Circulation 76,548 • Volume 20, No. 4 • Winter 2005   Issue PDF

Forced Air Warmer Burn Can Occur With Poor Circulation

Samuel Golden, MD

To the Editor

We recently had a child in the cardiac catheterization lab experience extensive third-degree burns of a leg due to the forced-air warmer. After analysis of this case, it is apparent that the cause for the burn was poor circulation to the affected leg. Under normal conditions, blood flow removes the heat locally and redistributes it to the rest of the body. In conditions of extremely poor blood flow, temperatures that would normally cause no consequences may lead to significant burns. In this patient as well as many others in the cardiac catheterization lab, causes for diminished lower extremity perfusion include sheaths placed in the groin vessels, thrombosed groin vessels from previous procedures, and low cardiac output. We urge anesthesia providers in the cardiac catheterization lab to use extreme caution when applying forced air warmers to the lower extremities of children, including keeping an adequate amount of space between the warmer and the skin, not using higher temperature settings, and considering placing a blanket between the legs and warmer. Also, the warming sleeve can be placed from the cephalad position toward the torso instead of around the lower extremities first, if there is adequate room at the head of the bed for the warming unit.

Samuel Golden, MD
Cathy Bachman, MD
Chicago, IL