Best iv warming system
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rwik123
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The truck's defroster. During the winter months I keep one up there constantly up on the dash.
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I agree. We aren't warming them to give "hot fluids," we're doing it just get them to the patient's body temperature. I was under the impression that newer trauma guidelines state that this is pretty important considering how many trauma patients end up being hypothermia by the time they reach the ED.
We use these in all our ambulances right now.
Stationary vs Bag style
You have a stationary warmer. Who makes it? Why was that type chosen?
I believe warned fluids going in is important. There was never a question about that from me. My service is rural with long to longer transports and harm could certainly be done to our patients. Winter is just around the corner (tomorrow I may say it is here already). Traumas often involve MVA with difficult extrications. Even medicals can present hypothermic in our communities poorer, elderly population. And then there is hunting season which presents a Search & Rescue situation that complicates everything.
I have no experience with this particular piece of EMS equipment and appreciate all constructive comments.
Many Thanks
You have a stationary warmer. Who makes it? Why was that type chosen?
I believe warned fluids going in is important. There was never a question about that from me. My service is rural with long to longer transports and harm could certainly be done to our patients. Winter is just around the corner (tomorrow I may say it is here already). Traumas often involve MVA with difficult extrications. Even medicals can present hypothermic in our communities poorer, elderly population. And then there is hunting season which presents a Search & Rescue situation that complicates everything.
I have no experience with this particular piece of EMS equipment and appreciate all constructive comments.
Many Thanks
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The stationary warmer is from Smithworks Medical, the link to the product is in my previous post. I have no idea why they were selected, we've had them in the ambulances since 2002 however. The bag type devices are probably more probably more effective (more insulation) but with the stationary wamer we can heat the whole cabinet, so our tubing and small bags are warmed too.
Providers need to be diligent to remember to actually use it though. Many of our patients that may benefit from warmed fluids will receive an IV on scene using IV supplies from the bag, which is obviously room temperature. When you get the patient in the ambulance, don't forget to switch out for warmed fluids.
Providers need to be diligent to remember to actually use it though. Many of our patients that may benefit from warmed fluids will receive an IV on scene using IV supplies from the bag, which is obviously room temperature. When you get the patient in the ambulance, don't forget to switch out for warmed fluids.
TheLocalMedic
Grumpy Badger
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Cheap but effective. Plug in to the inverter and wrap it around a bag or two.
If you have to "dump in fluids", your patient doesn't really care from a comfort standpoint.
I teach this to my anesthesia students all the time, because a lot of people want to warm IV fluids in the OR, but it really doesn't do much. It is physically impossible to warm a patient with IV fluids, and they really have a negligible cooling effect as well unless you're running in massive amounts of fluid, which is not the current trend in resuscitation.
It's really simple physics - for all practical purposes, the body is a big bag of water.
70kg x 37degC = 2,590 kcal
Add one liter of IV fluid at room temp
1kg x 20degC = 20 kcal
Add the calories and divide by total weight
2,610 kcal / 71kg = 36.76degC
So - adding a liter of room temp IV fluid drops your temp, at most, 1/4 degree celsius. Not very clinically significant.
And if you do a calculation with warmed fluids - give a liter of IV fluids warmed to 40 degC - and their temp, in theory, would increase 0.04 degC. Even less clinically significant.
And lets remember - unless you're warming your fluids right up to the hub of your IV catheter, the fluids you're infusing are closer to room temperature than they are to the fluid warmer you're using.
Now - does warming fluids hurt anything? Of course not. Does it help anything? More than likely, in most cases, no, because you're just not giving the volume of fluids that would make any significant difference. When you start talking about infusing refrigerated blood products, then it becomes a little more worthwhile.
For those of you who spend a lot of time in hospitals, you will rarely see fluid warmers used. And lots of refrigerated blood products are given without warming because they're allowed to run in over a couple hours. Unless you're pouring in liter after liter of fluid during those 30-45 minute transports, which I suspect you're not, it just doesn't make a difference. If hypothermia is a true concern, you should be using forced-air warming blankets (BairHugger or similar).
One caveat I would point out - the idea of using a heating pad to warm fluids is a bad one. You have no idea how warm those fluids are. If you're going to warm fluids, it needs to be done with a device intended for that purpose. The same concept follows for heating IV fluids in a microwave, which was tried in the past. Warmed IV fluids are one thing - but infusing hot IV fluids can be extremely dangerous.
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Thank you for the details
I appreciate you taking time to write a complete explanation of you viewpoint. For my needs warming is the best option due to the climate, where the ambulances are housed and for the type of patient we are likely to encounter. I ordered 2 Soft Sacks today.
Thanks to all for your feedback,
Theresa
I appreciate you taking time to write a complete explanation of you viewpoint. For my needs warming is the best option due to the climate, where the ambulances are housed and for the type of patient we are likely to encounter. I ordered 2 Soft Sacks today.
Thanks to all for your feedback,
Theresa
Christopher
Forum Deputy Chief
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During deployments for Ironman triathlons we use warmed IV fluids in conjunction with BairHuggers for our hypothermic patients. The fluids are stored in a warmer at 42C, which usually equates to temperatures of around 38-39C while hanging and roughly "body temperature" during infusion over 10-20 minutes (unless placed on a hot line).
Typical oral temps on these patients is ~95F and a number end up being 93-94F if the weather sucks.
The other point to make is that the simple act of hanging a bag without something keeping it warm rapidly drops its temperature, so you really have to be dumping the fluids on board to keep it above body temp.
All in all, if you're not pushing a ton of fluid or keeping the bag itself warm...there isn't much utility to it.
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http://www.conterra-inc.com/index.php?dispatch=products.view&product_id=52
Conterra makes nice stuff, if a little pricey at times.
Not sure what to do about line warmers, at the very least keep tubing in your IV warmer if possible.
Conterra makes nice stuff, if a little pricey at times.
Not sure what to do about line warmers, at the very least keep tubing in your IV warmer if possible.
I think the most important use of the fluid warmers is warming blood before massive transfusion in volume depleted patients. The experiences I have had show a much greater ability to transfuse blood rapidly when it's not being pulled out of a cooler that had 4 ice packs in it. When the blood is that damn cold it's about like trying to pressure bag D50 in. Warming the blood (again in my experience) makes a huge difference in the ease in which you can transfuse 4-10 units rapidly in the ER setting.
TheLocalMedic
Grumpy Badger
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They may not feel the chilly fluid, but they will feel the cumulative effects of hypothermia...
If your fluid is at room temp, then yeah, maybe not a huge deal. But how about fluid that is downright cold from sitting in an ambulance parked in an unheated bay in the dead of winter? I always throw a bag on the dash to warm up in the winter. Can make a difference of 30+ degrees.