Letter to dvm360: Hot water bottles in the hot seat
A surgery article recommending hot water bottles as patient warming devices draws concern due to patient burn risks.
I received the July 2018 issue of dvm360 magazine today. I enjoy the opinions and expert tips but was very concerned about some information presented in the article titled, “6 savvy tips and tricks to try in the surgical suite.” In this article, Jennifer Wardlaw, DVM, MS, DACVS-SA, recommends using hot water bottles to keep patients warm, but hot water bottles can cause serious burns in our patients and should never be used.
In the past, our hospital routinely used hot water bottles (IV bags heated in the microwave) to help us keep pets warm. These were always warmed by an experienced nurse and were always wrapped in fleece or a towel before being placed next to a patient.
However, several years ago, we used hot water bottles wrapped in fleece to warm a surgical patient and the patient ended up with third-degree burns. The burns were severe enough that, despite three surgical procedures and round-the-clock critical care, the dog passed away after nine days.
In the last several years I have spoken with many veterinarians who've had similar experiences with hot water bottles for warming. Hot water bottle burns have also been reported in online forums.
Last year, I was granted a certificate in patient safety and quality from the Institute of Healthcare Improvement. In taking classes for this certificate, one of my biggest learnings was that in order to improve in healthcare, we must talk openly about risks and work to make our hospitals “mistake-proof.” For heating, that means we should only use methods that have no risk of burns to patients.
Beth Davidow, DVM DACVECC
Dr. Wardlaw's response
Anytime you're using a self-heated item like a water bottle, blanket, tube sock or gel pack, it's important to first test it on the inside of your arm before placing it near the patient-even if it's wrapped in a blanket or fleece. This practice is very similar to what you do when you warm a baby bottle. You test the temperature of the liquid first before giving it to the infant.
Since surgery patients are anesthetized, they are unable to move away and are at risk of sustaining burns if the heating device is too hot. So if you are not using an FDA-approved heating device, these extra precautions are necessary to minimize any potential risk to the patient.
I consider this to be a common-sense safety precaution for heating devices, so it was not covered in this brief article. Device malfunctioning was also not covered. I would never advocate for electrical heating blankets as these will have hot spots in short circuits. Only FDA-approved warming blankets (such as the Hot Dog or ChillBuster) should be even remotely considered.
Jennifer Wardlaw, DVM, MS, DACVS-SA
Owner and chief surgeon, Gateway Veterinary Surgery