Maintaining patient normothermia offers more than just comfort. It's a standard of care that can positively affect surgical outcomes and prevent post-op complications. You've got numerous options for warming your patients, but the decision of which device to purchase comes down to the type of cases you're doing and a cost-versus-effectiveness comparison between your choices.

Blanket approach
The warming modality that your staff uses depends primarily on what the perioperative situation calls for and will allow. In the most basic scenario, consider the patient in a pre-op bay, waiting a half an hour or an hour as he's readied for surgery. You're likely to offer him a blanket, perhaps one fresh from a warming cabinet. There's always a role for a warmed blanket, especially since our facilities are kept so cold. It's a low-tech and quiet method.

Blanket warming cabinets are fairly straightforward, their features pretty much the same. They all heat to the same temperature range and they're all thermostat-driven. If you're in the market for a warming cabinet, a key consideration is size, both exterior and interior. How much space will it take up in your facility? Which cabinet will fit in the physical space you can allot to it? Which one can accommodate the blankets you'll need to warm?

In a facility that handles one or two cosmetic surgery cases a day, for instance, a small, countertop cabinet will likely suffice. But a cataract center that sees dozens of elderly patients every morning will need a bigger, standalone model.

While working facial procedures in a cosmetic surgery office, I've found that covering the body with a warmed blanket beneath the drape, with only the head exposed, seems to maintain patient normothermia really well throughout a case.

Active alternatives
Whether you can employ the low-tech, passive warming of a blanket during the entire perioperative process depends on the procedure, of course. If the answer is no, then seek an ergonomically acceptable alternative, taking into account the patient access and positioning that the procedure demands.

Consider for instance an abdominal case, or a breast augmentation or reconstruction. Access to the patient's mid-section is required, and the patient will clearly be losing heat. In such cases I've seen good results by placing a convective, or forced-air, warming blanket beneath the patient from head to toe, and by covering their head with a blanket. Drape the patient from the waist down.

In addition to forced-air warming blankets, your active warming options include thermal pads for the OR table, circulating water pads that affix to various areas of the patient's body and semi-conductive polymer fabric blankets that serve as high-tech electric blankets.

A device's cost and its effectiveness are the two most important considerations in selecting a warming modality for your facility. While bottom-line thinking generally leans toward choosing the product that works best for the least amount of money, you may want to trial all serious competitors with patient temperature studies. I know I've been surprised by how well some of the newer warming technologies compare to the effects of forced-air blankets, and I'll seriously consider buying a more expensive option if it does a better job.

In terms of price, be sure to get a complete view of what it will cost to acquire, as well as to continue to operate, a particular warming system, especially if it includes single-use components. With forced-air warming systems, for instance, the blower unit might be offered free, or at a negligible cost, as long as you buy a specified amount of or sign on for regular purchases of the disposable blankets. Note carefully the number that need to be bought, or whether the buys will interfere with any contractual obligations or restrictions you may have through purchasing agreements.

Practical use
Of course, a system consisting entirely of reusable components offers advantages of its own. Chief among those advantages is that it represents one less line item on your inventory, one less item to store on your shelves and one less item filling your wastebaskets.

Plus, reusable components are "green," and more and more surgical personnel seem to be getting into the trend toward sustainable ORs. Just make sure that cleaning the components for reuse is an easy and quick task for your turnover staff to do.

Most manufacturers offer different sizes and variations on their warming systems. These accommodate the needs of patient sizes, from infant to adult, and the access required for specific procedures, as when only the upper body or lower body or extremities can be covered. Also, keep your eyes open for products that can multitask. For instance, a thermal pad that can warm a patient and serve as a pressure reduction device at the same time might prove valuable during longer surgeries.

Finally, in all the assessment of a system's capabilities and efficiency, don't neglect the size of its components. As you're probably painfully aware, we've tended to build our surgical facilities too small, without enough space for storage. Make sure that a warming device's dimensions won't obstruct operations at a patient's bedside, in the OR or even in equipment storage rooms.

Arizant Healthcare
Bair Hugger Therapy
(800) 733-7775
www.bairhugger.com
List price: not disclosed
FYI: Arizant Healthcare created the forced-air warming category with the 1987 launch of Bair Hugger Therapy. Today, this system consists of 25 different disposable warming blankets for use before, during and after surgery, and its warming units can also be used with Arizant's Bair Paws perioperative gowns. The newest blankets, the underbody series, let you warm patients from below and maintain full access to the patient.

Blickman
Warming Cabinets
(800) 247-5070
www.blickman.com
List price: ranging from $4,648 to $10,180
FYI: This line of warming cabinets includes tall, freestanding models with single- or dual-chamber variations as well as shorter models. Glass or stainless steel doors are available at the same price, and pass-through versions offer doors on the front and back. Custom models can be fabricated.

Cincinnati Sub-Zero
Gelli-Roll
(800) 989-7373
www.gelliroll.com
List price: not disclosed
FYI: Why burden the environment — and your checkbook — by purchasing disposable blankets for forced-air warmers? The Gelli-Roll benefits the patient, the caregiver and the earth, says the company, by cost-effectively keeping patients normothermic and comfortable while reducing red bag waste. The Gelli-Roll can also be used with Cincinnati Sub-Zero's Norm-O-Temp Hyperthermia unit as well as its Blanketrol Hypo-Hyperthermia units.

Covidien
WarmTouch Patient
Warming System
(800) NELLCOR
www.nellcor.com
List price: not disclosed
FYI: This system warms up quickly, operates quietly and offers a range of temperature settings for all patient needs, says the company. WarmTouch's blankets, designed for maximum skin surface coverage, are made from soft yet strong, two-ply, quilted material and are fluid-, tear- and puncture-resistant.

Dynatherm Medical
vitalHeat vH2 Temperature Management System
(510) 249-1300
www.dynathermmedical.com
List price: not disclosed
FYI: Scheduled for summer 2009 availability, this product non-invasively prevents or treats intraoperative hypothermia through the encapsulation of a single extremity, says the company. By applying heat under low vacuum to open thermoregulatory structures in the palm and fingers, the system warms blood in the hand and arm, then delivers this heat directly to the core through venous vasculature, eliminating the need to cover large surfaces of the body. Convenient to apply and simple to operate, it warms patients without interfering with the surgical site or draping.

Enthermics Medical Systems
EC1540bl Combination Fluid/Blanket Warmer
(800) 862-9276
www.enthermics.com/ec1540bl.html
List price: $12,806
FYI: This dual-chambered warmer with independent touch keypad controls takes the chill off of injection fluids, irrigation fluids and cloth blankets, says the company. The fluid compartment holds up to 72 liters at 98 ?F to 104 ?F for injection fluids or 98 ?F to 150 ?F for irrigation fluids. The blanket chamber has a capacity of 7.7 cubic feet and can be warmed as high as 200 ?F to keep blankets — and patients — warmer longer.

Future Health Concepts
Blanket Warmer
(800) 282-8644
www.fhcusa.com
List price: $4,200 to $9,000, depending on model
FYI: This line of blanket warmers includes countertop models as well as standing dual- and triple-chambered cabinets, with the option of full-view glass or stainless steel doors. Each model features a temperature range of 90 ?F to 160 ?F, digital controls, push-button operation, audible and visual over-temp alarms, a rapid warming time and uniform heating. Each also includes a one-year parts warranty and five-year labor warranty, says the company.

Gaymar Industries
Thermacare
(800) 828-7341
www.gaymar.com
List price: blower, no-charge rental to $1,200; disposable blankets, $6 to $15 each
FYI: This forced-air patient warming system features a lightweight, portable blower with multiple temperature settings, says the company. The flexible, covered hose is easy to clean and attaches easily and securely to the blower, which you can mount on an IV pole or portable stand, or simply set on the floor. Single-use patient blankets are available in six sizes. Their air distribution is designed for optimal effectiveness, their ample dimensions accommodate the majority of patients, and some sizes are perforated for quick and easy patient access.

Hot Dog USA
Hot Dog Patient Warming System
(888) HD-WARMS
www.hotdog-usa.com
List price: not disclosed
FYI: Here's a forced-air-free, easy-to-clean, cost-effective solution for maintaining patient normothermia, says the company. A reusable blanket made of a lightweight, conductive fabric encased in a waterproof, antimicrobial shell warms patients. Since there's no blowing air, the Hot Dog works silently, without the risks of spreading airborne contaminants, using less energy and generating less waste than forced-air systems.

Kimberly-Clark Health Care
Patient Warming System
(800) 528-5591
www.kcpatientwarming.com
List price: not disclosed
FYI: This small, portable, easy-to-use control unit circulates heated water through thermal pads placed on the patient's body, says the company. The control unit allows precise automated or customizable patient temperature management. The disposable, non-slip, hydrogel thermal pads, available in various sizes, conduct heat directly through the skin to safely maintain normothermia while allowing surgical access.

Lexion Medical
Insuflow Laparoscopic Gas Conditioning Device
(877) 9-LEXION
www.lexionmedical.com
List price: $100
FYI: This device, clinically proven to reduce intraoperative hypothermia during laparoscopic procedures, delivers insufflation gas that has been humidified to 95 percent relative humidity and warmed to 95 ?F instead of cold and dry CO2. This provides patients with a quicker, more comfortable recovery at the facility and at home, says the company.

LMA North America
PerfecTemp Patient Warming System
(800) 788-7999
www.lmana.com/perfectemp
List price: $14,500
FYI: Designed to replace an OR table's existing pad and available to fit most configurations and models, this warming system provides evenly distributed warming to the patient from the moment they arrive on the table, says the company. The system not only monitors and controls the precise temperature to which the patient's skin is being exposed, but it also provides built-in pressure reduction without the need for additional equipment in the OR.

Mac Medical
TWC24-G
(877) 828-9975
www.macmedical.com
List price: $7,200
FYI: This new warming cabinet can heat three separate chambers at three separate temperatures simultaneously, a benefit for perioperative personnel seeking to heat irrigation fluids, IV fluids and blankets at the same time, says the company. Its digitally controlled, insulated chambers heat uniformly from 90 ?F to 160 ?F, with a rapid warm time (two to six hours, depending on the load) and with audible and visual over-temp alarms.

NovaMed USA
Koala T Warming System
(800) 425-3535
www.novamed-usa.com
List price: $7,000
FYI: Here's an eco-friendly, economical way to warm patients from beneath, says the company. Designed with conductive technology, the Koala employs a noise-free controller and a reusable, latex-free, multi-layer mattress to ensure the uniform delivery of warmth from beneath the patient without restricting access. The mattress is available in four sizes.

Pedigo Products
P-2010-S Countertop Blanket Warmer
(800) 822-3501
www.pedigo-usa.com
List price: $4,040
FYI: This countertop warmer is ideal for keeping warm blankets close to your patients in pre-op and PACU, says the company. It offers 2.3 cubic feet of internal space, solid door construction and analog temperature control to warm blankets up to 200 ?F. Radiant heat technology uses an array of electrothermal cables in two sides and the bottom of the warmer to ensure accurate set-point temperatures.

Progressive Dynamics Medical
Life Air 1000 Warming Unit and Soft Flex Blankets
(269) 781-4241 x116
www.progressivedyn.com
List price: warming unit leased for $1 with purchase of 30 blankets per month at $7 to $13 each, depending on style
FYI: The company promotes its filtered warm air as reliable and effective, easy to use and self-diagnostic, providing fast and safe patient warming in pre-, post- and intra-operative environments. The single-use Soft Flex warming blankets are available in infant as well as adult sizes to fit your patient needs.

Skytron
J2 Series Warming Cabinets
(800) SKY-TRON
www.skytron.us
List price: countertop model, $3,800 to $4,200; standalone model, $5,400 to $7,000
FYI: These cabinets are designed to maintain clinically ideal temperatures for solution bottles and blankets, says the company. They're available in countertop or standalone models with tempered glass or stainless steel doors that hinge right or left. The cabinets feature fully insulated heating compartments with separate recirculating fans, adjustable stainless steel shelves, adjustable temperature ranges, lock-in temps, audible and visual over-temp indicators and auto shut-off for temperatures exceeding 180 ?F.

Smiths Medical
Snuggle Warm Convective Warming Blankets
(800) 553-8352
www.smiths-medical.com
List price: $6 to $20
FYI: Envelope your patients in warmth with these blankets, designed for use with the Equator Convective Warming System. The soft, cloth-like blankets resist tears, punctures and fluids, says the company. Each latex-free, easy-to-use, radiolucent blanket can be folded and repositioned for quick patient access.

Steris Corporation
Amsco Warming Cabinets
(800) 548-4873
www.steris.com
List price: $6,220 to $11,850, depending on configuration
FYI: The choice is yours: These cabinets are available in single- or dual-compartment versions, in freestanding or recessed units, with 18-inch or 24-inch depths, and with glass or solid doors. Each compartment has individual controls and digital readouts for a temperature range from 90 ?F to 160 ?F.