Readers Reveal Their Patient Warming Preferences

Just 2.3% of readers said they "never" warm patients, and the bulk of these respondents came from facilities that were only doing extremely short procedures like cataracts.

In terms of when they warm patients, 68.8% of respondents warm patients pre-operatively (a big jump from the 33.2% who responded this way in 2013); 89.3% warm intraoperatively; and 72.1% warm patients post-operatively. For the facilities that practice prewarming, 50.6% do it for 30 minutes or longer, while around one-third (34.6%) of facilities prewarm patients for less than 30 minutes. For some, prewarming isn't based on a standardized time frame like 30 minutes or less, but on a number of factors such as patient choice, or anesthesia and procedure type.

For example, DeShawn Bhooshan, RN, HCRM, CNOR, the clinical nurse manager at USF Health Endoscopy and Surgical Center in Tampa, Fla., says that in pre-op all patients "get a warm blanket upon arrival and if it's a general anesthetic case or a case other than eyes, they get a full-body forced-air blanket."

Our survey found that readers predominantly use 2 methods to warm patients: a forced-air warming system (Bair Hugger) or a cotton blanket pre-warmed with a blanket warmer, cited by 83.2% and 81.4% of respondents, respectively. Among the other warming methods: 6.61% use a spinal underbody blanket (or thermal mattress or bed pad on which the patient lies), 3% use some type of radiant warming device and 1.5% use a conductive polymer fabric that warms the patient from above and below simultaneously. Another 6.3% cited "other" and listed a variety of warming methods including warm compresses, hot packs and a Mylar blanket.

Nearly two-thirds (63.9%) of respondents warm fluids. By far, the top fluid-warming method cited was a warming cabinet (84.8%). Nearly one-third (32.7%) use "a warming device as the fluid is administered intravenously."

While Ms. Borello says patient safety is her facility's top priority, she also understands that patients have different concerns when they're coming out of anesthesia. "When patients wake up, they're not worried about SSIs," says Ms. Borello. And though you may not find clear evidence directly linking warmer, more comfortable patients and reduced pain, Ms. Borello has seen this connection firsthand. Patients' pain just seems less when they're warm. They're not shivering, they're not stiff. You just can't relax when you're in the PACU shivering, Ms. Borello says.

It's impossible to talk about patient warming without at least addressing the state of the 3M lawsuits and their effect on outpatient facilities. As Outpatient Surgery reported in August (osmag.net/YNnu4Q), a federal court dismissed more than 5,000 lawsuits against 3M that claimed its Bair Hugger device was responsible for infections suffered by patients during surgery. The dismissal is the latest in a 6-year legal battle between plaintiffs and 3M, and comes on the heels of the Minnesota Court of Appeals upholding a state court order that dismissed 61 similar lawsuits against the company's patient warming system. The judge's memorandum does not impact 2 similar state court cases against 3M's Bair Hugger (one in Missouri and one in Texas), which are ongoing.

We asked readers whether the lawsuits against the Bair Hugger system impacted their attitudes toward and/or their use of forced-air warming systems. While most readers (93.3%) said the lawsuits did not have an impact, 6.7% said the legal action against the most popular patient warming system on the market did affect their attitudes, policies or both. And that small percentage had some interesting things to say about the latest chapter in the forced-air warming controversy. A source from a facility in Nebraska who asked to remain anonymous said, "the lawsuits definitely made our surgeons a bit hedgy. There had been concerns about infections for years, and we made a safety decision not to go with the Bair Hugger long before the legal action began. But for us, the lawsuits showed our concerns were justified and that we made the right decision."