PATIENT CARE


‘As many as 70% of all patients undergoing surgicalprocedures develop inadvertent hypothermia.’


budget to a capital purchase. To help overcome this problem Inditherm offers monthly payment schemes and rental plans that will allow Trusts to continue using revenue budget if they wish and start to realise cost savings from the first month. Other well-known air-free products on


the market include the ‘Hot Dog’ under body mattress and torso blanket, from Nordic Surgical, which warm the patient through radiant fabric technology. The system is easy to use and position on patients, as well as being easy to clean, while temperature sensors communicate with a microprocessor to ensure maximum safety. PerfecTemp is a new patient warming


product available on the market, launched at the 59th


Annual Association of


periOperative Registered Nurses (AORN) congress, in March 2012, and in the UK at the Association for Perioperative Practice (AfPP) annual congress, in October 2012. Medline’s PerfecTemp patient warming system features conductive heating delivered through a high-tech synthetic OR table pad. Explaining the benefits of the


technology, Frank Czajka, president of the Proxima division at Medline, said: “With its large table pad, PerfecTemp warms uniformly over a larger surface area of the patient. It also monitors the temperature at the point where the patient’s skin meets the mattress, allowing for safer and more efficient delivery of the heat. Since PerfecTemp warms the body from underneath, the product design also allows the surgeon to have complete access to the patient and surgical site.” Single-use, simple solution: Another


development in the area of patient warming has been the introduction of an active self-warming blanket from Molnlycke. Once opened and unfolded, the blanket reaches operational temperature within 30 minutes and maintains an average temperature of 40˚C for up to 10 hours. The heat of the active self-warming blanket Barrier EasyWarm is produced via an exothermic chemical reaction initiated by exposure to air, resulting from the oxidation of iron. A clinical study evaluating the safety and efficacy of the blanket was performed


58 THE CLINICAL SERVICES JOURNAL


in 2011 at the University General Hospital, in Houston, Texas and at the Physicians’ Surgical Care Center in Winter Park, Orlando, Florida, both in US. With the active self-warming blanket, intraoperative temperature was maintained at a stable level for 2.5 hours. The typical temperature drop of 1˚C-1.5˚C on induction of anaesthesia did not occur in patients; a temperature drop of only 0.6˚C was recorded, while no serious adverse events were reported. The active self-warming blanket was also well received in terms of comfort and warmth by the patients. EasyWarm can be used in various


treatment scenarios – including the ambulance, A&E, patient transfer, pre-op, in theatre and recovery. It is designed to be used on top of the patient and is quick and easy to set up, without the need for any wires or hardware. After use, Barrier EasyWarm can be disposed of with regular waste. Inventor of the Barrier EasyWarm,


Dr Mark Kyker, anaesthesiologist, Indiana Heart Hospital, commented: “The design of the active warming blanket means it can be placed on the patient like any other blanket when they arrive at the facility. The blanket then stays with the patient as they are transferred to the operating suite and then to the recovery room area. There are no attachments, no hoses, no electrical requirements, no noise involved and no risk of air borne pathogens. It is very different from anything else currently on the market, in terms of active warming devices.”


Controversy In recent years, there has been debate over the pros and cons of forced-air warming vs conductive technologies – with no consensus achieved, as yet, over the best method of active warming. A study by Belani et al recently


concluded that excess heat from forced- air warming resulted in the disruption of ventilation airflows over the surgical site,


whereas conductive patient warming devices had no noticeable effect on ventilation airflows. Ventilation performance was assessed


by releasing neutrally buoyant detergent bubbles into the non-sterile region under the head-side of the anaesthesia drape. The team then tracked whether excess heat from upper body patient warming mobilised the bubbles into the surgical site.


The team reported that direct mass-


flow exhaust from forced-air warming generated hot air convection currents that mobilised bubbles over the anaesthesia drape and into the surgical site, resulting in a significant increase in bubble counts for the factor of patient warming device (P<0.001). Forced-air had an average count of 132.5 versus 0.48 for conductive fabric (P=0.003) and 0.01 for control conditions (P=0.008) across both drape heights. Differences in average bubble counts across both drape heights were insignificant between conductive fabric and control conditions (P=0.87). The factor of drape height had no significant effect (P=0.94) on bubble counts. The authors commented that the


findings warrant future research into the effects of forced-air warming excess heat on clinical outcomes during contamination-sensitive surgery.12 This is opposed to the results of an


earlier a peer-reviewed study by Sessler et al which found that forced-air warming systems do not impair operating room air quality, with or without laminar flow ventilation.13 The authors concluded that the use of


the forced-air warming blankets caused no statistically significant difference in particle counts, regardless of whether the forced-air warming unit was set to off, ambient air or high heat settings. In all cases, the particle concentration at the test point was reduced 3-log to 5-log (1,000x to 100,000x) compared to background particulate levels in the room. This surpassed the 2-log reduction


An active self-warming blanket from Molnlycke. NOVEMBER 2012


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