# heated IV fluids



## RALS504 (Mar 17, 2007)

I did a field rotation for my medic program last week and my medic preceptor had a regular heating pad she wrapped IV fluids in to warm them. I use to have a mountainous response area where hypothermia pts were not uncommon. All of our amulances had hot paks that held 3 liters of IV fluids at a toasty temp. Does anyone else have heated fluids on thier rigs?


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## Silverado94 (Mar 17, 2007)

We have a pad with IV Fluid tucked in it to keep it toasty. Cheap and easy whats not to love.


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## MMiz (Mar 18, 2007)

We have cheap heat packs that work for a few minutes and then you toss.  I've seen medics heat the fluids with them though.


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## chico.medic (Mar 20, 2007)

We just keep a standard heating pad in the cabinet plugged into one of the 110V outlets. When it's cold out, we leave the inverter on and it keeps the fluids warm.  
     In the summer I keep a cheep Styrofoam ice chest in my rig.  I steal Ice from the er throughout the day and keep it in the bottom of the cooler w/ a few towels on top of that.  I try to keep at least 3 liters in there at all times.  Otherwise I'm stuck w/ fluid that's the ambient temp of the inside of the locked Ambulance on a summers day.  
     My heat exhausted pt's didn't respond well to 110 degree Saline.


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## Tincanfireman (Mar 20, 2007)

chico.medic said:


> My heat exhausted pt's didn't respond well to 110 degree Saline.


 
Chico, I'm not second guessing you; this is a sincere question from a -B transitioning to -I. For any pt suffering heat exhaustion or any heat-related illness/injury (other than heat stroke), is it beneficial to use chilled fluids vs. ambient temperature fluids? For heat exhaustion, I would think (keeping in mind my student status) the underlying cause of heat exhaustion would be fluid loss resulting in dehydration, not excessive core temperature. For a heat stroke victim, are there any special considerations that have to be weighed when introducing chilled fluid into a patient? Are there contraindications outside the normal precautions for fluid overload/CHF that have to be considered? Finally, would there be any problems using chilled fluids in the elderly? Thanks, TF


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## chico.medic (Mar 21, 2007)

I use the towels to keep the bags off the ice, keeping them close to ambient, not "inside the car ambient."  They are not "chilled" by any means.  The comment I made was mostly a joke, but I don't like to give people fluids that are warmer than 98.6.  



Tincanfireman said:


> Chico, I'm not second guessing you; this is a sincere question from a -B transitioning to -I. For any pt suffering heat exhaustion or any heat-related illness/injury (other than heat stroke), is it beneficial to use chilled fluids vs. ambient temperature fluids? For heat exhaustion, I would think (keeping in mind my student status) the underlying cause of heat exhaustion would be fluid loss resulting in dehydration, not excessive core temperature. For a heat stroke victim, are there any special considerations that have to be weighed when introducing chilled fluid into a patient? Are there contraindications outside the normal precautions for fluid overload/CHF that have to be considered? Finally, would there be any problems using chilled fluids in the elderly? Thanks, TF


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## Jon (Mar 21, 2007)

chico.medic said:


> I use the towels to keep the bags off the ice, keeping them close to ambient, not "inside the car ambient."  They are not "chilled" by any means.  The comment I made was mostly a joke, but I don't like to give people fluids that are warmer than 98.6.


that sounds fine.... I'd be concerned with "chilled" fluids that were 40-50 degrees... 70 or 80 is probably fine.

One of the things most trauma centers use is warmers for saline... trauma patients are at a great risk for hypothermia (Why... because we get them naked year-round, and they are hypovolemic). I was taught that if you're infusing fluid/blood... it should be warmed to body temperature for trauma patients, so that they don't have to work harder to maintain a normal temp.


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## chico.medic (Mar 21, 2007)

Jon said:


> that sounds fine.... I'd be concerned with "chilled" fluids that were 40-50 degrees... 70 or 80 is probably fine.



I'm glad you approve.  I was a little worried there for awhile.


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## Tincanfireman (Mar 23, 2007)

chico.medic said:


> The comment I made was mostly a joke, but I don't like to give people fluids that are warmer than 98.6.


 
Gotcha, and thanks. Me & my literal mind working overtime again


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## chico.medic (Mar 30, 2007)

I ran into our Physician Medical Director at an AMLS instructor course I was taking and asked him about this.  He seemed to think that whatever you give the patient, (warm or cold) most of the temperature will be lost between the IV bag and the site while running through the line, making the fluid pretty close to ambient temp. anyway.  Just figured I'd add that.


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## Jon (Mar 31, 2007)

chico.medic said:


> I'm glad you approve.  I was a little worried there for awhile.


Oh... sorry... I didn't mean to sound holier-than-thou.... I can do that sometimes.


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## KEVD18 (Apr 1, 2007)

chico.medic said:


> I ran into our Physician Medical Director at an AMLS instructor course I was taking and asked him about this.  He seemed to think that whatever you give the patient, (warm or cold) most of the temperature will be lost between the IV bag and the site while running through the line, making the fluid pretty close to ambient temp. anyway.  Just figured I'd add that.



first let me preface this with the statement that i am a basic, not an i or a medic intern but a basic and therefore know very little, comparitively, about als.

i recently received iv fluids that were taken from the cabinet in the rig, which was in the bay but still only about 50deg. iv was for dehydration seconday to etoh and the medic doing it for me had it running damn near wide open through a 16. the fluid in the bag was cold. it remained cold through out the drip set into my vasculature and had me shivering like i was naked rolling in a snow bank in short order. maybe warmed fluids will cool from the bag to the vein but, at least at that drip rate, they certaintly wont warm. just my experience though...........


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## Ridryder911 (Apr 1, 2007)

That Doc was not very smart in physics. Look at the millimeters of tubing and the lumen (opening) of the tubing and how much fluid is running through at a time. Look at how long medication goes from drip chamber to patient ... and it is supposed to warm up by then.. the IV would clot off... Geez....

What he seen and thought (albeit being stupid), was IV warmers/blood warmers use a pump type device that a tubing goes through and has heated warm ater to warm the IV tubing (blood and fluid) so it does not get too hot or cold.  

Room temp is not 50 degrees either, and trauma patients should recieve warm fluids. We have a special heater in the ER for fluids. 

R/r 911


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## chico.medic (Apr 1, 2007)

Ridryder911 said:


> That Doc was not very smart in physics. Look at the millimeters of tubing and the lumen (opening) of the tubing and how much fluid is running through at a time. Look at how long medication goes from drip chamber to patient ... and it is supposed to warm up by then.. the IV would clot off... Geez....
> 
> What he seen and thought (albeit being stupid), was IV warmers/blood warmers use a pump type device that a tubing goes through and has heated warm ater to warm the IV tubing (blood and fluid) so it does not get too hot or cold.
> 
> ...



Never said I agreed w/ him, but figured I'd air an argument for the other team.


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## chico.medic (Apr 1, 2007)

Another problem I have; is it really necessary to call someone, or his perception of something "stupid" because it differs from your own opinion?  That's like the earlier "fire monkey" comment you made.  I respect your experience, but it's hard to relate one's personal belief or bias in a public forum.  All the details don't always make it from the brain to the keyboard.  One could have difficulty understanding your retort simply from grammatical errors alone.  

The simple fact is, in the field, we do our best to keep our patients exposure to extreme elements (hot or cold) to a minimum.  I don’t think anyone here is going to bolus his patient w/ 50 degree IV fluid.  On the same note, we try not to give them 110-degree fluid either.  As far as loosing temperature between the solution bag and the IV site, allow me to clarify: He was speaking of heated fluid, from an ambulance cabinet, in the field.  We left our fancy IV warmer back at the station along with our portable CT scanner, and the R.T. we usually keep under the bench seat.


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## Ridryder911 (Apr 1, 2007)

Sorry, if that offended you but I don't cuddle to stupidity. It kills !

Infusing fluids at fifty degree temperature will and could have produced serious side effects. If one did not understand or have such knowledge that would be called ignorance. However; for one to have a medical license to practice medicine and this individual has at least eight years of advanced upper level of studies including mathematics, advanced science, physics, advanced physiology and at least three years of residency..... Yes, that could be considered to be stupid! Period.

If the physician would had infused such IV fluids, the courts would have said it another word called gross negligence. Yes, there has been documented IV's from medics with ice in the bag. So yes, it happens, as well as physicians and nurses microwaving blood products to heat them! Know what happens when you microwave blood and fluids ?

Part of the problem in EMS is we want to paint a pretty picture with rose colored glasses, and so we have many out there that do not have a concern of their actions. Yes, we all make common errors and mistakes and hopefully learn off them, but not to use common sense such as having knowledge of infusing fluids of fifty degrees will produce hypothermic reactions produce conditions such as v-fib, is not being ignorant but dangerous!

P.S. If you are going to be working in areas that are prone to handle hypothermic conditions, then be prepared for them. The statement said the fluids were fifty degrees, not heated or even at ambient room temperature.

As well, even though I do not work in areas that have little frigid conditions  we still have IV warmers for blood and fluids if it is cold outside; there called thermal angels developed by a paramedic for EMS, to prevent infusion of cold fluids. If all else fails, carry a bag of 500 on your coat with your body heat to maintain the warmth or on the defroster unit or make some type of device to maintain fluid warmth > 70 degrees. 

Ignorance in medicine is not negotiable because of whom you are or how your feelings might be hurt. It is well taught in medical curriculum's the dangers of infusing cool and cold fluids and the dangers associated with such. This is the reason of blood warmers and the legal documentation required to monitor temperatures for patients receiving large amounts of fluids such as post-op patients, patients on dialysis therapy with bath solutions and continue infusion of fluids. 

Again, part of the problem in in EMS we assume. Not realizing some of our mundane actions can actually effect treatment outcomes and lives. Good intentions are not always enough to justify one's actions. We need to point out problems and be a patient advocate instead of worrying about peer's feelings. We are really supposed to be there for the patient. 

For as calling firefighters firemonkeys or fire dogs, hose draggers, etc. As I have mentioned, there is a big difference between professional firefighters and those of the slang, the same as Paramedics and ambulance drivers. Whenever, either does not take their profession or position serious, then the name fits. I was promoted to Battalion Chief in a fire service, and earned my first degree in Fire Science, so I do know the difference between the two. 


R/r 911


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## chico.medic (Apr 1, 2007)

(i really dislike these edit features, lol.)


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## chico.medic (Apr 1, 2007)

Ridryder911 said:


> Sorry, if that offended you but I don't cuddle to stupidity. It kills !
> 
> Infusing fluids at fifty degree temperature will and could have produced serious side effects. If one did not understand or have such knowledge that would be called ignorance. However; for one to have a medical license to practice medicine and this individual has at least eight years of advanced upper level of studies including mathematics, advanced science, physics, advanced physiology and at least three years of residency..... Yes, that could be considered to be stupid! Period.
> 
> ...



Jon brought up fluid's that were 40-50 degrees.  That was a random number brought about by his misunderstanding of my earlier comment.  As fas as I know, no one has been giving anyone 50 degree IV fluid, especially not me.  The physician was referring mostly to fluids coming off of a heating pad in an ambulance cabinet.  As far as the thermal angel goes, I'd love to see one.  I'd love it even more if my service would put the money out for anything new.....we're still fighting for portable electric suction instead of the v-vac's. 

Bottom line, Summer time, I keep my fluids in an environment that keeps them close to body temp.  Winter, they sleep on the heating pad plugged into the inverter.  Sorry for the misunderstanding.  

BTW, it takes a lot for me to get my "feelings hurt".  I agree, there is no place in medicine for ignorance, but let's not confuse a misunderstanding on an online forum w/ the ignorance of a provider.


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## Ridryder911 (Apr 1, 2007)

Understood... I unfortunately have received patients that had ice crystals in a IV bag. The reason was .. "uh, their service would not provide heaters for the back of the truck"... Unfortunately, the EMS personnel did not understand the dangers of the IV, was far more dangerous than not having an IV at all. Again, so many are NOT thinking.

Thermal Angels are nice disposable units designed for EMS and can be plugged into EMS and aircraft. Any critical care transport units that routinely transport patients with whole blood should look into it. The cartridges are disposable. I do like the electric pad trick. 

I believe we are on the same track. I just get very tired over the years of the "allowance" of so much ignorance that is pacified and excused as ..."Well, their intentions was good"...Maybe, if we were in designing widgets and gadgets, that might be excusable, but we are dealing with human lives, the most precious commodity. There is nothing more sacred and valuable, however we continue to allow those that refuse to increase standards both personal and industrial levels. Again, only to allow excuses. Maybe, we allow such because of lack of formal control and administration. 

I do understand the difficulty of getting administration of purchasing just the essentials. This is why I endorse an industry accreditation before allowing an EMS to exist and reimbursement payments to EMS services. 

R/r 911


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## Guardian (Apr 2, 2007)

Anybody throw their cold IV bags on the windshield heater vents like I do on a cold morning?  

Rid, the thought police are going to haul you away if you keep speaking your mind like that.


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## Guardian (Apr 2, 2007)

chico.medic said:


> Another problem I have; is it really necessary to call someone, or his perception of something "stupid" because it differs from your own opinion?



Yes, it is.  The word stupid plays a very important role in the English language.  It's a word that makes very clear and strong statements such as “what in the hell were you thinking” or “don’t waste our time with this BS.”  Someone who uses the word stupid isn’t necessarily right; they just want to make it perfectly clear they’re not going to sit around and tolerate a certain level of dumbness.


I’m seeing an increased level of sensitivity among ems providers lately.  I can’t explain why, all I know is it is annoying as crap.  We have to walk on eggshells anymore because god forbid you hurt someone’s feelings.  I’m not saying we should turn into drunken sailors but we shouldn’t be choir boys and girls either.  This job requires a healthy dose of no none-sense reality every once in a while.


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## chico.medic (May 4, 2007)

Guardian said:


> I’m seeing an increased level of sensitivity among ems providers lately.  I can’t explain why, all I know is it is annoying as crap.  We have to walk on eggshells anymore because god forbid you hurt someone’s feelings.


 

Like I said before.....


chico.medic said:


> BTW, it takes a lot for me to get my "feelings hurt".  I agree, there is no place in medicine for ignorance, but let's not confuse a misunderstanding on an online forum w/ the ignorance of a provider.


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## StClairMedic (May 24, 2007)

We have IV fluid warmers in all of our units. I haven't needed to go to warm fluids much, or very often, however when I have needed to use them, it was very nice to have them.


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## TheWedgie (Jun 18, 2007)

Indeed, all of our vehicles have a fridge (which also has various drugs), and a heated cabinet (which usually also has blankets), most of the crews I've been on clinical placements with have had a bag or two of saline in each.

As an aside, N/S is the only fluid we carry, despite all (paid) Emergency Ambulances having two Paramedic or Intensive Care Paramedics onboard (or one of each).

-Nick


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## RedZone (Jun 26, 2007)

Wow.  I know this thread is old, but I found it interesting.

In my 13 years of EMS in NYC, I have never once been on an ambulance with an IV warmer.  Yes, we get some cold winters too!  

The majority of the 911 units are run 24/7, and we idle our engines with the heat on in the winter.  

For units that aren't run 24/7 (911 or private), we usually remove all the portable equipment (includes most of the ALS supplies) to an indoor locker.  

Now I am curious to see if this is sufficient.  I guess I'll have to wait until winter unless someone else already looked into this.  Also, thanks for the idea of keeping an IV bag in my jacket.


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## sksmedic (Jul 19, 2007)

Once again, sorry to revive an old thread. I am am a medic in Montana. It is not unusual to have winters that reach -50. I have seen frozen IV's and it is not pretty. We have commercial warmers in all the rigs and they work very well. We have started using a new product which I think is kick ***. It is made by a company called Dr.Down and it is an iv bag warmer that insulates the tubing as well. It comes with re-useable hot packs.  It is not designed for everyday calls, but is useful for the lost hiker or avalanche victim where you have to hike in sub arctic temps.


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## BAMAMEDIC (Jul 19, 2007)

Guardian said:


> Anybody throw their cold IV bags on the windshield heater vents like I do on a cold morning?
> 
> Rid, the thought police are going to haul you away if you keep speaking your mind like that.



I was starting to think I was the only one that did that.In the winter I usually keep 1 or 2 bags on the table with our radio and grab them on the way to the truck.


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## thermalangel (Mar 14, 2008)

Ridryder911 said:


> If the physician would had infused such IV fluids, the courts would have said it another word called gross negligence. Yes, there has been documented IV's from medics with ice in the bag. So yes, it happens, as well as physicians and nurses microwaving blood products to heat them! Know what happens when you microwave blood and fluids ?
> ...
> As well, even though I do not work in areas that have little frigid conditions  we still have IV warmers for blood and fluids if it is cold outside; there called thermal angels developed by a paramedic for EMS, to prevent infusion of cold fluids. If all else fails, carry a bag of 500 on your coat with your body heat to maintain the warmth or on the defroster unit or make some type of device to maintain fluid warmth > 70 degrees.
> ...
> R/r 911



Hello forum members,
I was Googling our company and Thermal Angel and ran across your discussion on fluid warming in the field.  Our website has quite a bit of information on hypothermia if this would be helpful to anyone.  The U.S. Military had done a great job in pushing the care far forward in the field, and fluid warming has always been a big concern.

http://www.thermalangel.com/html/hypothermiainfo.html

Let me know if I can be of service to anyone.


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## Ops Paramedic (Mar 15, 2008)

So i guess i'll be the last the post to this "Hot" thread then...

From reading all the posts, it seems as if you perform active rewarming in the field??  No one one has mentioned anything about the core temperature of the patient.  The guys always come to me and say: "we put up the ringers that was lyinig on the engine compartment (On the maybe hypothermic patient without taking a core temp)".  I Chringe.

On this side active rewarming in the field is not provogated at all and rightly so.  This is a process best reserved for the contolled environment, which we do not play in.  Fully remebering that "...the patient is not dead until he is warm and dead" Think about it this way...  Would you take a frosted glass out the the freezer and fill it with hot water??

Should you have a fluid warmer on the bus, it is great.  But the guys who don't have try and improve by placing them strategically where it is warm.  Does anyone actually monitor the temperature of these fluids and keep record??  The manufacturer of these fluids specifically states tht these fluids should be stored at a specific temperature.  The problem is aggrivated by these fluids being exposed to continuous temperature changes I.E. hot cold hot cold.   

More to follow.


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## daemonicusxx (Mar 15, 2008)

We use the thermal angel in the system i work for. 


http://www.thermalangel.com/


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## fightin17 (Apr 10, 2008)

Our service has a heated tray that holds four 1000ml bags of NS.  We also heat two 250ml bags of D5W.


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## uselessmedic (Apr 10, 2008)

*warm IV fluids*

We have heating pads in all of our trucks to keep our fluids warm.


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## MasterIntubator (Apr 23, 2008)

Speaking of physics.... you would be surprized how much heat you loose thru a standard 78" primary drip set.  We did a little study on that, used 2 calibrated thermocouple thermometers ( Fluke.... for those wanting to know ), had one in the warmed fluid bag ( 110 degrees F ), the other at the end point of a catheter cannula ( 16ga ) wide open, and found out a significant enough drop in temp not to be worth the time or effort.  Needless to say, we now warm the fluids with a coiled line between to hotpacks  just before entry to the pt or insulate the pt.

But that was just us in our 'real world' findings.  Others may have different results.  Maybe that doc wasn't too far off.


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