# IV bag frozen?



## Hockey (Feb 6, 2010)

While in a discussion with my partner today, he said the chances of a bag of fluid freezing would be pretty small unless it was *extreme *cold.  He said because its "basically salt water" :glare:


I must have been seeing things the other day when an old bag of fluid was about half froze then eh? ^_^


Yes we have heaters in the truck.  Was just in a general discussion today.


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## Dominion (Feb 6, 2010)

Atleast you have heaters.  We have to hope our fluids warm up on the way to the run, if the truck fluids are cold we have to hope the medic has a bag in their jump kit.


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## Hockey (Feb 6, 2010)

Dominion said:


> Atleast you have heaters.  We have to hope our fluids warm up on the way to the run, if the truck fluids are cold we have to hope the medic has a bag in their jump kit.





I would think there is a policy/safety protocol that would cover that.


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## Shishkabob (Feb 6, 2010)

I put an IV bag on the defroster at the front windshield anyhow, per PHTLS guidelines of giving warmed fluids.


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## Ocean711 (Feb 6, 2010)

I guess it could happen, saltwater freezes at around 28 F. I know normal saline is not the same as seawater, but I think you get the point. I don't think you want to use it even if you thawed it, but you could use it as an ice pack, I suppose. I don't know too much about cold weather and IV fluids, I live in a warm climate.


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## xgpt (Feb 6, 2010)

Linuss said:


> I put an IV bag on the defroster at the front windshield anyhow, per PHTLS guidelines of giving warmed fluids.



Do the guidelines really say to throw it on the defroster? Or was that something you came up with? Some of these guidelines are so random...


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## JPINFV (Feb 6, 2010)

0.9% NaCl is essentially salt water? Well... technically it is salt water. How ever you aren't going to get that much freezing point depression with a 0.9% salt concentration. Any liquid can be frozen, the question is just how cold you want to go (0 kelvin anyone?).


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## TransportJockey (Feb 6, 2010)

xgpt said:


> Do the guidelines really say to throw it on the defroster? Or was that something you came up with? Some of these guidelines are so random...



They mention warm IV fluid is helpful with shocky patients. The tossing it on the defroster just helps it get warm


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## Shishkabob (Feb 6, 2010)

xgpt said:


> Do the guidelines really say to throw it on the defroster? Or was that something you came up with? Some of these guidelines are so random...



Nope, just a piece of advice my EMT teacher gave us back in EMT school should any of us continue to paramedic... it has since stuck with me.


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## lightsandsirens5 (Feb 6, 2010)

Linuss said:


> I put an IV bag on the defroster at the front windshield anyhow, per PHTLS guidelines of giving warmed fluids.


 
Linuss, you live in TX! You don't have IV bags freeze there in the trucks, do you!?!?

~~~~~~~~~

Sometimes, if the crew forgets to turn on the hot plate, we will have bags feeeze while the rig is sitting outside the hospital while we are inside doing report. I have never forgot the heater or had a bag freeze on me. *knock on wood* If you pay attention, you don't have to worry about it.


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## Shishkabob (Feb 6, 2010)

It's not so much the freezing aspect (although Texas can't make up its mind... one day it's 20 next day it's 70), but more for the shocky trauma pts.


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## 18G (Feb 7, 2010)

I remember being on a call once during the winter and it was extremely cold outside in the early AM. We were on an entrapment call where a vehicle was wedged underneath the trailer portion of a tractor-trailer.

I remember holding the IV bag for the Paramedic on the call and the fluid was freezing as it was going through the line into the patient! Not cool at all I know.... just thought I'd share that.


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## lightsandsirens5 (Feb 7, 2010)

18G said:


> I remember being on a call once during the winter and it was extremely cold outside in the early AM. We were on an entrapment call where a vehicle was wedged underneath the trailer portion of a tractor-trailer.
> 
> I remember holding the IV bag for the Paramedic on the call and the fluid was freezing as it was going through the line into the patient! Not cool at all I know.... just thought I'd share that.


 

No not cool at all, cold.

I really hope that medic decided to d/c fluids until they could be warmed. Even if it was not freezing it would be way too cold, right? (Must find firefighter to have put bag inside turnout jacket and get up really close to pt so to minimize exposure of lines to cold air. See......us firefighters _are_ good for _some_ things!


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## wyoskibum (Feb 7, 2010)

*Your partner was wrong....*



Hockey said:


> While in a discussion with my partner today, he said the chances of a bag of fluid freezing would be pretty small unless it was *extreme *cold.  He said because its "basically salt water" :glare:
> 
> 
> I must have been seeing things the other day when an old bag of fluid was about half froze then eh? ^_^
> ...



Trust me, normal saline will freeze.  I've been on many wilderness rescues in the Rocky Mountains and it was a challenge to keep the fluids warm.  I forgot about one bag of fluid in a pack and it was frozen solid when I found it.


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## Tincanfireman (Feb 7, 2010)

Dominion said:


> Atleast you have heaters. We have to hope our fluids warm up on the way to the run, if the truck fluids are cold we have to hope the medic has a bag in their jump kit.


 
Maybe an extension cord, a space heater for the back of the unit and a heating pad for keeping fluids warm might be a good idea? In addition, I wouldn't want to be the patient on a 20F (or colder) cot mattress; that cold pad would suck the heat right out of you, no matter how many (20F) blankets are piled on.


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## WolfmanHarris (Feb 7, 2010)

To control the temperature in the back our trucks are required to stay running whenever they are outside of the base or a garage at the hospital. Anywhere else they're left running. This has only been reinforced since we started the thrombolytics study since the various trial meds have incredibly stringent temperature ranges. So I've never had a problem with fluids freezing.

That being said, freezing and being too cold for the patient are very different. If you don't have an IV warmer keep the hot packs handy and wrap the tubing around a hot pack.


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## mycrofft (Feb 7, 2010)

*Carry the IV fluid on you.*

Have kept it in the sleeping bag or in a jacket pocket. Cold tubing is harder to manage than warm tubing also. Ditto the adhesives involved.
Wonder what Army mountain troops do?


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## wyoskibum (Feb 7, 2010)

mycrofft said:


> Have kept it in the sleeping bag or in a jacket pocket. Cold tubing is harder to manage than warm tubing also. Ditto the adhesives involved.
> Wonder what Army mountain troops do?



This is what we ended up using for our Wilderness SAR:

http://hotpack.net/ultimate_hot_pack.html


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## Dominion (Feb 7, 2010)

Tincanfireman said:


> Maybe an extension cord, a space heater for the back of the unit and a heating pad for keeping fluids warm might be a good idea? In addition, I wouldn't want to be the patient on a 20F (or colder) cot mattress; that cold pad would suck the heat right out of you, no matter how many (20F) blankets are piled on.



Some of our trucks have heating pads but they suck.  We also have a powered unit that we plug in if we're not at the garage that can keep the back warm to prevent drugs and fluids from freezing or dropping too low.  But the fluids are hardly warm at all, just enough heat to keep it around 50's in the back.  

Generally we keep a couple bags up on the dash to warm up while we're on a way to a run and keep the back blasted to keep the stretcher and re-warm the stuff in the back.


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## zmedic (Feb 7, 2010)

I'd say that if your truck get cold enough that your fluids are freezing you should be keeping the jump bag somewhere else like inside the house. Especially if it's an ALS bag, drugs really aren't supposed to be that cold either. (Same goes for the summer, if your rig lives outside and it's going to be 110 inside it, the bag should be stored inside at normal temps.)


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## rescue99 (Feb 7, 2010)

Linuss said:


> I put an IV bag on the defroster at the front windshield anyhow, per PHTLS guidelines of giving warmed fluids.



Yep...works fairly well. I've also hung em in front of the rear heater fan just above the jump seat.


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## Medic744 (Feb 7, 2010)

We just hook our trucks up to the shore lines which keep the generator juiced to control temp in the back of the truck.  For our meds that have to be cold we have a plug in cooler and heating pads to warm up the fluids a tad more in the really cold days.  Its not nice in general to give chilly fluids to anyone, except maybe fevers and hyperthermia.  If you have ever been on the receiving end of a chilled IV it makes you COLD and really really really have to pee faster than the warm fluid would.


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## NomadicMedic (Feb 7, 2010)

I guess I'm just spoiled. The medic unit I currently ride has both fluid warmers and blanket warmers. (If you like to look at ambulances, you can see it here) It's pretty nice to not have to worry about warming fluid.


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## Aidey (Feb 8, 2010)

I hope people are throwing away these bags that get too cold and aren't warming them up and using them. Even after thawing there can be large crystals of salt suspended in the fluid, which is not so great for your patient.


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## usalsfyre (Feb 8, 2010)

Any drug that has been stored in conditions outside of the recomendation in it's package insert is considered adulturated by the FDA. Just something to keep in mind.


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## wolfwyndd (Feb 8, 2010)

We have two medics.  The newest one has a little heater in the drawer where we keep the IV fluids and it keeps the fluid CLOSE to body temp.  To keep the fluids warm in the 'old' medic we installed heaters in the bay so the entire bay hovers around 65 or so.  Once we roll the heat in the back of the medic (generally) warms it up for the patient.


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## RESQ_5_1 (Feb 8, 2010)

Interesting that I found this today. Just came on this morning for a 4-day tour. First call 45 minutes in to the day was for a Hypothermic pt. Response time was around 45 minutes and then another 40-45 minute transport. Pt was found wearing t-shirt, jeans and hiking boots. Temperatures here were around -20C overnight(to convert, mutiply C x 1.8 and add 32).

We have an IV fluid warmer, but it doesn't heat the fluids by much. And, our protocols state to use fluids at or near body temperature. His initial temp was 33.8C Tympanic. It peaked at 35.2C Tympanic and then started to decrease again. 

In the prehospital setting, there isn't very much you can do for a severely Hypothermic pt. We didn't get much of a temperature change even with warmed IV fluids, 3 blankets (cotton), and the heater cranked to 83F.


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## rmellish (Feb 11, 2010)

If the unit is parked in a cold environment then it's running with the pt compartment heater on. Our inside bays are heated obviously.


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