PATIENT CARE


‘Nurses should ensure that effective patient warming methods are employed in all patients, particularly in patients with compromised thermoregulatory systems (such as older adults), and in surgeries considered to be exceptionally painful (such as TKA).’


The accuracy, mobility, and speed of


the device make it ideal for the emergency department (ED). The warmer’s single- patient use cartridge moves with the patient – providing a cost effective way to start the warming process early. With enFlow, the disposable cartridge can attach inline to standard IV fluid/blood delivery sets at the start of an ED case. When it is time to move the patient to the next area, the clinician simply removes the cartridge from the enFlow warming unit stationed by the patient’s bed in the ED, allowing the IV set in its entirety to be moved with the patient as they are transported. This cartridge stays in-line, which avoids exposure to potential IV infection. Once the patient arrives at the next


area of the hospital – be it the operating room, intensive care unit, or another department, the cartridge is simply inserted into a new warming unit in that area and the patient is back to receiving warmed fluids within a few seconds. The enFlow IV Fluid/BloodWarming System also allows intraoperative staff to keep warming constant as anaesthetic is applied in the operating room to either treat unplanned hypothermic responses or stop them from developing in the first place.


Another fluid/blood warming solution


is the light-weight Medi-Temp blood/fluid warming system from Stryker, which provides warm fluid to the patient over a wide range of flow rates. The system features ‘dry heat technology’, avoiding the need for water and eliminating contamination issues, while the fast-acting device heats fluids to normothermic temperatures in about 60 seconds. The company also offers a range of


temperature management devices based on various approaches – from the Medi- Therm Hyper/Hypothermia System for conductive patient warming and cooling; to the Thermacare system which provides patient warming through a lightweight, portable warm-air blower unit. Forced-air warming: The benefits of


forced-air warming in maintaining normothermia have been documented in a large number of scientific papers. In one


NOVEMBER 2012


study, forced-air warming provided effective warming therapy, even when less than 50% of the patient’s body surface was covered.10 The 3M Bair Hugger and Bair Paws


systems are also based on this type of approach. Using a Bair Paws gown, patients may be pre-warmed before surgery or receive comfort warming as they await a procedure. Once in theatre, the same gown offers warming for select surgical procedures when connected to the Bair Hugger warming unit. Heated mattresses, sheets, pads


and gowns: There are also a number of alternatives to forced-air warming, available on the market, which may include heated mattresses, blankets, pads and gowns that use conduction and radiation to warm patients. In recent years, a growing evidence base has been emerging to support such alternative technologies and NICE guidance has now been issued for Inditherm’s patient warming mattress. A range of solutions are available from


Inditherm, including the company’s Alpha and TraumaTherm products. Alpha is designed for perioperative and intensive care unit applications, while TraumaTherm is ideally suited for use in the emergency room, ambulances and other transport needs. The technology uses a patented carbon


polymer sheet to deliver warming, providing a large, homogeneous warming surface area with no ‘element’. One of the fundamental characteristics of the polymer technology is that the warming surface area properties are completely uniform, ensuring precise and even temperature distribution across the whole warming sheet. The mattress polymer is combined with a viscoelastic foam pad which is designed to mould itself to the shape of the patient. Pressure-relieving pads are integrated under the heating surface, while over-blankets are also available where this offers an advantage (e.g. in the


recovery room where ease of removal is often important). To prevent over-heating, there is an alarm and an automatic over- temperature shut-off. Inditherm highlights the fact that an


important characteristic of using a mattress for warming is that cleaning can be easily carried out in exactly the same way that existing operating table mattresses are cleaned. This avoids any infection control issues and adds no extra workload or turn-round time. Another benefit relates to the


prevention of pressure ulcers. During research on the pressure-relieving properties of an intra-operative warming device, Baker & Leaper concluded that with its inherent pressure-relieving properties, the Inditherm system can help prevent pressure ulcers during the intra- operative period and may offer superior pressure relief compared with commonly used gel pads. Results showed that the Inditherm mattress provided better or equivalent pressure relief when compared with operating table mattress alone or with gel pad.11 According to Inditherm, payback


from implementing the warming product is normally under 12 months, with a six month return on investment being typical. One of the issues facing Trusts in the UK in relation to switching from disposable patient warming to reusable is the difficulty in moving from a revenue


Warming mattresses such as those offered by Inditherm, allow cleaning to be carried out easily, avoiding any infection control issues.


THE CLINICAL SERVICES JOURNAL 57


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