Level 1 Temperature Management - Smiths Medical€¦ · nu g le W arm ® 26 f7 40-70 00-64 A 3 0-4...

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


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


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


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



Fluid warmer


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


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


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



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



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)




• Maximum Flow Rate: 950 ml/min. (crystalloid, 300 mmHg, 8.5 F catheter)

DI-60HL



• 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.






DI-300

Disposables

Automated Pressure Chambers

Aluminium Heat Exchanger


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


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



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



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)


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)





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




Esophageal Stethoscope

Esophageal Stethoscope - Single use


ES400-9 Esophageal Stethoscope – YSI 400 sensor 9F (Pediatric)

ES400-12 Esophageal Stethoscope – YSI 400 sensor 12F (Adult)



Esophagus


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



Level 1®

Skin Temperature Sensor

Skin

Skin Temperature Sensor - Single use


STS-400 Skin Temperature Sensor – YSI 400 sensor Adult and pediatric


Mylar® backing reflects operating room lighting and insulates sensor

Embedded sensor lies flat against patient’s skin for more reliable monitoring



Tympanic Temperature Sensor - Single use


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



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



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

Level 1 Temperature Management - Smiths Medical€¦ · nu g le W arm ® 26 f7 40-70 00-64 A 3 0-4...

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Transcript of Level 1 Temperature Management - Smiths Medical€¦ · nu g le W arm ® 26 f7 40-70 00-64 A 3 0-4...