Anesthesia costs the average surgical patient 3 ?C, a debt that can easily push him into perioperative hypothermia. Even mild hypothermia can increase bleeding, pain and infection, prolong PACU stay and delay wound healing. It doesn't do much for patient satisfaction scores, either. Fortunately, you've got a wide array of options for keeping core temperatures between 36 ? and 38 ?C. From convective (forced-air) warming technologies to electrically conductive table pads, and from blanket and fluid warming cabinets to heat-reflective garments, the goal of maintaining normothermia and ensuring comfort before, during and after surgery for every patient is within your reach.

But given the many solutions available, how do you know which ones will work best for your facility? We've compiled information on 15 warming products on the next several pages. First, though, here are 3 factors experts say you should consider before making your purchasing decision.

What procedures are you doing? Or, to be more specific, what parts of the body are your surgeons operating on? The answer to this question will help to determine whether a warming method can flexibly accommodate patients' and physicians' needs.

Anesthesia impairs the body's thermoregulatory responses, rendering it unable to shiver and generate heat on its own. Add to that situation the typical chill of the perioperative environment and the exposed skin of the surgical patient, and there's a high likelihood you'll see a case of inadvertent hypothermia. Covering the patient's body with a forced-air, electric or cloth blanket can help to head off hypothermia, but between pre-op and PACU, the surgeon will need access to knees, hips, abdomens or other anatomy. Make sure that the warming methods you're considering offer configurations that are able to work around — or, in the case of underbody warmers, beneath — ?surgical site demands.

What's your surgical schedule look like? Cataract, pain management and some cosmetic surgery patients are in and out of the OR during the course of the surgical day. They spend such a short time under the knife and receive such light anesthesia that setting up extensive warming efforts for each one of them might seem overly time-consuming or costly. They may be best served by cloth blankets, fresh from a warming cabinet.

In longer cases, on the other hand, every detail plays a part. When a hip arthroscopy is expected to run through a high volume of irrigation fluid, a patient (particularly an elderly patient) may benefit if the fluid has been warmed by a cabinet, basin or in-line device. Since patient safety depends on knowing the precise temperature of warmed fluid, the product should include a readout display. Since having the fluid close at hand during surgery — as opposed to outside of the OR — will limit exits and entries and make sure the fluid stays warm, the footprint of the warming method in a crowded OR is key.

How effective, and how cost-effective, is it? The advantages that active patient warming brings to surgical outcomes have been well-documented in clinical studies, and the manufacturers of warming devices will be eager to share them with you. But why not seek out the evidence yourself? Trial the options you're considering on a series of patients, recording their core temperatures throughout the perioperative process as you do, to see which ones deliver effective results.

Keep track of the cost per case that each method represents, as well. A solution's practical economics hinge not just on such continuing purchases as disposable forced-air warming blankets, but also on the time it takes to set up the system, the convenience of cleaning it for reuse, its portability and the possibility of maintenance versus replacement.

In the end, remember that maintaining patient normothermia is as much a quality-of-care issue as it is a necessity for good surgical outcomes. OSM

3M
Bair Hugger System
bairhugger.com
(800) 228-3957
List price: not disclosed
FYI: Offering 25 different blanket styles, 3M's Bair Hugger forced air warming system provides a simple, effective and flexible solution for maintaining perioperative patient normothermia without compromising the surgical access needs of a specified procedure. Since 1987, Bair Hugger blankets have warmed more than 200 million patients, says the company.

Augustine Temperature Management
HotDog Patient Warming System
hotdogwarming.com
(888) 439-2767
List price: about $2 to $3 per patient
FYI: The key to effective warming is taking advantage of surface area, says Augustine, whose HotDog air-free conductive polymer fabric blankets and mattresses can warm patients from above and below at the same time for versatile, economical and effective normothermia management. Compact controllers and advanced sensors deliver low-voltage electricity to the flexible, lightweight devices for uniform and precise heat.

Belimed
DWC24-TL-G Warming Cabinet
belimed.com
(800) 451-4118
List price: $8,516
FYI: Belimed's fluid and blanket warming cabinet features digitally operated, individually heated chambers, 3 adjustable shelves, a choice of a stainless steel or full-view glass door, a keyed door lock and audiovisual over-temperature alarms. Its integrated "Easy Log" data logger tracks temperatures every 30 minutes on a removable USB drive. Optional features include custom sizes, pass-through chambers and recessed unit design.

Blickman
Blanket and Solution Warming Cabinet
blickman.com
(800) 247-5070
List price: not disclosed
FYI: Part of Blickman's line of warming cabinets, the double-door blanket and solution warming cabinet (model 7924TG) features 2 independently controlled, separately heated chambers. Digital operation, protected by key and passcode lockout, ensures that the temperature remains within plus or minus 1 ?F of the set point, and virtually no heat leaks into the adjoining chamber or the cabinet's exterior. The full height and width windows on self-closing, magnetic gasket doors make it easy to stock and retrieve blankets and bottles from the cabinet.

Cincinnati Sub-Zero
WarmAir Convective Warming System and FilteredFlo Blankets
cszmedical.com
(800) 989-7373
List price: not disclosed
FYI: The compact, lightweight WarmAir unit filters air twice before channeling it to the FilteredFlo blankets, whose design enables the use of a lower velocity of forced air to minimize air currents in the OR. The blankets are available in several configurations and sizes to accommodate the needs of different procedures. The system features 4 warming levels, and high- and low-temperature alarms.

Ecolab
IntraTemp Fluid Warming System
ecolab.com/healthcare
(800) 824-3027
List price: negotiated based on annual usage
FYI: Warming saline in a cabinet outside the OR requires time-consuming labeling and rotation, increases OR traffic and infection risks, and lets the solution cool to imprecise temperatures before use. Ecolab's IntraTemp Fluid Warming System provides the OR team with immediate access to irrigation fluid at a controlled and verifiable temperature without leaving the sterile field.

Encompass Group
Thermoflect Heat Reflective Technology
thermoflect.com
(800) 826-4490
List price: not disclosed
FYI: Thermoflect blankets, patient gowns, bouffant caps and pediatric pajamas begin working immediately to warm the patient by capturing and reflecting their radiant heat without electricity. When applied in pre-op, they effectively maintain normothermia throughout the perioperative process and reduce the need for both active warming methods and cloth blankets. Thermoflect's line of staff apparel can keep your employees warm in chilly ORs, too.

Enthermics
ivNow Fluid Warmer
enthermics.com
(800) 862-9276
Pricing: from $1,249 for the 1-pod model to $5,310 for the 6-pod model.
FYI: The ivNow Fluid Warmer from Enthermics heats intravenous and irrigation fluids and keeps them at a safe temperature at the point of use. The compact unit, which is mountable on walls, booms, equipment poles and countertops, is activated by placing a bag on the warming tray and heats the fluid inside to 40 ?C (104 ?F) in less than 30 minutes. A digital display shows the temperature of every bag and records how long each one has been warmed.

Futuremed
Astoflo Plus eco
futuremed.com
(800) 222-6780
List price: not disclosed
FYI: The eco-friendly advantage of the Astoflo system is that it warms fluids and blood directly in standard IV tubing, without any additional warming set or disposables needed, to reduce costs, waste and setup time. The IV line is threaded into a heating sleeve, and can easily be detached from the warmer without interrupting the flow of fluid. The dry heat is adjustable from 33 ?C to 43 ?C in 1 ? increments, and multiple independent sensors and audiovisual alarms ensure precise temperature control and patient safety.

MAC Medical
D-Series Blanket and Fluid Warming Cabinets
macmedical.com
(877) 828-9975
List price: $3,991 to $9,783, depending on model
FYI: MAC Medical's data logging D-Series warming cabinets are equipped with independent, digitally controlled heating chambers that display actual and set point temperatures. The cabinets record temperature data every 30 minutes and store it internally for up to 2 years. The plug-and-play interface requires no additional software to download the data. The D-Series offers single-, dual- or triple-chamber units, with optional glass doors, left-side hinges, and mobile stands or bases available.

Medical Solutions
Cocoon Patient Warming System
msi-healthcare.com
(800) 435-7600
List price: not disclosed
FYI: Compact, quiet and portable, the Cocoon system's microprocessor-controlled unit produces filtered forced air to convectively maintain patient normothermia. The system's size- and case-specific blankets employ micropore technology to deliver constant, concentrated and uniform warming. Inlet port ties secure the hose to its connection, letting one blanket accompany the patient from pre-op to PACU. An easy-to-wipe hose cover and large filter keep maintenance needs low.

Medtronic
Covidien WarmTouch Convective Warming System
medtronic.com
(800) 962-9888
List price: not disclosed
FYI: The intuitive control screen of the WarmTouch convective warming unit displays the temperature and status of 5 different settings, including "ambient" and "boost," for more flexibility and precision in maintaining patient normothermia. A wide range of forced-air warming blankets accommodate anatomy and access for every patient and procedure. They're strong enough to resist tearing but soft enough for patient comfort.

Pedigo
P-2012 Countertop Blanket Warmer
pedigo-usa.com
(800) 822-3501
List price: $6,100
FYI: Pedigo's countertop warmer lets you keep blankets close to your pre- and post-op patients. Its 2.5 cubic foot interior features an adjustable temperature range of 90 ? to 160 ?F (32 ? to 71 ?C) and Radiant Heat Technology, which monitors the cabinet's surfaces to evenly distribute warmth throughout the chamber and its contents. Easy to use and precise electronic controls ensure accurate set-point temperatures. The stackable unit is built with a single-pane, energy-efficient glass door.

Pintler Medical
Summit Ortho Heated OR Pad
pintlermedical.com
(877) 620-9868
List price: $2,910 (control unit sold separately)
FYI: Designed for use with any orthopedic specialty table, including Wilson, Jackson and Hana tables, and peg board positioners, Pintler's Summit pad combines conductive underbody patient warming with a pressure redistribution and reduction surface. The flexible, fluid-impervious pad is available through many group purchasing organization agreements.

VitaHeat Medical
UB3 Patient Warming System
vitaheatmedical.com
(800) 850-8350
List price: not disclosed
FYI: VitaHeat's UB3 system innovates underbody patient warming through the use of conductive ink technology, a thin mattress design and interactive temperature sensors that monitor independent heating zones. The portable, flexible, low-profile mattress doesn't interfere with surgical access or patient positioning, and is easy to set up and wipe down for reuse, says the company. Electrical or battery operated, it requires no disposable components.