I am interested to know how many Ambulances Services around the world have the ability to administer fluid that has been warmed to normal body temperature, in the field. It is particularly useful in the bleeding trauma patient, to prevent the complications associated with hypothermia.
Normothermic Fluid Administration
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abckidsmom
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We do not. It's rare that we are giving enough fluid to make a difference in the patient's temperature. Plus, the standard IV tubing allows the fluid to cool back to room temperature between the bag and the patient.
Normothermic fluid
Even if you are only administering small amounts of fluid, it should still be "normothermic". The statistics are amazing when you look at how hard the body must work to heat the fluid given at a temperature less than "normal". Even though it may not drop the core temperature, sick and injured patients are placed under a great deal more stress to maintain homeostasis.
Even if you are only administering small amounts of fluid, it should still be "normothermic". The statistics are amazing when you look at how hard the body must work to heat the fluid given at a temperature less than "normal". Even though it may not drop the core temperature, sick and injured patients are placed under a great deal more stress to maintain homeostasis.
Too Old To Work
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Not necessarily. The studies done show that trauma patients are generally hypothermic, so many surgeons recommend saline warmed to 104F, if you are going to fluid resuscitate at all.
We have a heater in the ambulance and I use heated saline for just about every patient during the winter. That includes CHF patients who are also likely to be pretty hypothermic from the diaphoresis.
I work with one paramedic who heats his IV fluids in the microwave for two minutes at the start of the shift. He claims that it keeps the fluids warm for most of the shift. I'm not sure about that myself, I'd like to see some sort of science to base that on.
I think in general warm fluid is better than cold fluid for any patient that isn't hyperthermic.
Just my experience after all these chilly winters.
1) Bad practice and 2) wrong.
Unless you are actually checking the temp of the fluid, you have NO idea what the temp is prior to administering it. Microwaving anything gives a very uneven distribution of heat - parts of the pizza are hot, parts are cold.
And there is no way a heated bag of fluid will just sit there all day and stay warm.
Except for trauma cases with large volumes of fluid and blood for resuscitation, heated fluid really does very little for the patient. It is not physically possible warm a patient with warm fluid, particularly at the volumes we would usually give.
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bigbaldguy
Former medic seven years 911 service in houston
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I would be concerned that microwaving the fluid in the bag could leach chemicals out of the plastic. I have seen some articles suggesting microwaving food in plastic containers can be a bad idea for this reason.
Too Old To Work
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That would be my concern as well. I'll have to see what they do in the hospitals. I know that a couple used to have warmers, but I haven't seen that in a while other than blood warmers that blood is run through before it enters the patient.
8jimi8
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We use the Level 1 rapid warm/transfuser. If you are talking about trauma resuscitation, the standard of care from the ENA is warmed blood/fluids. I can understand your thought process, but the temperature we use with the Level 1 is 42 C. It cannot get hotter than 43.9 C
DesertMedic66
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If we need to warm or cool the temp of the fluid we will wrap the IV tubing around a cold or hot pack a couple of times. Just by feeling the temp before it reaches the cold or hot pack and then feeling it afterwards it seems to work.
Now with that being said I have never seen anyone actually do this for hyperthermic or hypothermic patients.
Now with that being said I have never seen anyone actually do this for hyperthermic or hypothermic patients.
Level 1 is great for big volume resuscitation - we use another of their warmers in the OR that's cheaper and more compact. Regardless, the stuff we use is specifically made for that purpose. Nobody should be using microwaved fluids, and unless you know your warming cabinet temp is under 104 (a lot of them are not) then you shouldn't be using those fluids either.
8jimi8
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At the Level 1 trauma center, the trauma bay has a fluid warming case. They also have the capability to cool the fluids. I know that not every resuscitation is massive transfusion protocol, but the standard of care remains, warmed fluids.
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Same. We keep 2 1L LR bags and 2 500ml NS bags. We also have a cooler on the box for cold fluids
Warm fluid
We use a system that heats and maintains 24 1L bags of fluid at 40C, at the station. In the ambulance we have specially made bag that keeps 4 x 1L bags of fluid at 40C - ready to use 24/7. We also use "sleeves" that go over the bags of warmed fluid to reduce heat loss from the bags. The weak link is the IV line - this can be shortened by making loops and using a pressure bag to assist the infusion. The system certainly works and is far better for all our patients that do not require therapeutic cooling.
We use a system that heats and maintains 24 1L bags of fluid at 40C, at the station. In the ambulance we have specially made bag that keeps 4 x 1L bags of fluid at 40C - ready to use 24/7. We also use "sleeves" that go over the bags of warmed fluid to reduce heat loss from the bags. The weak link is the IV line - this can be shortened by making loops and using a pressure bag to assist the infusion. The system certainly works and is far better for all our patients that do not require therapeutic cooling.
LucidResq
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Pretty much every bag of fluid and blanket we used in the PACU was pulled fresh from the warmer.
Effects of administering fluid that is NOT normothermic !
Even if we are not making our patients "really cold", just by dropping their core temperature a little bits means that they are working very hard to stay warm.
Core temp decreased by 1.0°C results in an:
- increase in plasma noradrenaline by 230%
- increase in plasma adrenaline by 68%
- increase in CO by 23%
- increase in HR by 16%
We know that by giving fluid that is less than body temperature we are "trying" to drop their core temperature!
Even if we are not making our patients "really cold", just by dropping their core temperature a little bits means that they are working very hard to stay warm.
Core temp decreased by 1.0°C results in an:
- increase in plasma noradrenaline by 230%
- increase in plasma adrenaline by 68%
- increase in CO by 23%
- increase in HR by 16%
We know that by giving fluid that is less than body temperature we are "trying" to drop their core temperature!
DesertMedic66
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Look at all you guys with your fancy warmer ovens in your station/ambulance and your bag selves haha. Sadly we don't have any of that. For us all our IV bags are kept in a green bucket kind of thing. So whatever the tempature in the back of the ambulance is, our fluids are the same temp. Luckily it doesn't get extremely cold in our area.