# IV Bag Warmers



## Steinkrunk (Mar 7, 2010)

Have a quick question for any of you guys that use an IV warmer.  For our warmer the recomended interval for switching out the saline bags is every 14 days.  Then, after that bag is taken out it is never to be "rewarmed" again.  I tried finding any studies done on it to figure out why but only could find one and it wasnt too informative, it just said not to overheat the bags so they won't burn patients.

So my question is what do you guys do?  I just want to know what the reason behind it is(example: breaks down the molecules too much) or something to that extent.  I dunno I just wanted to know the reason behind it because if that bag is taken out of the warmer then used in a patient then its gonna get rewarmed again anyways.  

Thanks to anyone that can shed some light on this for me


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## Steinkrunk (Mar 8, 2010)

Anybody find anything? Is it because of the plastic packaging deteriorating? Just wondering, if any body has any info to shed some light on this that'd be great


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## Lifeguards For Life (Mar 8, 2010)

Steinkrunk said:


> Anybody find anything? Is it because of the plastic packaging deteriorating? Just wondering, if any body has any info to shed some light on this that'd be great



reheating iv bags could breach its integrity and may cause substances from the bag to be released into the IV solution. reheating could cause deterioration and chemicals like polychlorinated biphenyl could be absorbed into the IV solution.


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## Steinkrunk (Mar 8, 2010)

Thanks for the info! I knew it had to be something with the bags.  Do you have any info or reading I could use to make sure that this is a rule that is definately used by my ambulance committee. As of now there is kind of a misunderstanding and many emt-b's and paramedics alike that aren't changing the bags or dating them when replacing bags.  I just want to make sure we all use the warmer in it's correct way and want to be armed with plenty of info whn I bring it up


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## MS Medic (Mar 9, 2010)

It is pretty much the same thing as when you microwave food in a ziploc bag. The chemical structure is such that when the molecules in the plastic leech into the object in the bag on heating. It is also the reason that salt water has an experation date.

Thanks for the info though. My bag warmer is a heating pad I bought and brought in and I did not put much thought into the amount of time to keep the bag in the warmer. :blush:


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## LondonMedic (Mar 9, 2010)

I don't and never have used pre-warmed IV fluids (we use a Level 1 Infusor).

However, I understood that fluids could be kept warm for 14-days and then must be disposed of. I can't remember whether that's to do with the bags or with the composition of the solution but I would suggest that they go in the bin rather than back into stock unless there is clear guidance otherwise.

What are you using it for? The evidence for them except in certain situations isn't great.


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## Steinkrunk (Mar 9, 2010)

The only time we really use the warmer is during the winter to deal with hypothermic patients.  Using warm iv fluids along with the basic measures of dealing with hypothermia have netted us a couple degrees and at least a normal body temp by the time we get to the hospital.  Thanks for all the info guys you all have been a great help


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## MasterIntubator (Mar 9, 2010)

Food for thought..... having a warm IV bag really does not do much good, unless you have an insulated IV line.

Now.... to back that up. We did a study in college where we took IV fluids that were 104 degrees F in the bag, using the standard 72 inch IV admin set we carry, and an in-line surgical thermometer at the distal end of the 72 inches gave us an average reading of about 70 degrees F in a room that was about 78 degrees F ambient air.
Outside temps of about 40 degrees reduced this to close to a non-heated bag, and sometimes colder depending on the time spent outside.

We found that coiling IV line within a hot pack near the IV site provided us the best results, reducing the temp loss thru the line prior to reaching the pt.  Controlling the temp was another story.

In the field, we don't worry about warm fluids too much. The active rewarming takes place in the ED with proper chemistry monitoring for us.

:-/


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## SCFlightMedic (Mar 11, 2010)

Hello!

I was following this thread and thought I might be able to help out.  I've done research on both warm and cold IV fluids.  I've talked to the R&D department at Baxter Healthcare (they make the majority of IV fluids in the US).  To echo what the others have said, the temperature really does not affect the fluid per se.  The temperature variations DO affect the bag that the fluid is held in.  Now, Baxter and others will not officially endorse allowing fluids to go below 2 degrees C or above 42 degrees C.  Using fluids outside of these ranges are considered off-label use.  The problem with freezing temperatures is the possibility for the bag to develop microtears in the plastic allowing for contaminants to enter (or fluid to leave).  The problem with temperatures above 42 degrees C is the possibility for the breakdown of the plastic byproducts of the bag into the fluid.  

The importance of warmed IV fluids cannot be over emphasized.  Many of our patients coming into Level 1 Trauma Centers are mildly to moderately hypothermia on a routine basis. A 2006 study by the Joint Theater Trauma System (JTTS) found that 66% of combat casualities arrived at the hospital hypothermic.  The same study found that there is a 20% increase in mortality if the core temperature on arrival is below 95 degrees F, and an 80% increase in mortality if the temperature is below 95 degrees F on arrival.  

Like was mentioned in an earlier post, the problem with using warming methods (defroster, heating pads, gel packs, microwave [God forbid], etc) is the lack of control of the temperature of the fluid.  All of those methods have been found to have the ability to make fluid so hot that it can potentially burn the patient.  The Level 1 is an effective way to warm patients, but it has no use in the pre-hospital arena (it very big and bulky and has to be wheeled around).  Plus, the Level 1 is an "all or none" device.  You're either giving nothing or a couple liters every few minutes.  Lastly the Level 1 cost about $15,000-$18,000 a pop.

At the helicopter we have a lot of patients that are either hypothermia or have a huge potential to become rapidly hypothermia.  One of the devices that we found on the market has been used extensively by the military and and is now being used by civilian air medical services and 911 services is an inline IV fluid (and blood) warmer called the Thermal Angel.  It is talked about in the military PHTLS book and is in the TCCC protocol for hypothermia prevention and treatment.  The Thermal Angel heats the IV fluid almost right at the site of insertion so there is no heat loss through the tubing.  Like someone mentioned above, it does no good to heat the bag when the tubing is left exposed.  We are getting ready to start using the Thermal Angel on the helicopter to prevent and treat hypothermia in nearly all of our patients. You might want to Google the Thermal Angel and check it out.  

Hope this helps!

Mike


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