Most hospitals would have blanket/fluid warming cabinets in regular use throughout their facility yet, there is a need for more education and studies on their use.
It is a great tool in preventing hypothermia, surgical site infection, improving medicinal effectiveness and much more but there are some things that are often not understood. The unfortunate reality is that the warming cabinets are put into service and often with little or no training. Here are some of the common misconceptions that I run into when making site visits to hospitals.
-Mixing blankets and fluids
Blankets are typically warmed to 150-200 F (65-93C) for most effectiveness. Click Here to view a study conducted on blanket temperatures and effectiveness. Fluids on the other hand cannot sustain these temperatures and will shorten the effective life of the IV solution. Injection fluids are warmed at 104F (40C) while irrigation fluids may be warmed to a maximum of 150F (66C). There will be ill effect on the IV Fluids since the blankets create an additional convection heat that will over warm the fluids and reduce its effectiveness and/or lifespan of the solutions. If you are warming both fluids and blankets, you will need a dual chamber cabinet.
-Over Stuffing the blanket compartment
To ensure that your blankets are evenly warmed, you should leave air space around all edges of the compartment. By over stuffing your blanket compartment you will decrease the warming value of every blanket in the cabinet.
-IV fluid life span
You should refer to the instructions from the supplier of your IV solutions for the longevity of warmed fluid. Fluids cannot remain in the warming cabinet indefinitely without some effect to the solution. Usually it will be good for up to 14 days (depending on manufacturer recommendations and temperature of the cabinet) and then the fluid should be removed from the cabinet and discarded. We recommend that you train all staff to "Take from the front" and "supply to the back" however if you don't use a lot of fluids regularly, it is suggested to not use the warming cabinet for storage . It is important to implement a system so that fluids do not remain in the warming cabinet for longer than what is specified by the IV supplier. Higher temperatures will decrease lifespan faster.
-Not all fluids are warmed equally
Hence the reason for a three chamber cabinet. When you have more than one type of solution that you would like to warm, it is possible that it may call for two different temperatures to achieve the greatest value from the process of warming. In this case, you will need to separate the fluids into two chambers that have independent temperature control for each.
-How accurate is the temperature management
I can't count the amount of times I have seen the sign taped to the old warming cabinet stating that "Blankets will catch fire on bottom shelf". This is a disturbing thought, especially if fluids are being kept in this cabinet. Current warming devices are regulated to +/- 2 F so that you know what you are offering the patient and that your fluids are not spoiled due to overheating. Additionally, it takes temperature exceeding 250F to start a blanket smoldering which is way above recommendations. If that is the temperature of the bottom shelf; what temperature are the remaining shelves?
In a world where litigation is only one incident away, warming cabinets are just another area that closer attention to detail is needed. Older cabinets often have no data logging abilities and/or alarms for product malfunction. Every new cabinet we offer today has this option but the more advanced models now offer network ready systems that automatically monitor and report on the cabinet function. This is a feature that the early adopters have found very useful and provides a peace of mind. In addition to data logging, it is also a very good idea to document a first-in-first-out policy for fluids being replenished and used from the cabinet.
In summary, warming cabinets have a great clinical benefit however, it is worth taking the time to make sure that your team is aware of these few simple tips and to make sure that the cabinets are used as recommended.