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Thermal injury due to use of a forced air warming blanket during paediatric surgery
G Model
ACCPM-111; No. of Pages 1 Anaesth Crit Care Pain Med xxx (2016) xxx–xxx
Letter to the Editor Thermal injury due to use of a forced air warming blanket during paediatric surgery
A R T I C L E I N F O
Keywords: Paediatrics Thermal burns Warming blanket
Maintenance of normal body temperature (normothermia) is a realistic goal for surgical patients. Hypothermia can cause serious complications and has been associated with adverse effects on body systems and functions, including shivering, prolonged recovery time, altered drug metabolism, pressure sores, increased hospital stays, and even increased mortality and morbidity. Therefore, warming devices are routinely used during anaesthesia to keep patients normothermic. We report the case of an 11-yearold boy who underwent thermal injury from a Bair Huggerß forced air warming unit and blanket during surgery (circumcision). The 11-year-old boy presented for circumcision without any remarkable past medical history. After mask induction and intubation, a ‘‘Pediatric Upperbody’’ Model 55501 Bair Huggerß warming blanket was placed around the patient from the umbilicus towards the arms and neck and attached to a Bair Huggerß 775 forced air warming unit. For about 15 minutes, the warming unit was set at high (43 8C), and trans-nasal temperature monitoring was implemented during the operation. Surgery was performed without complications. Intra-operative monitoring of the patient’s vital signs revealed stable blood pressure (around 117/88 mmHg) and heart
rate (around 88 b/min). Temperature varied between 36.5 and 37.2 8C. After removal of the drapes, burns on the skin of the chest and both arms were noted. After extubation, the patient’s burns were observed in the recovery room without any medical or surgical intervention, and the burns healed remarkably after 48 hours without any scarring. Evaluation of the warming unit by a biomedical technician revealed the unit to be functioning properly (Fig. 1). Warnings about the risk of improperly using forced air warming systems are provided in operating manuals, service manuals, printed instructions, and on the device labels. Forced air warming systems are routinely used during surgery to keep patients warm and prevent complications from hypothermia. However, when perioperative practitioners do not follow instructions or use the system without attaching the blanket to the hose, the warm airflow is concentrated on one area of the patient’s body and burns have occurred. As per our report, the patient was previously healthy without any risk factors or family history, presenting for a short surgical procedure (15 min) limiting skin exposure to the forced air warming. Our patient’s thermal injury was likely due to the absence of an isolator between the skin and blanket, combined with using the high setting (43 8C) for the warming unit. Anaesthesiologists must read the instructions included with forced air warming devices and must be familiar with the risk of thermal injury from their use in patients such as ours. Monitoring the patient’s temperature per the instructions of use is important for maintaining safety. Appropriate steps should be taken to minimize the potential for this injury, such as adequate placement of the warming blanket and limiting the maximum temperature setting to 38 8C. Lastly, should injury occur, consultation with a burn specialist should be obtained and the considered conservative management should be performed. Forced air warming is an effective way to prevent and treat hypothermia in surgical patients. However, the improper use of these warming systems can cause serious harm to patients and create legal liability for the practitioner and institution. Disclosure of interest The authors declare that they have no competing interest. Hazem Kafrouni, Ziad Fadel* Saint-Georges hospital university, medical center SGHUMC, Beirut, Lebanon *Corresponding author E-mail addresses: [email protected] (H. Kafrouni), [email protected] (Z. Fadel)
Fig. 1. Thermal injury.
Received 19 October 2015 Received in revised form 8 November 2015 Accepted 22 November 2015 Available online xxx
http://dx.doi.org/10.1016/j.accpm.2015.11.003 2352-5568/ß 2016 Socie´te´ franc¸aise d’anesthe´sie et de re´animation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Kafrouni H, Fadel Z. Thermal injury due to use of a forced air warming blanket during paediatric surgery. Anaesth Crit Care Pain Med (2016), http://dx.doi.org/10.1016/j.accpm.2015.11.003
ACCPM-111; No. of Pages 1 Anaesth Crit Care Pain Med xxx (2016) xxx–xxx
Letter to the Editor Thermal injury due to use of a forced air warming blanket during paediatric surgery
A R T I C L E I N F O
Keywords: Paediatrics Thermal burns Warming blanket
Maintenance of normal body temperature (normothermia) is a realistic goal for surgical patients. Hypothermia can cause serious complications and has been associated with adverse effects on body systems and functions, including shivering, prolonged recovery time, altered drug metabolism, pressure sores, increased hospital stays, and even increased mortality and morbidity. Therefore, warming devices are routinely used during anaesthesia to keep patients normothermic. We report the case of an 11-yearold boy who underwent thermal injury from a Bair Huggerß forced air warming unit and blanket during surgery (circumcision). The 11-year-old boy presented for circumcision without any remarkable past medical history. After mask induction and intubation, a ‘‘Pediatric Upperbody’’ Model 55501 Bair Huggerß warming blanket was placed around the patient from the umbilicus towards the arms and neck and attached to a Bair Huggerß 775 forced air warming unit. For about 15 minutes, the warming unit was set at high (43 8C), and trans-nasal temperature monitoring was implemented during the operation. Surgery was performed without complications. Intra-operative monitoring of the patient’s vital signs revealed stable blood pressure (around 117/88 mmHg) and heart
rate (around 88 b/min). Temperature varied between 36.5 and 37.2 8C. After removal of the drapes, burns on the skin of the chest and both arms were noted. After extubation, the patient’s burns were observed in the recovery room without any medical or surgical intervention, and the burns healed remarkably after 48 hours without any scarring. Evaluation of the warming unit by a biomedical technician revealed the unit to be functioning properly (Fig. 1). Warnings about the risk of improperly using forced air warming systems are provided in operating manuals, service manuals, printed instructions, and on the device labels. Forced air warming systems are routinely used during surgery to keep patients warm and prevent complications from hypothermia. However, when perioperative practitioners do not follow instructions or use the system without attaching the blanket to the hose, the warm airflow is concentrated on one area of the patient’s body and burns have occurred. As per our report, the patient was previously healthy without any risk factors or family history, presenting for a short surgical procedure (15 min) limiting skin exposure to the forced air warming. Our patient’s thermal injury was likely due to the absence of an isolator between the skin and blanket, combined with using the high setting (43 8C) for the warming unit. Anaesthesiologists must read the instructions included with forced air warming devices and must be familiar with the risk of thermal injury from their use in patients such as ours. Monitoring the patient’s temperature per the instructions of use is important for maintaining safety. Appropriate steps should be taken to minimize the potential for this injury, such as adequate placement of the warming blanket and limiting the maximum temperature setting to 38 8C. Lastly, should injury occur, consultation with a burn specialist should be obtained and the considered conservative management should be performed. Forced air warming is an effective way to prevent and treat hypothermia in surgical patients. However, the improper use of these warming systems can cause serious harm to patients and create legal liability for the practitioner and institution. Disclosure of interest The authors declare that they have no competing interest. Hazem Kafrouni, Ziad Fadel* Saint-Georges hospital university, medical center SGHUMC, Beirut, Lebanon *Corresponding author E-mail addresses: [email protected] (H. Kafrouni), [email protected] (Z. Fadel)
Fig. 1. Thermal injury.
Received 19 October 2015 Received in revised form 8 November 2015 Accepted 22 November 2015 Available online xxx
http://dx.doi.org/10.1016/j.accpm.2015.11.003 2352-5568/ß 2016 Socie´te´ franc¸aise d’anesthe´sie et de re´animation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Kafrouni H, Fadel Z. Thermal injury due to use of a forced air warming blanket during paediatric surgery. Anaesth Crit Care Pain Med (2016), http://dx.doi.org/10.1016/j.accpm.2015.11.003