Post on 02-Jul-2021
Level 1® Temperature Management
Managing Normothermia
Normothermia management : Critical aspect in patient handling
General Anesthesia prevents vaso-constriction of the blood vessels which normally helps retain blood heat. As a result, the patient’s heat is redistributed and decreases core temperature, below 36°C.
Administration of cold intravenous and / or irrigation fluids results in heat loss.
Radiation: All surfaces above absolute zero radiate heat. Therefore patients radiate heat into the surrounding environment.
Convection: Surgical settings exchange air more often than normal settings which makes patients feel colder.
Conduction: Patients in contact with cool surfaces, such as surgical procedure tables, transmit body heat to those surfaces. Wound irrigation and the administration of cold fluids also produces conduction effects.
Evaporation: This typically occurs when sterile preparation solutions are applied. Evaporation losses from surgical wounds may contribute to heat loss as well.
Surgery and Anesthesia: Reasons for heat loss
4 mechanisms of heat loss adversely affect the patient’s core temperature
0
-1
-2
-3
Elapsed Time (hr)
Phase I Redistribution0-1 hr Rapid DecreaseThermal RedistributionCore to periphery
Cor
e Te
mpe
ratu
re (C
°)
0 2 4 6
Phase II Heat Loss1-3 hrs Linear ReductionFrom Periphery toEnvironment
Phase III Steady State3-6 hrs Plateau
Stages of Unintended Perioperative Hypothermia1
p. 3Temperature Management
Normothermia management : Critical aspect in patient handling
Core hypothermia: Main consequences1
Stress and greater pain
Increased risk of myocardium ischaemia
Increased oxygen consumption
Coagulopathy and bleeding
Higher wound infections
Longer recovery time
Prolonged hospital stays and increased health expenditures
Research has demonstrated a correlation between UPH and a higher incidence of adverse events in surgical patients with core temperatures outside the normal range.2
RESULTS OF A 200-PATIENT MULTICENTER TRIAL
Normothermia group - 104 patients / Hypothermia group - 96 patients
In the normothermia group, only 6 of the 104 patients experienced surgical-wound infections.
In contrast, the hypothermia group had a 3-fold increase in this type of infection with 18 out of 96 patients experiencing surgical-would infections.
Patients in the normothermia group were discharged from the hospital after an average of 12.1 days.
Patients in the hypothermia group stayed in the hospital approximately 2.6 days (21%) longer with an average of 14.7 days of hospital stay.
15
10
5
0
12.1
14.7
NormothermiaHypothermia
Days of Hospitalisation
25%
20%
15%
10%
5%
0%
6%
19%
NormothermiaHypothermia
Surgical Wound Infection (%)
A META-ANALYSIS FOUND THAT ADVERSE OUTCOMES FROM UNINTENDED HYPOTHERMIA
RESULTED IN PROLONGED HOSPITAL STAYS AND INCREASED HEALTH EXPENDITURES BY
$2,500 TO $7,000 PER PATIENT. 3
p. 4 Temperature Management
Level 1®
PERFORMANCE AND CONTROL, AT ANYTIME
• The Equator® convective warmer maintains patient normothermia and provides thermal comfort before, during and after surgery, in Emergency room and ICU
• Patented hose-end temperature control facilitates consistent temperature of delivered air
• Delivered air temperature is displayed on Equator® convective warmer screen
Equator® - convective warmerIdeal system designed to regulate patients core temperature, in complete safety
High temperature alert (visual and sound)
Low temperature alert (visual and sound)
Disconnection alert Hose and/or sensor (visual and sound)
Off
On
Temperature selection
Delivered temperature
SAFETY AND EFFICIENCY
• Over temperature, under temperature and disconnect/occlusion alarms ensure accurate warming delivery to your patients
• Disconnection alert shuts down warmer
• Patented hose-end openings maintain air flow if the hose end is ever occluded by blanket material
OPTIMAL THERMAL REGULATION
• Equator® convective warmer self regulates flow rate, along with temperature selection
• High warming performances which help in preventing consequences of hypothermia, increasing patients comfort, decreasing stays in recovery room
p. 5Temperature Management
Temperature Management
Snuggle Warm® patient warming blanketsSoft and resistant blankets
SWU-2113Underbody blanket with arm openings
BLANKETS FOR ADULTS BLANKETS FOR NEONATES AND PEDIATRIC
SWU-2001Full body blanket
SWU-2003Upper body
blanket
SWU-2004Lower body
blanket
SWU-2007Tube
blanket
SWU-2008Sterile cardiac
blanket
SWU-2010Small upper body
blanket
SWU-2013Adult underbody
blanket
SWU-2014LLeft lateral access
blanket
SWU-2014RRight lateral access
blanket
SWU-2016Full body split access
blanket
SWU-2018Multi-access
blanket
SWU-2119Poncho blanket with
arm openings
SWU-2002Pediatric full body blanket
SWU-2009Neonates underbody
blanket
SWU-2011Pediatric full body
blanket
Snug
gle
War
m®
2 6
f7
40-7000
-64A
30-4726
Snug
gle
War
m®
2 6
f7
40-7000
-64A
30-4726
Snuggle Warm®26
f740-7000-64A
30-4726
PERFORMING AND COMFORTABLE BLANKETS
• Made of soft fabric-like material, resistant to tears, punctures and fluids
• Wide variety of patient positioning and surgical access needs providing you with numerous options for warming your patients
Convective warmer
Code Description Qty
EQ-5000 Equator® Convective warmer
Accessories
SW5-HOSE-7 Hose (2,3m)
SC-5000 Clip
S0950312 Trolley
Adapters
Snuggle Warm® patient warming blankets can be used with blowers different from the Equator® convective warmer. Contact your Smiths Medical Sales Representative for more information.
Snuggle Warm® patient warming blankets
Code Description Qty
SWU-2001 Adult – Full body blanket
SWU-2002 Pediatric - Full body blanket
SWU-2003 Adult – Upper body blanket
SWU-2004 Adult – Lower body blanket
SWU-2007 Adult – Tube blanket
SWU-2008 Adult - Sterile cardiac blanket
SWU-2009 Neonates – Underbody blanket
SWU-2010 Adult - Small upper body blanket
SWU-2011 Pediatric - Full blanket
SWU-2013 Adult - Underbody blanket
SWU-2014L Adult - Left lateral access blanket
SWU-2014R Adult - Right lateral access blanket
SWU-2016 Adult - Full body split access blanket
SWU-2018 Adult - Multi-access blanket
SWU-2113 Adult - Underbody blanket with arm openings
SWU-2119 Adult – Poncho blanket with arm openings
p. 6 Temperature Management
Level 1®
Alerts and alarms
HOTLINE®- Fluid warmerNormothermic Infusions, up to 5 liters/hour
Disposable set up: Patient line must be oriented to the bottom
Warming solution temperature is displayed on the screen
Alarms and alerts LEDs
PERFORMANCE
• 3 lumen tubing provides even heating for normothermic fluid delivery
SAFETY AND EFFICIENCY
• Warming solution temperature is displayed on the screen
• Visual and sound alerts/alarms
EASY TO USE
• 1 dedicated disposable
• Easy & quick warmer set up
• Annual maintenance
1. Green: Warmer is OK2. Orange: Check disposable
connection3. Orange: Warming solution level
below minimum4. Red: Over-heating of warming
solution (>43°C) Warming solution stops circulating
1
2
3
4
p. 7Temperature Management
Temperature Management
Fluid warmer
Code Description Qty
HL-90 HOTLINE® - HL90
Disposables and accessories
L-70NI 3 lumen tubing for HOTLINE® - HL90
PC-8 Extension tubing with T connection - 20 cm
L-10 Gas vent for L-70NI tubing
Fluids temperature - measured with L-70NI, at patient side Homogenous fluid warming all along patient line
20
22
24
26
28
30
32
34
36
38
40
42
44
50 250
500
750
1000
1250
1500
2000
2500
3000
3500
4000
4500
5000
Soluté à 10°C
Soluté à 20°C
Flow Rate ml/h
Tem
pera
ture
°C
Fluid at 10°C
Fluid at 20°C
Source: HOTLINE® Blood and Fluid Warmer Operator’s Manual, HL-90, PN 40-7049-51A
Source: Internal study
Internal lumen for infused fluid
External lumens for warming solution
Luer-lock connection at patient side
L-70NI DISPOSABLE
p. 8 Temperature Management
Level 1®
Level 1® H-1025-Fast Flow Fluid WarmerWarmer Patients. Better Outcomes
The Level 1® H-1025 High-Flow fluid warming devices and disposable administration sets allow a rapid administration of heated fluids such as crystalloid solutions or blood products (e.g. red blood cells for volume replacement in patients with postpartum hemorrhage). In cases of surgical interventions, the fluid warmer also ensures rapid administration of heated fluids for warming patients – performed by your trained medical staff.
AUTOMATED PRESSURE CHAMBERS
• Accommodates blood and crystalloid bags up to 1 liter
• Provides constant pressure of 300 mmHg
• Fast and easy bag changes
ALUMINUM HEAT EXCHANGER
• Heat transfers 1000 times faster than plastic4
• Counter-current fluid technology promotes effective and stable heating at 42°C
• Re-circulating solution isolated from intravenous fluid path
Intended for warming performance during your most challenging procedures:
• Trauma
• Major Surgery
• Aneurysms (AAA)
• Liver Transplants
• Open Heart
• Orthopedic
• Labor & Delivery
• Burn O.R.
Fast Flow Fluid Warmer
Code Description Qty
H-1025 Fast Flow Fluid Warmer
Disposables
DI-50 Disposable Normothermic IV Administration Set
DI-60HL Disposable Normothermic IV Administration Set with insulated patient line
DI-100 Disposable Normothermic IV Administration Set
DI-300 Disposable Normothermic IV Administration Set
Accessories
F-10 & F-30
Degassing System with 170 μ Particle Filter for replacement filters DI-50, DI-60HL, DI-100 & DI-300
PF-1 Pre-filter 340 μ
Y-30 High Flow Y extension
X-36 High Flow extension line
SC-3 High Flow 3-way stopcock
60
p. 9Temperature Management
Temperature Management
DI-50
DI-100
• Filter Size: 170 micron
• Priming Volume: 56 ml
• Normothermic (35-41°C) Fluid Delivery Range 10°C Input: 40 ml/min. to 300 ml/min. 20°C Input: 40 ml/min. to 400 ml/min.
• Maximum Flow Rate: 500 ml/min. (crystalloid, 300 mmHg, 14g catheter)
• Filter Size: 170 micron
• Priming Volume: 65 ml
• Normothermic (35-41°C) Fluid Delivery Range 10°C Input: 30 ml/min. to 650 ml/min. 20°C Input: 30 ml/min. to 950 ml/min.
• Maximum Flow Rate: 950 ml/min. (crystalloid, 300 mmHg, 8.5 F catheter)
DI-60HL
• Filter Size: 170 micron
• Priming Volume: 74 ml
• Normothermic (35-41°C) Fluid Delivery Range 10°C Input: 75 ml/hr. to 530 ml/min. 20°C Input: 75 ml/hr. to 530 ml/min.
• Maximum Flow Rate: 530 ml/min. (crystalloid, 300 mmHg, 8.5 F catheter)
• Filter Size: 170 micron
• Priming Volume: 90 ml
• Normothermic (35-41°C) Fluid Delivery Range 10°C Input: 30 ml/min. to 650 ml/min. 20°C Input: 30 ml/min. to 1100 ml/min.
• Maximum Flow Rate: 1400 ml/min. (crystalloid, 300 mmHg, 8.5 F catheter)
DI-300
Disposables
Automated Pressure Chambers
Aluminium Heat Exchanger
p. 10 Temperature Management
Level 1®
NORMOFLO® Irrigation fluid warmer
The Level 1® NORMOFLO® fluid warming device is designed to warm irrigating fluids during clinical scenarios such as urology and gynecology procedures. Thus, it is an important tool for infusing normothermic fluids and helping prevent Unintended Perioperative Hypothermia (UPH).
REDUCE BLEEDING, SPEED RECOVERY TIMES AND LOWER INFECTION RATES
The Level 1® NORMOFLO® fluid warming device delivers large volumes of body temperature irrigation at optimum flow rates.
This innovative system helps you effectively maintain your patients’ core temperature during the entire length of the procedure. Minimizing hypothermia has been shown to reduce bleeding, speed recovery and lower infection rates. 2,5
NO CHANGE IN SURGICAL TECHNIQUE
The Level 1® NORMOFLO® irrigation fluid warmer delivers a clear, bubble-free field of vision, which assists surgeons to operate with confidence and with no change in surgical technique. It easily interfaces with standard surgical tools, hand pieces, scopes and specialized pumps to provide consistently safe performance that helps improve patient comfort and delivers better outcomes.
EASY TO SET UP AND USE
The model H-1100 fluid warmer is intended for gravity flow procedures and features an electrically-operated IV pole that can automatically lift up to four 3-liter bags at the touch of a button.
WHY SHOULD IRRIGATING FLUID BE WARMED?
Administration of fluids ambient temperature causes a decrease in core body temperature6-15. Potential consequences of UPH include coagulopathy, patient discomfort and cardiac events.
The use of non-warmed irrigation fluid in patients undergoing transurethral prostatectomy (TURP) has been shown to impact hemodynamic variables, including increased mean arterial pressure, systemic vascular resistance, bradycardia and decreased stroke volume.9 TURP patients who were given warmed irrigation fluids showed a stable hemodynamic response.9
Irrigation Fluid Warmer
Code Description Qty
H-1100 NORMOFLO® irrigation fluid warmer
Disposables and accessories
IRI-600 Irrigation set
IRI-600B Irrigation set for Baxter bag
PL-6 Replacement line for IRI-600
USAGE OF NORMOTHERMIC IRRIGATING FLUIDS ALLOWS YOU TO:
• Maintain patient core body temperature 6-14
• Limit bleeding 8,11,16
• Provide stable cardiac function 7,8,12,13,15
p. 11Temperature Management
Temperature Management
Green: the fluid warmer is operating
Orange: the disposable set is not properly installed
Orange: additional recirculating solution must be added to the reservoir
Red: recirculating solution is over the acceptable temperature for safe use Warming solution stops circulating
Warming solution temperature
Clear field of vision of irrigation tubing
Power pole, up to 2m54
Extension tubing connecting to the endoscope - no change in surgical procedure
Heat exchanger for heating of fluids during the procedure
Gas vent for improved visibility
Highly visible operating status
Temperature monitoringFollowing induction of anesthesia, patient core temperature can drop 1.6°C within the first hour.16 Thus, core temperature control is a major element in patient handling. It is crucial when it comes to early diagnosis of hypothermia, hyperthermia and malignant hyperthermia.
Smiths Medical offers a wide range of single use Temperature probes, for every usage:
• General purpose probe
• Temperature-Sensing Foley catheter
• Esophageal stethoscope
• Skin temperature sensor
• Tympanic temperature sensor
Esophagus
Tympanic
Bladder
Rectum
Skin
Nasopharynx
Level 1® temperature monitoring placement sites
Every Smiths Medical probe is made with the same monitor plug, homogeneous connection.
General purpose probe Esophageal Stethoscope
Tympanic Temperature Sensor Skin Temperature Sensor
Temperature- Sensing Foley Catheter
p. 13Temperature Management
Temperature Management
General Purpose Probes
Temperature is sent to monitor with 400 series reusable cable
PVC Tube
Tapered distal tip for atraumatic insertion
Temperature sensor at distal tip is designed to ensure exceptional device accuracy
Esophagus
Rectum
Nasopharynx
General purpose probes – Single use
Code Description Size
ER400-9 General purpose probe – YSI 400 sensor 9F (Pediatric)
ER400-12 General purpose probe – YSI 400 sensor 12F (Adult)
p. 14 Temperature Management
Level 1®
Temperature-Sensing Foley catheter
Bladder
Temperature-Sensing Foley catheter – Single use
Code Description Size Qty
FC400-8 Temperature-Sensing Foley catheter – YSI 400 sensor 8F (Pediatric)
FC400-10 Temperature-Sensing Foley catheter – YSI 400 sensor 10F (Pediatric)
FC400-12 Temperature-Sensing Foley catheter – YSI 400 sensor 12F (Adult)
FC400-14 Temperature-Sensing Foley catheter – YSI 400 sensor 14F (Adult)
FC400-16 Temperature-Sensing Foley catheter – YSI 400 sensor 16F (Adult)
FC400-18 Temperature-Sensing Foley catheter – YSI 400 sensor 18F (Adult)
Temperature is sent to monitor with 400 series reusable cable
100% silicone construction eliminates risk of latex sensitivity reactions
Tapered distal tip for atraumatic insertion
Uniform cuff ensures optimal positioning and securement
Inflate cuff
Urine bag connection
Large catheter eyeholes maximize urine flow
Temperature sensor at distal tip is designed to ensure exceptional device accuracy
p. 15Temperature Management
Temperature Management
Esophageal Stethoscope
Esophageal Stethoscope - Single use
Code Description Size Qty
ES400-9 Esophageal Stethoscope – YSI 400 sensor 9F (Pediatric)
ES400-12 Esophageal Stethoscope – YSI 400 sensor 12F (Adult)
ES400-18 Esophageal Stethoscope – YSI 400 sensor 18F (Adult)
ES400-24 Esophageal Stethoscope – YSI 400 sensor 24F (Adult)
Esophagus
Temperature is sent to monitor with 400 series reusable cable
Transparent PVC tube
Male luer allows convenient attachment to standard acoustical earpieces
Tapered distal tip for atraumatic insertionSmooth, heat-bonded cuff to tube
transition minimizes potential for esophageal irritation
Temperature sensor at distal tip is designed to ensure exceptional device accuracy
p. 16 Temperature Management
Level 1®
Skin Temperature Sensor
Skin
Skin Temperature Sensor - Single use
Code Description Size Qty
STS-400 Skin Temperature Sensor – YSI 400 sensor Adult and pediatric
Temperature is sent to monitor with 400 series reusable cable
Mylar® backing reflects operating room lighting and insulates sensor
Embedded sensor lies flat against patient’s skin for more reliable monitoring
p. 17Temperature Management
Temperature Management
Tympanic Temperature Sensor - Single use
Code Description Size Qty
TTS-400 Tympanic Temperature Sensor – YSI 400 sensor Adult and pediatric
Tympanic Temperature Sensor
Tympanic
Temperature sensor is recessed into two pieces of memory foam, which keeps the sensor in place and insulates from ambient conditions
Push tube aids insertion and acts as stain relief on lead wire
Temperature is sent to monitor with 400 series reusable cable
p. 18 Temperature Management
Level 1®
Temperature Monitoring Reusable Cables
Complete list of compatible monitors. Contact your Smiths Medical Sales Representative for more information.
Latex Free
Temperature Monitoring Reusable Cables
Code Description Length Qty
C400-10 Reusable Cable with Jack plug 3,05m
C400-10HP Reusable Cable with 2 pins 3,05m
1010132007 Reusable Cable with 2 pins 3,05m
p. 19Temperature Management
Temperature Management
References :
1. Hart SR, Bordes B, Hart J, Corsino D, Harmon D. Unintended Perioperative Hypothermia. The Ochner Journal. 2011;11:259-270.
2. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. New England Journal of Medicine 1996;334: 1209-1215.
3. Mahoney C, Odom J. Maintaining intraoperative normothermia a meta-analysis of outcomes with costs. AANA 1999;67:155-164.
4. Flancbaum L et al. Evaluation of blood-warming devices with the apparent thermal clearance. Ann Emer Med 1989; 18:355-9+
5. Schmied H et al. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347(8997):389-92
6. Allen, Terry D., Body Temperature Changes during Prostatic Resection as related to the Temperature of the Irrigating Solution, The Journal of Urology, Oct. 1973; Vol. 110: 433-35
7. Carpenter, A. Alden, M.D., Hypothermia during transurethral resection of the prostate, Urology, Feb. 1984; 23(2): 122-4
8. Evans, J.W.H., et al., Hemodynamic and Cardiological Responses to TURP, Standard vs. Isothermic Techniques, British Society of Urological Surgeons, June 1991
9. Evans, J.W.H., Singer, Mervyn, et al., Cardiovascular Performance and Core Temperature During Transurethral Prostatectomy, The Journal of Urology, Dec. 1994; Vol. 152: 2025-2029
10. Heathcote, P.S., Dyer, P.M., The Effect of Warm Irrigation on Blood Loss during Transurethreal Prostatectomy under Spinal Anesthesia, British Journal of Urology, 1986; 58: 669-71
11. Ogura, Keiji, Fukuyama, Takuo, Nakagawa, Kirohide, The Effect of Warm Irrigating Fluid during and after TURP, Clinical Therapeutics, 1988; Vol. 10, Special Issue
12. Winter, Maureen, BSN, RN, CPAN, Effects of Irrigation Fluid Warming on Hypothermia during Urologic Surgery, Urology Nurse, 1994; 14: 6-8
13. Mirza, Saqeb, Panesar, Sukhmeet, AuYong, Kong Jung, French, Jane, Jones, David, Akmal, Samira, The effects of irrigation fluid on core temperature in endoscopic urological surgery, The Journal of Perioperative Practice, Oct 2007; 17, 10; ProQuest Central pg. 494-501
14. Yinghui Jin, Jinhui Tian, Mei Sun, and Kehu Yang, A systematic review of randomized controlled trials of the effects of warmed irrigation fluid on core body temperature during endoscopic surgeries, Journal of Clinical Nursing, 2011; 20: 305–316
15. Parodi, Dante, M.D., Tobar, Carlos, M.D., et al, Hip Arthroscopy and Hypothermia, Arthroscopy, July 2012; 28(7): 924-8
16. Kim Y.S., Lee J.Y., Yang S.C., Song J.H., Koh H.S., Park W.K., Comparative study of the influence of room-temperature and warmed fluid irrigation on body temperature in Arthroscopic Shoulder Surgery, Arthroscopy, Jan. 2009; 25(1): 24-9
PRODUCT(S) DESCRIBED MAY NOT BE LICENSED OR AVAILABLE FOR SALE IN CANADA AND OTHER COUNTRIES
Smiths Medical International1500 Eureka Park, Lower PembertonAshford Kent, TN25 4BF Tel: +44 (0)845 850 0445
Find your local contact information at: www.smiths-medical.com/customer-support Smiths Medical is part of the global technology business Smiths Group plc. Please see the Instructions for Use/Operator’s Manual for a complete listing of the indications, contraindications, warnings and precautions. Equator, Snuggle Warm, HOTLINE, Level 1, NORMOFLO and the Smiths Medical design mark are trademarks of Smiths Medical. The symbol ® indicates the trademark is registered in the U.S. Patent and Trademark Office and certain other countries. All other names and marks mentioned are the trademarks or service marks of their respective owners. ©2019 Smiths Medical. All rights reserved. SM196421GB-122019
MPAUCA-1262
For more information visit our website at www.smiths-medical.comor call Customer Service on 0845 850 0445
Smiths Medical ASD, Inc.6000 Nathan Lane North, Minneapolis, MN 55442, USATel: 1-614-210-7300 Toll-Free USA: 1-800-258-5361www.smiths-medical.com