PATIENT CARE
required by the European performance standard. The authors also deployed a vapour
generator to assess airflow patterns above the patient with the forced-air blower set to high and the laminar flow system activated. Neither the forced-air warming blanket nor the forced-air blower generated upward air that interfered with the normal unidirectional stream of the laminar air flow system. Debate over the pros and cons of
convective vs conductive technologies is likely to continue – Trusts will have to consider the available evidence and make their own evaluations, but what exactly is the current guidance?
Guidance In April 2008, NICE issued clinical guidance on Inadvertent perioperative hypothermia (CG65), which advises that patients should be assessed for their risk of inadvertent perioperative hypothermia and potential adverse consequences before transfer to the theatre suite.14 Healthcare professionals should ensure
that patients are kept comfortably warm while waiting for surgery by giving them at least one cotton sheet plus two blankets, or a duvet. Special care should be taken to keep patients comfortably warm when they are given premedication
(for example, nefopam, tramadol, midazolam or opioids). The patient’s temperature should be measured and documented in the hour before they leave the ward or emergency department. If the patient’s temperature is below
36˚C, the guidance states that: • forced-air warming should be started preoperatively on the ward or in the emergency department (unless there is a need to expedite surgery because of clinical urgency, for example bleeding or critical limb ischaemia).
• forced-air warming should be maintained throughout the intraoperative phase.
The patient’s temperature should be 36˚C or above before they are transferred from the ward or emergency department (unless there is a need to expedite surgery because of clinical urgency). On transfer to the theatre suite, the patient should be kept comfortably warm and encouraged to walk, where appropriate.
Intra-operative phase The patient’s temperature should be measured and documented before induction of anaesthesia and then every 30 minutes until the end of surgery. Standard critical incident reporting should be considered for any patient
arriving at the theatre suite with a temperature below 36˚C. Induction of anaesthesia should not begin unless the patient’s temperature is 36˚C or above (except where there is a clinical urgency). In the theatre suite:
• The ambient temperature should be at least 21˚C while the patient is exposed. Once forced-air warming is established, the ambient temperature may be reduced to allow better working conditions. Using equipment to cool the surgical team should also be considered.
• The patient should be adequately covered throughout the intraoperative phase to conserve heat, and exposed only during surgical preparation. Intravenous fluids (500 mL or more) and blood products should be warmed to 37˚C using a fluid warming device.
• Patients who are at higher risk of inadvertent perioperative hypothermia and who are having anaesthesia for less than 30 minutes should be warmed intraoperatively from induction of anaesthesia using a forced-air warming device.
• All patients who are having anaesthesia for longer than 30 minutes should be warmed intraoperatively from induction of anaesthesia using a forced-air warming device. The temperature
NICEGuidance
supports the case to adopt Inditherm patientwarming systems in the NHS
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• Clinicalevidencesupports Inditherm’seffectiveness atpreventinghypothermia
• Annual costsavingsof £9800perOperating Theatre
• Additionalsavingsfrom reductionsinpost-operative infections,energyusage andclinicalwaste
Fullguidancecanbefoundat
www.nice.org.uk/guidance/MTG7
Contact any of ourMedical team today for further information or a free trial, on +44 (0) 1709 761000 or email:
medical@indithermplc.com, and quote Ref:MTG0811
www.inditherm.com/medical THE CLINICAL SERVICES JOURNAL 59
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