Bair Huggers

[canesdukegirl, BSN, RN]

I was taught that Bair Huggers should always be placed ABOVE the safety belt. I put a sheet folded lengthwise under the safety belt (only wide enough so that the belt and the metal buckle is not in direct contact with the patient), apply the belt, then apply the bair hugger (lower body), then apply a blanket above the bair hugger so that the drapes do not blow off when turning the bair hugger unit on. I always put a pillow or a folded blanket right under the hose so that the hose is not blowing directly onto an extremity.

As I was doing this, one of the anesthesia techs tells me that I am doing it wrong, and that the bair hugger should be directly on the patient, with the safety belt ON TOP of the bair hugger. I explained that this increased the risk of burns to the patient since the directed air was in effect, trapped under the belt. I have actually seen burns from this before.

What have your experiences been with this?

[Argo]

never put it directly on the patient. It can definately burn a patient with sensitive skin. I have always made it my practice and my departments practice to have either the gown, sheet or blanket between the skin and bair hugger. safety strap over the blanket/sheet/gown and under the bair hugger. Tell the AT to eat it....

[Rose_Queen, BSN, MSN, RN]

Check with the manufacturer- we were told by them that the blanket should be directly on the patient's skin, although I don't remember safety belts being addressed.

[Sister Fox]

Safety belts? Something I must have missed!

For sure, the Huggas should be in direct contact with the patient. The way to prevent burns (??) is to set a correct temperature!

[canesdukegirl, BSN, RN]

Safety belts? Something I must have missed!

For sure, the Huggas should be in direct contact with the patient. The way to prevent burns (??) is to set a correct temperature!

No, I am sure that you didn't miss the safety belt thing...we always ALWAYS put a safety strap on a patient when in the OR. This is one of the most important, and one of the very first things that we do in the OR after the patient has been transferred onto the OR bed from the stretcher.

The issue is that the Bair Hugger obviously provides forced air heating to the patient. The manufacturer recommends that the Bair Hugger should be in direct contact with the patient in order for it to warm the patient adequately. My issue is that I do not want the safety strap to go OVER the forced air warming unit. It will cause burns no matter the setting simply because of the constraint of the heat underneath the belt.

[PetiteOpRN]

I agree, canesdukegirl. Towel or blanket for padding, safety strap, bair hugger, blanket, drapes. I don't put the pillow under the hose, but I make sure that the hose does not come in contact with skin.

If the safety strap was over the bair hugger, half of it wouldn't work because the strap would prevent air from circulating.

[jwk]

The proper technique is strap over the patient (if you want a towel or even the gown between the strap and skin, that is fine), THEN the BairHugger blanket, and then a sheet or blanket if you want (but not necessary).

BairHuggers and similar devices are forced-air warming systems, and work because they circulate a constant supply of warm air around the patient - it's a convective warming system. A lot of people are under the mistaken idea that there needs to be a sheet or blanket between the patient and the BairHugger blanket because of a risk of burns. This is not correct, and in fact, all you're doing is insulating the patient from the warm airflow, and defeating the whole purpose of the device. You're not trying to warm the blanket to warm the patient - you're trying to warm just the patient.

Putting a strap over the BairHugger blanket restricts/obstructs the airflow through the channels in the blanket. If warm air can't move around inside the blanket, you can't warm the patient.

Out of an abundance of caution, manufacturers are recommending starting the blanket at lower temperatures and then increasing as needed. I don't believe there are any documented instances of burns from using these devices properly and as directed by the manufacturer. However, there are numerous reports of burns that have occurred from people using the devices improperly, particularly "hosing" the patient, by just sticking the hoze nozzle underneath cotton blankets or under the sheet the patient is lying on. That hot air flow is hitting one small spot instead of being circulated as intended, and can easily cause burns.

[megerler]

Always follow manufacturers instruction....always

[RosesrReder, BSN, MSN, RN]

Our hospital protocol and manufacturer's recommendations is that we place the Bair Hugger blanket directly onto the patient's skin. There should be no gown or blankets under that blanket. There should also be no hosing (using the unit without the disposable blanket), cannot use Bair Hugger with another brand because they are designed to work only with it's same Make/Model. No alterations of the unit(s) whatsoever. I have never seen any thermal burns when used properly as recommended. Check with manufacturer and your unit should have a policy in place.