Hot air warmers

[George Miklos]

There is no doubt that hot air warming blankets have made a big difference in patient care under anesthesia in the last 10 years.

My institution does a lot of short cases (<1hr) where hot air warming blankets are beneficial but not cost effective. We commonly use the hot air hose without the commercial hot air blanket. Does anybody else admit to this?

Now, I must elaborate. I use it on well patients at 38^oC (there are 2 hotter settings 43^oC and 46^oC on our machines). Never for more than 1 hour. Never on ischemic skin. Always with a cotton blanket between the hose and the patient.

Anybody see any problems with this? The alternative would be to use a new blanket (at about $8 per patient or over $16,000 per year) for each patient.

George

[Matthew Parsons]

This is a quote from the FDA:

Burns from Misuse of Forced-Air Warming Devices
FDA Patient Safety News: Show #9, October 2002

Forced-air warming systems are often used to maintain normal body temperatures in patients before, during and after surgery. They're an effective way to keep patients warm and prevent complications from hypothermia. These systems deliver heated air through a hose to an inflatable blanket that covers the patient. With the blanket attached, the heated air is evenly distributed across the patient's body.

But serious burns can occur when the hose isn't attached to the blanket. Without the blanket, the heated air can be extremely hot and concentrated at the hose nozzle, and blow directly onto the patient's skin. Burns can also occur if the patient's skin comes in direct contact with the hose surface.

This practice, where forced-air warming is applied without a blanket, is called "hosing" or "free hosing". Hosing has caused first, second and even third degree burns. The most serious report we've received to date describes a burn that resulted in muscle necrosis so severe that that the patient's leg had to be amputated above the knee.

This kind of injury can occur with any forced-air warming system that's supposed to be used with a blanket - but isn't. There are plenty of warnings about the risks of hosing - in manuals, in printed instructions, and on device labels. ECRI has published a Hazard Report specifically warning about this problem. Yet, despite all these warnings, hosing still occurs.

One manufacturer, Augustine Medical, has begun a campaign to help spread the word about the dangers of hosing. The company has developed a web site called "stophosing.com" where you can get more information on hosing and request educational materials like pamphlets, posters and warning labels for hoses. The web site also gives tips to help prevent hosing, such as storing blankets in a location that's close to where they're going to be used.

But the primary message is clear and simple: always use a blanket with forced-air warming.

Augustine Medical has even made a website to promote the use of a blanket with all hot air warming devices. www.stophosing.com

[Therese Huntly]

We also have a high turnover of patients, and most are warmed using hot air warming blankets. The solution is simple. re-use the blanket. As long as they are kept away from contamination and surgical sites, I do not see a problem with re-using these blankets. After all we apply the same blood rpessure cuff to every patient and I doubt they get washed more often than once per week.
;D

[gassleep]

Hi Im the other side of the mask so to speak,Ive trained as an ODP and understand a lot about anaesthesia(GA).Ive posted a good question regarding Dental Ga(GAS) anasthesia.although Ive been working in this field for 12months,Ive still only found 1 anaesthetist who would offer myself Gas induction.Ive read youre discussions on this site and thought maybe you could be the anaesthetist who could explain to me why Gas inductions are always questioned in healthy 35yr old males as in myself.Although there is the cream to numb before iv induction,when I see someone coming at me with an Iv line I tend to panic even with  sedation(oraly).I know a lot of Male and Female patients who say what Im thinking(Can I just have gas to go to sleep?)Maybe its time for anaesthesia to revert back to the old mask inductions.would love to hear your views.Paul