NURSING PATIENT CARE POLICY & PROCEDURE
August 21, 2015
Nursing Manual (Red)
Policy #: 8.19 AP
Title: Patient Warming System With Forced
Air Overbody and Underbody Blankets (such
as Bair Hugger® Patient Warming System)
(Adult and Pediatric)
Assure safe heat transfer to patients requiring re-warming as a treatment or prevention
A. Units with Bair Hugger® Systems include Cardiothoracic Surgery ICU; Cardiac
Medical ICU; Cardiology ICU; Trauma and Trauma/Surgical; General Surgery
and Bariatric Center of Excellence; Gyn, Urology, Plastics & ENT; Acute
Medicine/Progressive Care Unit; TLC; Burn Unit; Emergency Department;
Pediatric ICU; PACU (Inpatient, Outpatient, APC, TAC and AFCH); Operating
Rooms (Inpatient, Outpatient, TAC and AFCH); and the Heart and Vascular Care
B. Criteria for Use:
1. To maintain normothermia Bair Huggers® should be used on all
intraoperative patients unless contraindicated.
2. In the ED, the underbody blanket/Bair Hugger® will be applied for
hypothermia prevention in traumas and other patients who exhibit or are at
risk for developing hypothermia.
3. Frequent monitoring of patient’s temperature is important during use of
C. Contraindications for Use include but are not limited to:
1. The Bair Hugger® causes peripheral vasodilatation and should never be
used in patients at risk for spinal cord or visceral artery ischemia because
peripheral dilation shunts blood away from the central circulation,
increasing organ ischemia. The Bair Hugger® should not be used in the
situations listed below. (Note: For the trauma patient, hypothermia
prevention may override the listed contraindications. In these
circumstances, discuss with the physician/provider.)
a. Patients undergoing descending thoracic aortic aneurysm repair of
traumatic injury to the thoracic aorta, and patients with aortic
dissection or plaque hemorrhage (regardless of whether repair is open
or by endograft) have deliberate hypothermia during anesthesia and
must not have preoperative, intraoperative, or postoperative Bair
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b. Patients undergoing thoracoabdominal aortic aneurysm repair have
deliberate hypothermia during anesthesia and must not have
intraoperative or postoperative Bair Hugger® application.
c. Patients undergoing aortic endarterectomy or replacement for visceral
artery ischemia must not have intraoperative or postoperative Bair
2. Using a Bair Hugger® to warm extremities with compromised blood flow
will produce limb ischemia. This consideration usually involves a Bair
Hugger® applied to the lower extremities, but can occasionally involve
the upper extremities. A Bair Hugger® should not be used in the situations
listed below. (Note: For the trauma patient, hypothermia prevention may
override the listed contraindications. In these circumstances, discuss with
the physician/provider. Hypothermia in the trauma patient has been
associated with increased complications such as coagulopathies, and
dysrhythmias [ENA, 2007].)
a. Patients with any traumatic injury of an extremity that may involve
vascular compromise (including fracture, crush injury, DVT, and
iatrogenic arterial injury) may not have a Bair Hugger® applied to
b. Patients with peripheral vascular disease (occlusive or diabetic) of the
extremities may not have a Bair Hugger® applied to extremities with
arterial occlusion. This prohibits lower body application of Bair
Hugger® in patients with distal occlusive disease.
c. Lower body application of a Bair Hugger® must never be used during
surgery that involves cross clamping of the aorta, iliac or femoral
Bair Hugger® Patient Warming System
Disposable warming blanket
Disposable blankets are available from CS (order number 2220008, 2220010,
2220011, and Underbody blankets- (Pediatrics) 2220012, and (Adult) 8720331).
A. Refer to Nursing and Patient Care Policy 8.12, Hypo/Hyperthermia Thermal
Blankets for Adult and Pediatric Patients (excluding neonates), for
hypo/hyperthermia patient monitoring considerations.
B. Operating the Bair Hugger® System
1. The patient should be dry to optimize the warming effect. Remove any
wet clothing the patient may be wearing.
2. If radio frequency interference with monitoring equipment should occur,
connect the Bair Hugger® Patient Warming Unit to a different power
3. Explosion Hazard: Do not use in the presence of flammable anesthetics.
4. Plug the Bair Hugger® Patient Warming Unit into a properly grounded
5. Turn on the Power Isolation Switch, if so equipped.
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6. Turn the control panel power switch to "ON".
7. Turn the Heat Setting switch to the desired temperature (Off/Ambient,
Low, Medium, or High).
a. Overbody blanket: Unfold the disposable warming blanket and
place it over the patient with the paper side down. Lay one cotton
blanket or sheet over the Bair Hugger® blanket to focus heat on
the patient. Specific instructions for use are included with each
blanket, and should be referred to for specific heat settings.
b. Underbody blanket: The blanket should lie under the patient and be
in direct contact with the skin. “Bair” should read correctly. (If it
reads backwards, the blanket needs to be turned over to other side)
If the Underbody Blanket has a second hose opening, this should
be plugged with the white cardboard insert that comes with the
blanket so warm air cannot escape.
8. Insert the hose with a twisting motion into the cardboard connector on the
warming blanket unit until it fits snugly. (See Figure 1.) Always use the
warming blanket with the hose securely attached. The hose end has a
dangerously high air temperature. Using the warming unit without the
warming blanket can result in serious burns.
Figure 1. Attachment of Air Hose to Warming Blanket
9. If the red over-heat warning light illuminates and the audible alarm
sounds, turn the Warming Unit "OFF" and discontinue use. Tag the
machine appropriately, return it to Clinical Engineering, and complete a
Patient Safety Net (PSN).
C. Patient Monitoring and Documentation
1. Monitor and document the patient's temperature every 30-60 minutes for
the duration of therapy or as ordered. Reduce the air temperature or
discontinue therapy when desired patient temperature is achieved (37 C or
98.6 F). Continue to monitor the patient for potential hypothermia
D. Alarms/Troubleshooting and Maintenance
1. OVER-HEAT WARNING - If the temperature gets too high, the over-heat
warning light on the front panel will illuminate and the alarm will sound.
The heat will shut off and the blower will continue to run.
2. General Maintenance/Cleaning
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a. Clean the Bair Hugger® Patient Warming System cabinet and hose
with CAVI or bleach wipes after patient use. CAUTION:
i. Always unplug the Bair Hugger® Patient Warming System
ii. Do not use a dripping wet cloth to clean the cabinet.
Moisture may seep into the electrical contacts, damaging
iii. Do not use alcohol or any other solvents to clean the
cabinet. Solvents may damage the labels and the other
iv. The blankets are for single patient use only and are not
E. Operator’s Manual: Refer to manufacturer instructions as necessary.
V. UWHC CROSS RERERENCE
Nursing Patient Care Policy 8.12, Hypo/Hyperthermia Thermal Blankets for Adult
and Pediatric Patients (Excluding Neonates)
A. Guidelines for Perioperative Practice, 2015 Edition.
B. Bair Hugger® Model 505, Model 500/OR Model 775 Temperature Management
Units Operator’s Manual. www.arizant.com/us/bairhuggertherapy/warmingunits
C. Emergency Nurses Association (ENA) (2007). Trauma Nursing Core Course 6th
D. Proehl, J. A. (2009). Emergency nursing procedures (4th Ed.). St. Louis, MO:
VII. REVIEWED BY
Clinical Nurse Specialist, Nursing Program Development and Evaluation
Clinical Nurse Specialist, Pediatric Intensive Care Unit
Clinical Nurse Specialist, Trauma Life Support Center
Nursing Education Coordinator, Operating Room
Surgical Services Supervisor, Inpatient Recovery Room
Manager, Surgical Services Education and Informatics, Surgical Services
Director, Professional Services UW Health at The American Center
Nursing Patient Care Policy and Procedure Committee, August 2015
Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer