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Question: I work at an ambulatory surgery center. Many of our patients are awake during the skin prep and are very uncomfortable when cold prep solution is used. One of our staff members suggested stocking our prep sets and prep solutions in the blanket warmer. Our routine prep is povidone-iodine solution. I thought that warming povidone-iodine prep solutions is not recommended. Is it acceptable to warm prep solutions?
Answer: Most povidone-iodine skin prep solution products contain warning labels regarding warming. One manufacturer of povidone-iodine skin prep products does not recommend heating povidone-iodine before use. Their label contains the warning "Do Not Heat Prior to Application." Another manufacturer's skin prep solution product label reads, "Not to exceed 104deg F."1
In a February 1999 letter to the AORN Center for Nursing Practice, Health Policy, and Research, a manufacturer representative states that a facility may choose to warm preoperative prep solutions despite the product warning label. Povidoneiodine, however, should only be warmed for a brief period (ie, up to two hours) in a controlled environment where the temperature can be digitally adjusted to a specific temperature between 37degC and 47deg C (99deg F to 108deg F). Povidone-iodine must never be warmed in a microwave, autoclave, pot of boiling water, or under any other condition where the temperature cannot be controlled.2
When povidone-iodine solution is heated, two things can happen. Iodine can interact with dissolved oxygen, resulting in a net decrease in iodine concentration, or evaporation of the water from the povidone-iodine solution can cause an increase in iodine concentration. When povidone-iodine solution is heated in a closed container, iodine can interact with dissolved oxygen, resulting in a decreased concentration of iodine. If povidone-iodine is heated in an open container such as a bowl or prep tray with a large exposed surface area, however, sufficient evaporation of water may result, causing an increase in the iodine concentration. An increased iodine concentration could lead to patient skin reactions. Overheating the product could result in thermal burns.
Manufacturers' written recommendations for storage, heating, and proper use of all skin prep solution products should be followed. If the manufacturer has not provided specific instructions on heating, the manufacturer should be contacted for clarification before any prepping solution is warmed.
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