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Over-View of Patient Warming Systems
In the Beginning
Patient warming systems have come a long way from the early days 20 years ago of the first forced warm air blankets.
These early blankets, although better than using no blanket at all, suffered from the possibility of being a good
environment not only for bacteria to grow within the blower unit but also for blowing patient skin around the operating room.
There have been several scientific studies showing that under normal circumstances there are no increases in infection rate
and yet the man who invented the warm air blanket system has recently confirmed everyone’s concerns (1) and stated that
in his opinion “they also blow particles of potentially contaminated skin around the theatre, which poses a potential risk of
MRSA.” He added that “these devices cannot be effectively decontaminated, so their use contravenes the Health Act”.
In addition to these concerns the world’s main manufacturer of forced air warming systems have a separate web site (2)
that exposes the very real dangers of causing patients severe burns if the blankets are either not connected properly or
worse still not connected at all.
Recently several improved forced air warming systems have appeared on the market. However the hosing risk still seems
to exist as does the issue of blowing contaminated particles around the operating theatre. Newer systems are sometimes
fitted with a temperature sensor in the hose but hosing could still occur.
Patient warming systems have come a long way from the early days 20 years ago of the first forced warm air blankets.
These early blankets, although better than using no blanket at all, suffered from the possibility of being a good
environment not only for bacteria to grow within the blower unit but also for blowing patient skin around the operating room.
There have been several scientific studies showing that under normal circumstances there are no increases in infection rate
and yet the man who invented the warm air blanket system has recently confirmed everyone’s concerns (1) and stated that
in his opinion “they also blow particles of potentially contaminated skin around the theatre, which poses a potential risk of
MRSA.” He added that “these devices cannot be effectively decontaminated, so their use contravenes the Health Act”.
In addition to these concerns the world’s main manufacturer of forced air warming systems have a separate web site (2)
that exposes the very real dangers of causing patients severe burns if the blankets are either not connected properly or
worse still not connected at all.
Recently several improved forced air warming systems have appeared on the market. However the hosing risk still seems
to exist as does the issue of blowing contaminated particles around the operating theatre. Newer systems are sometimes
fitted with a temperature sensor in the hose but hosing could still occur.
Modern Patient Warming Technologies
The concerns about suitable patient warming systems have led to other companies to look at alternative methods and
materials to try and achieve controlled warming without the problems associated with warm air blankets. Heated wire
systems will suffer from hot spots especially if the heating wire becomes damaged. Carbon fibre technology is the latest
and most promising. Some manufacturers lay a carbon fibre thread between layers of material and then seal this inside an
insulated blanket or mattress. To date these have been relatively low power systems best suited to reducing further loss
of core body temperature, but not very good at increasing core temperature to 36C or above.
Geratherm, a German manufacturer, has developed a woven carbon fibre heating cloth that seems to have solved all the
problems. The heating cloth is far more powerful than the fibre and current polymer film systems. The cloth, being woven,
it is very pliable and this makes a lightweight blanket that has several layers incorporating insulation and thermal
sensors for safety. The whole Geratherm orange blanket warming system uses only about the same amount of power as
a domestic light bulb in normal use. The blanket exterior is made from a tough cotton fabric that is impregnated with
polyurethane so that it can be disinfected with the same disinfectants that are used for decontaminating operating tables.
This means full compliance with the AAGBI guidelines for disinfection.
Definitely the most important feature of the new Geratherm UniqueTemp system is that it has been shown to transfer
almost twice as much warmth to the patient when compared with forced warm air systems. This means the virtual
elimination of unintended hypothermia and will lead to even better patient outcomes than previously possible.
The area of patient transport and keeping warm between theatre and the ward also rates a mention since it is still part of
the peri operative picture. QED Scientific can supply a battery operated heated blanket that can keep patients warm and
comfortable in all areas of patient transport be it within a hospital, between hospitals or for the emergency services (8).
Nuova, for example, also have a range of in-line warming systems that have no special consumable items at all, suitable
for warming blood and fluids (6)
Legislation
All equipment for warming patients therapeutically is now required to comply, and be registered, to the MDD standard.
Financial Implications
With NICE, on behalf of the NHS, estimating that preventing perioperative hypothermia will cost the NHS an extra £21.6M
in disposable blanket costs alone it is definitely worth remembering that these re-usable blanket systems cost very little
when compared with the annual expenditure on disposable warm air blankets (7). Also see the brief guide to warming (4).
It is also worth noting that to fully implement the NICE guidelines patients should be pre-warmed on the ward, often for up
to 2 hours, in theatre if the period of anaesthesia is longer than 30 minutes, in theatre recovery and also when back on the
ward until such time that core body temperature has fully stabilised.
The concerns about suitable patient warming systems have led to other companies to look at alternative methods and
materials to try and achieve controlled warming without the problems associated with warm air blankets. Heated wire
systems will suffer from hot spots especially if the heating wire becomes damaged. Carbon fibre technology is the latest
and most promising. Some manufacturers lay a carbon fibre thread between layers of material and then seal this inside an
insulated blanket or mattress. To date these have been relatively low power systems best suited to reducing further loss
of core body temperature, but not very good at increasing core temperature to 36C or above.
Geratherm, a German manufacturer, has developed a woven carbon fibre heating cloth that seems to have solved all the
problems. The heating cloth is far more powerful than the fibre and current polymer film systems. The cloth, being woven,
it is very pliable and this makes a lightweight blanket that has several layers incorporating insulation and thermal
sensors for safety. The whole Geratherm orange blanket warming system uses only about the same amount of power as
a domestic light bulb in normal use. The blanket exterior is made from a tough cotton fabric that is impregnated with
polyurethane so that it can be disinfected with the same disinfectants that are used for decontaminating operating tables.
This means full compliance with the AAGBI guidelines for disinfection.
Definitely the most important feature of the new Geratherm UniqueTemp system is that it has been shown to transfer
almost twice as much warmth to the patient when compared with forced warm air systems. This means the virtual
elimination of unintended hypothermia and will lead to even better patient outcomes than previously possible.
The area of patient transport and keeping warm between theatre and the ward also rates a mention since it is still part of
the peri operative picture. QED Scientific can supply a battery operated heated blanket that can keep patients warm and
comfortable in all areas of patient transport be it within a hospital, between hospitals or for the emergency services (8).
Nuova, for example, also have a range of in-
for warming blood and fluids (6)
Legislation
All equipment for warming patients therapeutically is now required to comply, and be registered, to the MDD standard.
Financial Implications
With NICE, on behalf of the NHS, estimating that preventing perioperative hypothermia will cost the NHS an extra £21.6M
in disposable blanket costs alone it is definitely worth remembering that these re-
when compared with the annual expenditure on disposable warm air blankets (7). Also see the brief guide to warming (4).
It is also worth noting that to fully implement the NICE guidelines patients should be pre-
to 2 hours, in theatre if the period of anaesthesia is longer than 30 minutes, in theatre recovery and also when back on the
ward until such time that core body temperature has fully stabilised.
Benefits of Warming Patients
The benefits have been documented by many researchers over the years. (3)
The major benefits to the patient are minimising post operation shivering (seen in 60-80% of patients), a feeling of
greater comfort (98%), reduction in perceived pain and virtual elimination of feeling cold. And reduced mortality!
The major benefits to the hospital are reduced use of antibiotics, more efficient blood clotting, reduced use of platelets
and other blood products by up to 85%, reduce incidence of wound infections by 64%, reduction of intensive care
stay by 43% and shortened hospital stay by 40%. All this adds up to significant savings & improved use of resources.
The benefits have been documented by many researchers over the years. (3)
The major benefits to the patient are minimising post operation shivering (seen in 60-
greater comfort (98%), reduction in perceived pain and virtual elimination of feeling cold. And reduced mortality!
The major benefits to the hospital are reduced use of antibiotics, more efficient blood clotting, reduced use of platelets
and other blood products by up to 85%, reduce incidence of wound infections by 64%, reduction of intensive care
stay by 43% and shortened hospital stay by 40%. All this adds up to significant savings & improved use of resources.
(6) Nuova fluid and blood warmers
(7) What does it cost to warm a patient?
(8) Patient transport warming
(7) What does it cost to warm a patient?
(8) Patient transport warming