatic compression device
    • warming equipment constraints
    • potential for adverse events associated with the use of warming equipment
  • Consider using a combination of active warming methods or active and passive insulation methods.
  • Prewarm the patient with the selected method of active warming if indicated.
  • Determine the amount of time for prewarming the patient before anesthesia induction.
  • Normalize the hypothermic patient’s core temperature before the patient is transferred to the OR.


• Use one or more of the following passive insulation methods during all phases of perioperative care:
  • cotton blankets
  • surgical drapes
  • plastic sheeting
  • thermal clothing
  • a non-linting wrap
  • blankets or garments made of reflective composite fabric (eg, space blankets)

Passive methods provide insulation against heat loss, one of the mechanisms that causes hypothermia, but they are not an effective means of treating hypothermia.



• When indicated, warm the patient with one or more of the following active warming methods during all phases of perioperative care:
  • a forced-air warming device (eg, blanket, gown)
  • a water-filled mattress
  • a circulating-water garment
  • an electric warming blanket
  • a carbon-fiber blanket
  • a resistive polymer blanket
  • a thermal exchange chamber
  • a negative pressure warming system
  • warmed anesthesia gases
  • warmed IV fluids
  • warmed irrigation fluids
  • radiant warming
  • warmed insufflation gases
• Increase ambient room temperatures as an adjunct to other active warming methods.
• Use forced-air warming devices with the manufacturerdesignated blanket attached to the hose and according to the manufacturer’s instructions for use.
• When using a forced-air warming blanket with a head drape, arrange the drape in a manner that allows the air to flow freely from under the drape, and keep the blower activated while the drape is in place.
• Use US Food and Drug Administration–cleared technology that is designed for warming IV fluids in accordance with the manufacturer’s written instructions for use.
• Document measures taken to maintain patient normothermia in the patient’s medical record, including:
  • warming method used
  • warming device identifier
  • temperature settings when applicable

Numerous studies indicate that active warming methods are more effective for preventing hypothermia than passive methods. Use of active warming is also recommended in a number of clinical practice guidelines.


Recommendation Grading




Prevention of Hypothermia

Authoring Organization

Publication Month/Year

July 1, 2019

Last Updated Month/Year

January 5, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Hospital, Operating and recovery room

Intended Users

Surgical technologist, nurse, medical techologist technician, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D007035 - Hypothermia