MTG7 Inditherm mattress: Dr Mark Harper
Dr Mark Harper, Lead Expert Adviser for the Medical Technologies Advisory Committee, discusses use of the Inditherm mattress in practice.
This podcast was added on 31 Aug 2011
Interviewer: Hello and welcome to the NICE podcast about the NICE medical technology guidance on the Inditherm Mattress for the prevention of inadvertent hypothermia. This podcast will focus on implementing the recommendations in the guidance.
I am Steve Sparks I work on helping people put our guidance into practice and with me is Mark Harper, Consultant Anaesthetist at Royal Sussex County Hospital. Dr Harperhas provided expert advice to the Medical Technologies Advisory Committee who developed the recommendations on the Inditherm Mattress and Mark was also a member of the guideline development group for the NICE clinical guideline number 65 on inadvertent perioperative hypothermia which was published back in April 2008.
Interviewer: So Mark, thank you very much for doing this, this morning. Could you tell me what the Inditherm mattress is please?
MH: The Inditherm Mattress is a pressure relieving mattress, its a carbon polymer sheet which provides the warming. It differs very much from previous warming mattresses in that it heats a greater part of the surface area in contract with the mattress and also is a uniform distribution of heat from the mattress
Interviewer: Ok so why is it important to maintain the patient’s temperature during surgery?
MH: Basically to reduce complications; (there are) a large number of complications that you can get as a consequence of perioperative hypothermia. This can include discomfort either due to increased pain or shivering. There are also cardiac complications, increased rates of myocardial infarction and abnormal cardiac rhythms. You get more infections, greater pressure sores and longer hospital stays as a consequence of becoming cold.
Interviewer: Right, so this could have an impact on reducing the length of stay of patients in hospital potentially?
MH: Amongst other things, yes.
Interviewer: Great, and in the new guidance what are the situations in which NICE recommends that the Inditherm Mattress is used?
MH: The guidance says that it should be considered for use in all patients undergoing operations which carry a risk of inadvertent hypothermia which really is all operations.
Interviewer: Right so it is pretty much every circumstance in which patients are being operated on?
Interviewer: Okay and for patients undergoing operations who are at risk of inadvertent hypothermia: how are they managed at present and what are the advantages of using the Inditherm mattress over the current techniques?
MH: As I said just now, all patients are at risk of perioperative hypothermia, it is just the degree of risk that varies. Currently the recommendation is that high risk patients receive forced air warming. The advantage of the Inditherm mattress is that there are no disposables, there is no increased cost if you use it for low risk patients. It is also quiet, it is less intrusive. Surgeons sometimes complain about the forced air warming that gets into their field or makes them hot, we don’t have this issue with the Inditherm mattress. There is another issue with risk with the very very high risk patients it (the Inditherm mattress) can actually be combined with forced air warming or even a carbon polymer blanket because you find with some of the patients just one technique either forced air warming or Inditherm is insufficient to keep them warm during the procedure.
Interviewer: Right so it is not necessarily a replacement for forced air warming; in some circumstances it will be used with the forced air warming and in other circumstances it may just be used by itself.
Interviewer: So when should the patient who will be undergoing surgery and who has got some risk of hypothermia, be placed on the Mattress?
MH: The sooner the better is the short answer. There are studies which have looked at pre-warming them so you can put one (Inditherm mattress) on their hospital bed. In fact there are even mattresses which you can buy now which have the Inditherm technology in them which this guidance does not cover but they (the patient) can even be on the ward with a warming mattress essentially. You could put them (the inditherm mattress) on in the preoperative area, put them (the inditherm mattress) on in the anaesthetic room. Practically speaking on the whole I think it is easiest to just have it (the Inditherm mattress) on the operating table. The advantage over forced air warming here is that as soon as you transfer them (the patient) on to the operating table they are immediately being warmed. You do not have wait for the surgeons to scrub up, you don’t have to wait to put the blanket on and things like this and so even if it is just in the operating theatre you do get to start warming them a bit earlier.
Interviewer: You get an instant effect from applying the technology that is great, and in what clinical areas where patients are operated on do you see this device being used?
MH: I can see this device being used in all clinical areas where patients receive an anaesthetic or even where they are at risk of hypothermia which could be in the casualty department, it could be in the radiology department. I think from an anaesthetist’s point of view the biggest difference that we are likely to find is for its use in short operations. At the moment patients having short operations don’t receive warming at all. With the (Inditherm) mattress you just put it on the operating table, it stays there all of the time, there is no increased cost from running it for short procedures so it can just be used all of the time.
Interviewer: So at the moment for short operations people assess the hassle involved in setting up for forced air warming as outweighing the benefit that might be delivered?
MH: Yes it is the hassle but it is also the expense because the disposables (for forced air warming) add up over time particularly with short procedures, high throughput operating theatres there is a very serious expense involved (with warming methods other than Inditherm), and by the time you have actually got forced air warming blanket on its the end of the operation and it is off again so it doesn’t actually have very much effect on warming the patient
Interviewer: Right ok and for your clinical colleagues who might be thinking about adopting this technology, have you got any advice for them in terms of ways in which they can bring it into their practice?
MH: Essentially to use the mattress is very simple indeed. There are no technological or logistical issues in introducing it into practice. The thing that I would say is I think it is important that you try it out find out how it integrates into your own practice. There are different sized mattresses, it’s going to be different whether your patient is supine, whether you patient is a thoracotomy, whether the patient is on their side; how these things fit in to how you work so try it.
Interviewer: But because it is a relatively straightforward technology to use it makes it fairly easy to apply to a number of different situations.
MH: There are a lot of situations or the vast majority of situations where in fact it would be completely simple. You put it on the top of the operating table you treat it like it is just the top of the operating table and you can kind of almost ignore it at the end of the procedure; you just wipe it down like you would wipe down an operating table so it just stays there and you use it and it warms the patient
Interviewer: Very straight forward and in terms of managers who are looking to try and help people adopt the technology any advice that you would have for those who have got concerns around cost and resource utilisation perhaps?
MH: Cost and resource utilisation - essentially NICE have done the calculations. It’s a relatively cheap way of warming patients, I think it is more important to work out which patients it is really good for. Also we (Royal Sussex County Hospital) have produced a warming algorithm which includes the Inditherm mattress in it, it also includes forced air warming and from that it gives very clear guidance about what circumstances you should be considering using it. Again it is a simple device and very simple to put into practice but this is how you get people thinking about using it and how you get them more confident that they are using it in the right circumstances
Interviewer: So the algorithm is a tool for making that decision?
Interviewer: And am I right in thinking that the algorithm is on the NICE shared learning database?
MH: You are absolutely correct. It has been added to the NICE shared learning database along with various tools for helping audit your warming activity and I suppose success
Interviewer: And all of that can be found on the NICE website. I would advise you to go and have a look at that and download the algorithm and look at the other support that is available.
Well thank you very much Mark. We hope that people will find the information in this podcast useful in helping you put the NICE guidance in practice. For more information about this medical technology guidance and on the Inditherm Mattress including the support tools from NICE which can be adapted to your local use, please go and have a look on the NICE website which is www.nice.org.uk/MT where all the medical technology guidance can be found. For more information on the clinical guideline ‘Inadvertent perioperative hypothermia’ and access to the associated implementation tools including the shared learning case study which Mark just mentioned please visit www.nice.org.uk/CG65. Thank you very much for listening and goodbye.
This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.
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This page was last updated: 19 September 2012