heated IV fluids

[RALS504]

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?

 

[Silverado94]

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

 

[MMiz]

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.

 

[chico.medic]

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.

 

[Tincanfireman]

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

 

[chico.medic]

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.

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

 

[Jon]

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.

 

[chico.medic]

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.

 

[Tincanfireman]

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

 

[chico.medic]

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.

 

[Jon]

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.

 

[KEVD18]

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...........

 

[Ridryder911]

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

 

[chico.medic]

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

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

 

[chico.medic]

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.

 

[Ridryder911]

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

 

[chico.medic]

(i really dislike these edit features, lol.)

 

[chico.medic]

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

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.

 

[Ridryder911]

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

 

[Guardian]

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.