Fluid warming across care areas:
labor and delivery
Child delivery is an exciting but sometimes harrowing experience for mothers, newborns, and the clinicians who
care for them. Epidural anesthesia can alleviate the mother’s pain, but may create complications, especially in
cesarean delivery. According to the CDC, more than 30 percent of all deliveries in the United States are now
carried out by cesarean.1
Hypothermia in labor and delivery patients
• Prolonged postoperative recovery 8
Studies have shown that anesthesia delivered during
• Reduced resistance to surgical wound infections9
cesarean surgical procedures reduces patient core
temperature by provoking a core-to-peripheral
redistribution of body heat. 2 Factors such as chilled
IV solutions, cold OR environments and surgical procedure
length further impact the body temperature of patients.3
Unfortunately, core temperature loss is often unexpressed
• Reduced drug metabolism8
• Decreased circulation and cardiac function10
Pre-warming patients could help
minimize hypothermia
by the patient and unforeseen in neuraxial anesthesia. Thus,
Studies show that the combination of intraoperative
accidental hypothermia often accompanies spinal/epidural
warming during surgery and pre-warming before surgery
anesthesia for cesarean delivery.
can reduce the propensity for redistribution after the
4
Potential adverse effects of hypothermia
Mild hypothermia has been linked to various
complications and discomforts for patients, including:
• Severe shivering5
• Impairment of blood clotting
induction of anesthesia and, thus, the occurrence of
hypothermia in labor and delivery (L&D) patients.11
Research shows that one to two hours of prewarming
may prevent intraoperative hypothermia, even in
unwarmed patients undergoing prolonged abdominal
6
• Inhibited coagulation, which can increase the
likelihood of postpartum hemorrhage for mothers7
surgery.12 And laboratory studies suggest that as little as
30 minutes of pre-warming can provide clinical benefit.13
Clinical benefits of warming
How the system works
Studies looking at the impact of perioperative warming
The enFlow cartridge’s ability to move with the patient allows
on women undergoing cesarean delivery with epidural
caregivers a way to start the warming process early, increasing
anesthesia found that:
the likelihood of maintaining normothermia. With other fluid
• Maternal and fetal hypothermia were prevented
5
• Maternal shivering was reduced5
warming devices, warming across the L&D workflow can be
difficult and expensive, requiring either multiple disposables
or compromising infection control protocols. With enFlow, the
• Umbilical vein pH was improved5
disposable cartridge attaches in-line to standard IV fluid/blood
• Improved coagulation was seen which reduced
delivery sets at the start of procedures. When it is time to move
postpartum hemorrhaging for mothers7
to the next area, the user simply removes the cartridge from the
enFlow warming unit, allowing the IV set in its entirety to be
enFlow® warming system offers ease and mobility
moved with the patient as she is transported. Once the patient
The enFlow IV fluid/blood warming system can provide
arrives at the next care area, the cartridge is simply inserted into
a solution for minimizing patient hypothermia in L&D.
an enFlow warming unit and is back to heating within a few
The innovative and highly mobile enFlow cartridge allows
seconds. enFlow’s mobility enables active, continuous warming
clinicians to place it in standard IV sets at the beginning
across L&D patient stays.
®
of care and throughout interventions, enabling clinicians
to warm in the L&D department, continue warming in
Contact us
the OR, and then warm post-procedure in patient rooms
To learn more about the enFlow IV fluid/blood warming system
for up to 24 hours (or the length of time required under
in labor and delivery, please contact Customer Service at
hospital policies). Early and continuous warming enabled
800.323.9088 or visit carefusion.com/VitalSigns.
by enFlow means that more patients may have their core
temperatures maintained across the L&D care pathway,
leading to potentially improved outcomes including
reduced blood loss, potential reduction in iatrogenic
wound infections, and more.14,15
References
1 Centers for Disease Control and Prevention, FastStats, Births, Method of Delivery. Retrieved on October 15,
2011 from http://www.cdc.gov/nchs/fastats/delivery.htm. 2 Matsukawa, T., Sessler, D., Christensen, R., et al. Heat
flow and distribution during epidural anesthesia. Anesthesiology, 1995, 83:961-7. 3 Paulikas, C. Prevention of
Unplanned Perioperative Hypothermia. AORN J., 2008, 88(3):358-365. 4 Arkilic, C., Akca, O., Taguchi, A., et al.
Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesth Analg,
2000, 91:662–6. 5 Horn, E., Schroeder, F., et al. Active Warming During Cesarean Delivery. Anesthesia Analgesia,
2002, 94:409–14. 6 Reed, R., Johnston, T., Hudson, J., Fischer, R. The disparity between hypothermic coagulopathy
and clotting studies. J Trauma, 1992, 33:465-70. 7 Postpartum Hemorrhage in Emergency Medicine-Epidemiology.
Retrieved on October 15, 2011 from http://emedicine.medscape.com/article/796785-overview#a0199. 8 Lenhardt,
R., Marker, E., Goll, V., Tschernich, H., Kurz, A., et al. Mild intraoperative hypothermia prolongs postanesthetic
recovery. Anesthesiology, December 1997, 87(6):1318-23. 9 Mahoney, C., Odum, J. Maintaining intraoperative
normothermia: A metaanalysis of outcomes with costs. AANA Journal, April 1999, 67(2)155-164. 10 Frank, S.,
Fleisher, L., Breslow, M., Higgins, M., et al. Perioperative maintenance of normothermia reduces the incidence of
morbid cardiac events. A randomized clinical trial. JAMA, April 9, 1997, 277(14):1127-34. 11 Hynson, J., Sessler,
D., Moayeri, A., et al. The effects of preinduction warming on temperature and blood pressure during propofol/
nitrous oxide anesthesia. Anesthesiology, 1993, 79:219–28. 12 Just, B., Tre´vien, V., Delva, E., et al. Prevention of
intraoperative hypothermia by preoperative skin-surface warming. Anesthesiology, 1993, 79:214–8. 13 Sessler,
D., Schroeder, M., Merrifield, B., et al. Optimal duration and temperature of pre-warming. Anesthesiology, 1995,
82:674–81. 14 Bailey, C. The Effects of Mild Perioperative Hypothermia on Transfusion Requirement, Survey of
Anesthesia, October 2008, 52(5). 15 Kurz, A., Sessler, D., Lenkhardt, R. Perioperative normothermia to reduce the
incidence of surgical-wound infection and shorten hospitalization. N Engl J Med, 1996, 334:1209-15.
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