On any given day, at any given surgical facility, patients who are wheeled into the OR will remark that it's cold. There's no doubt about that: it tends to be a cold room. But while waking up shivering after surgery is a miserable experience, the risks carried by even mild perioperative hypothermia are even worse: higher incidences of surgical bleeding and post-op infection as well as delayed recoveries.

If you're in the market for patient warming devices to avoid these outcomes, there are three main issues to evaluate before you make your purchasing decision: cost, features and efficiency. Here are some insights into those areas.

1. Cost
Discussing the cost of a patient warming system can be a little complex, but we can break it down into two components. The first component to consider is the acquisition cost for the warming unit itself. The second is the cost of any disposable accessories that the system uses, if applicable. For instance, the commonly used convective (or forced air) warming systems employ single-use blankets to warm patients. For newer, non-convective systems with durable, reusable polymer or liquid-filled thermal pads, though, the warming unit is the only issue.

If you belong to a purchasing alliance, be sure to check with your materials manager to find out if you're under any contractual purchasing obligations or restrictions. This may impact your choice of warming system. That having been said, the cost of systems that include both the warming unit and disposables are open to negotiation. Typically, manufacturers will grant the user a reduced price on the warming unit if the buyer agrees to use a specific threshold number of disposables. Often that number is calculated from your monthly or quarterly caseload.

Your estimated caseload also typically places you in the disposables' tiered pricing system: high-volume disposable users can get a reduced price on the blankets, and the manufacturer may even agree to supply the warming units at no cost. The manufacturers' representatives usually have some latitude in this area, so it's worth the effort to negotiate with them for a good price.

Make sure you find out ahead of time what happens if you miss your threshold number for disposable purchases. Ideally, you wouldn't be penalized on a monthly basis, but would have a six-month rolling average to reach that number. If, however, you find that you're buying more than you originally estimated, be sure to renegotiate your price.

Depending on your volume, you might expect to pay anywhere from $5 to $14 per disposable blanket. If you use any volume at all, you're probably going to be able to net a low price, and purchasing alliances can get you a really low price. Keep in mind that whatever you're paying, it's less than what you'll pay for a patient's longer stay in PACU or for treatment of hypothermic complications.

2. Features
The second issue to consider is the warming unit's size and weight, ease of use and specific features. This is the area where you really have the opportunity to tailor the purchase to your facility's specific needs.

Size and weight will play an important role in the unit's mobility if you're looking to continuously warm the patient throughout the perioperative process as he moves between care delivery areas. Many warming units have casters or can be mounted to IV poles or other stands. Some feature a battery-powered mode, which frees them from electrical outlets during transport.

Of course, simple and clear user controls are a plus. Most units have a simple keypad interface for setting temperature and fan speed. Most feature alarms to alert clinicians to unsafe temperature levels; they should be clear and audible to your staff. Also on the safety front, make sure that it's easy to connect the unit's hose to the warming blanket and that, once joined, the two components stay joined to prevent accidental burns.

One area of operation that's easily overlooked but very important to surgical personnel is the amount of noise that the warming unit generates during use. There is significant variability across the market with regards to the noise levels generated, so it's definitely worthwhile to listen carefully to a unit in operation before you buy.

Find out the full complement of features the systems you're considering offer. Some include special filters to reduce particulates and potential contaminants driven through the disposable blanket, others offer cooling functions for when that's clinically indicated. You may want to weigh such additional features into your decision.

3. Efficiency
A patient warming system's cost and features won't do you any good if your patients still complain that they're cold. Carefully consider the ability of a unit to deliver heat to the patient efficiently, keeping in mind that the unit that's able to produce the highest temperature isn't necessarily the one that transfers it most effectively.

There is some variability with regards to heat delivery from different manufacturers' warming units and disposable warming blankets. Fortunately, some solid clinical research comparing the major manufacturers and technologies has been published in the anesthesia literature, so with just a little bit of homework it's fairly easy to compare the efficiency of different units' heat delivery. Each manufacturer should also be able and willing to provide you with the data on its own equipment.

Let's not forget safety
In closing, I would like to emphasize the importance of safe patient warming. Safety comes from proper assembly and use according to manufacturers' directions. Forced air warming units, in particular, are designed and engineered for use with their manufacturers' warming blankets. The use of the unit's hose without the disposable blanket exposes the patient to a significant burn risk, and should be in all instances discouraged.

Adroit Medical Systems
HTP-1500
(800) 267-6077
www.adroitmedical.com
Price: Not disclosed
FYI: Adroit Medical's HTP-1500 uses tap water to provide continuous, low-level heat therapy up to 107?? ?F for effective drug-free pain relief, says the company. It can also be used to safely increase circulation in diabetic limbs. The system can be used in surgical settings or prescribed for home use. Available accessories include a five-leg stand and an IV pole mount. A lifetime warranty is included.

Arizant Healthcare
Bair Paws System
(800) 733-7775
www.bairpaws.com
Price: Varies depending on product kit configuration
FYI: A single Bair Paws gown can pre-warm before surgery, then travel with the patient and provide clinical warming for select surgical procedures when connected to a Bair Hugger warming unit. The gown continues to warm in PACU. The Bair Paws system's patient-adjustable warming lets patients adjust the temperature of the air flowing through the gown to a level that's right for them, says the company.

Covidien
WarmTouch Patient Warming System
(800) NELLCOR
www.nellcor.com
Price: $850
FYI: This convective air warming system provides a convenient, cost-effective way to maintain normothermia, says the company. The quiet warming unit features a rapid warmup, a high airflow rate and a "boost" setting to quickly manage core body temperatures. The blankets, made from strong, two-ply quilted material that is fluid-resistant as well as tear- and puncture-resistant, are easy to drape and comfortable against patients' skin.

Enthermics Medical Systems
Enthermics Blanket and Fluid Warmers
(800) TO-B-WARM
www.enthermics.com
Price: Not disclosed
FYI: Enthermics' blanket and fluid warmers are supported by the company's WarmRight technology: the right temperature for the right product. Three different warming environments allow blankets to be warmed to 200?? ?F, irrigation fluids to 150?? ?F and injection fluids to 110 ?F. The company's warming cabinets are available in a variety of configurations and sizes, with interior chambers ranging from 2.3 cubic feet to 21.8 cubic feet.

Gaymar Industries
Thermacare
(800) 828-7341
www.gaymar.com
Price: Blower unit, $1,200 to $1,500; single-use blankets, $6 to $8 each
FYI: This force-air patient-warming system comes with disposable blankets in dimensions to accommodate all patients. The hose attachment method is easy to use and secure, and the lightweight blower unit offers multiple temperature settings and can be mounted on an optional stand or IV pole for portability over floor use, says the company.

Inditherm Medical
Inditherm Alpha
+44 (0) 1709 761000
www.inditherm.com/medical
Price: Not disclosed
FYI: Inditherm Medical describes its pre-op, OR and PACU patient warming system, which uses the company's patented flexible polymer technology, as "revolutionary." Clinical trials have shown that the system outperforms traditional warming methods while also providing pressure relief for the patient, says the company. The system is reusable for cost savings.

Kimberly-Clark Health Care
Kimberly-Clark Patient Warming System
(800) KC HELPS
www.kcpatientwarming.com
Price: Not disclosed
FYI: Kimberly-Clark's Patient Warming System consists of a small, portable, easy-to-use control unit that allows precise automated or customizable patient temperature management in circulating heated water through single-use, non-slip, hydrogel thermal pads placed directly on the patient's body surfaces to conduct heat directly through the skin, says the company.

KLIMAmed AG
KLIMAmed Patient Warming System
011-41-71-677-3000
www.klimamed.ch
Price: Not disclosed
FYI: This silicone gel-filled thermal mat designed to prevent perioperative hypothermia is durable and can be reprocessed with clinical detergents or steam autoclaves, says the company. Its radiolucence and the ability to attach to an IV stand, OR table or any tubular structure let it move with a patient through the surgical process.

LMA North America
LMA PerfecTemp
(800) 788-7999
www.lmana.com
Price: $9,810
FYI: LMA's PerfecTemp system replaces existing OR table pads to easily warm every patient, says the company. A heating element sandwiched between viscoelastic foam layers warms patients on contact while reducing pressure, with temperature continuously monitored. The product is durable, easy to clean and radiolucent.

MAC Medical
Blanket and Fluid Warmers
(877) 828-9975
www.macmedical.com
Price: $3,400 to $7,400
FYI: MAC Medical's blanket and fluid warming cabinets are available in a variety of different and custom sizes, from countertop units to double- and triple-chambered units with independent digital temperature controls for each chamber, as well as with a range of options that include temperature lockouts, data loggers, stainless steel or glass doors, door locks, and left- or right-hand side hinges.

Pedigo Products
P-2145 Blanket and Fluid Warmer
(800) 822-3501
www.pedigo-usa.com
Price: $14,038
FYI: Pedigo's dual-chambered P-2145 Blanket and Fluid Warmer uses electrothermal radiant heat to safely warm blanket and irrigation or injection fluids, says the company. Fully insulated, it features windowed doors, an LED display and independent temperature controls for each compartment. The lower blanket chamber has an interior volume of 11.9 cubic feet, while the upper fluid chamber has a maximum capacity of 30 one-liter bottles or their equivalent.

Progressive Dynamics Medical
Soft Flex Patient Warming Cover
(269) 781-4241
www.progressivedynamicsmedical.com
Price: $5.30 to $12.75 per blanket
FYI: Progressive Dynamics Medical's Soft Flex Patient Warming Covers are designed to efficiently and effectively warm the patient before, during and after surgery. The controlled convective warming process of the covers combats hypothermia while comforting the patient and providing faster recovery with fewer complications.

Smiths Medical
Level 1 ConductiTherm Warming System
(800) 848-1757
www.smiths-medical.com
Price: $6,000
FYI: Smiths Medical's Level 1 ConductiTherm Warming System uses a patented flexible carbon polymer to cost-effectively warm perioperative patients. Simply turn it on and set the temperature, and every patient put onto the mattress or under the blanket will experience warmth.