warm IV

[Ewok Jerky]

I have seen crews keep an IV bag on the dash to keep it warm, and I am wondering if that is clinically necessary. at what temp do you worry about it? can I just keep the cabin heat on instead?

 

[reaper]

Depends on temp of box. You want it to at least be body temp.

 

[Shishkabob]

Yes, you could put it on the dash. You could also put it in your jacket. Or you could even just tape a heat back to the IV tubing while running it in to the patient.

Just be careful though.

 

[johnrsemt]

or an IV warmer, they are made for that type of thing.

we did a quick study with expired bags of fluids; setting them on the dash can get them up to over 120 deg F, which can hurt the patient

 

[EMS49393]

It's best to use an IV fluid warmer. They are designed for the purpose of warming fluid making it less likely to burn a patient.

We were also required to change our fluid out every month and toss the bags that have been in the warmer longer than a month. I tended to encourage the use of warmed fluids because it's much less of a shock to a patient so we did not have many that got tossed because they had reached the 30 day mark.

In this day and age, with the world be so litigious, it's important to limit improvisation as much as possible. For example, it's common for services to use 14 gauge Excalibur IV catheters for chest decompression. They are not indicated for that use and as such could potentially cause a provider and service a lawsuit, especially since they make catheters specifically designed for needle chest decompression.

"Winging it" is anymore just a bad idea. Invest in the IV bag warmers if you plan to use warmed fluids.

 

[Blessed187]

It's best to use an IV fluid warmer. They are designed for the purpose of warming fluid making it less likely to burn a patient.

We were also required to change our fluid out every month and toss the bags that have been in the warmer longer than a month. I tended to encourage the use of warmed fluids because it's much less of a shock to a patient so we did not have many that got tossed because they had reached the 30 day mark.

In this day and age, with the world be so litigious, it's important to limit improvisation as much as possible. For example, it's common for services to use 14 gauge Excalibur IV catheters for chest decompression. They are not indicated for that use and as such could potentially cause a provider and service a lawsuit, especially since they make catheters specifically designed for needle chest decompression.

"Winging it" is anymore just a bad idea. Invest in the IV bag warmers if you plan to use warmed fluids.

What is the result of IV fluids being too cold? Is it more so a comfort issue? You mentioned using certain sized gauges for chest decompression, in any medical situation do medics need to use a certain size for certain situations? The one time I was a patient on the truck I was used as a pin coushion, one guy tried 3 times on one arm and at the same time an EMT was trying 2 times to get a vain. The medic finally got the needle in on the inside of my wrist, OUCH! he failed to set back the drip therefore the vain blew out before we got to the hospital leaving my wrist with a huge painful mark and fluid right under the skin, was it the fluid that caused this or the morphine that she shot into the line? I cringe when I see RN's and other medical perfessionals shoot narcotics into the line like there in a race. BP,HR,O2sat drops and I see the patient sit there in a daze looking like there about to pass out... are there not any rules against doing this?

 

[Akulahawk]

Cold IV fluid can be quite uncomfortable. Your arm can feel much colder... like someone is putting cold water inside your arm. Which is what is happening, actually. Warm IV fluid is a LOT more comfortable. It also won't contribute to hypothermia. With the catheter size thing, well, selection of the right catheter comes from experience. If you're decompressing a chest, then if all you have is a 14g cath, then that's what you have to use. I would prefer to have a cath specifically designated for that. Sac City Fire used to (and probably still does) carry 12g catheters specifically for the purpose of chest decompression. They were most emphatically NOT for placement in a vein for delivering fluids.

 

[Smash]

Cold fluid (less than body temperature) contributes to coagulopathies and inflammatory response and initially increases basal metabolic rate as the body tries to compensate.
Hyopthermia is an independant predictor of mortality in trauma patients.
I agree, however, that the proper equipment should be used to warm fluid.

 

[Blessed187]

Cold fluid (less than body temperature) contributes to coagulopathies and inflammatory response and initially increases basal metabolic rate as the body tries to compensate.
Hyopthermia is an independant predictor of mortality in trauma patients.
I agree, however, that the proper equipment should be used to warm fluid.

Gotcha, thanks

 

[Blessed187]

Cold IV fluid can be quite uncomfortable. Your arm can feel much colder... like someone is putting cold water inside your arm. Which is what is happening, actually. Warm IV fluid is a LOT more comfortable. It also won't contribute to hypothermia. With the catheter size thing, well, selection of the right catheter comes from experience. If you're decompressing a chest, then if all you have is a 14g cath, then that's what you have to use. I would prefer to have a cath specifically designated for that. Sac City Fire used to (and probably still does) carry 12g catheters specifically for the purpose of chest decompression. They were most emphatically NOT for placement in a vein for delivering fluids.

Should you adjust the size of the needle or the amount on the drip depending on the vein size?

 

[medicdan]

Cold fluid is clinically indicated prehospitally principally for peri (post) cardiac arrest patients, after a resumption of spontaneous circulation-- as a part of a total therapeutic hypothermia protocol, with reasonable expectations it will be continued at the ED.

Warmed fluids are clinically indicated for hypotensive patients, in an effort to increase body temperature, but again, only if a part of a protocol that will be continued at the emergency department.

Although all ambulances should be garaged in a heated environment when not on calls, that is not always the case-- and ensuring that the environment in the back is appropriate for patients is important.

 

[Shishkabob]

In this day and age, with the world be so litigious, it's important to limit improvisation as much as possible. For example, it's common for services to use 14 gauge Excalibur IV catheters for chest decompression. They are not indicated for that use and as such could potentially cause a provider and service a lawsuit, especially since they make catheters specifically designed for needle chest decompression.

Not really. A lot of what is used in medicine is used in off label ways. Off-label doesn't mean "against the standard of care" and infact could mean the opposite.


That's like saying you can expect a lawsuit for an agency using NS instead of LR for a burn patient.

 

[Shishkabob]

Should you adjust the size of the needle or the amount on the drip depending on the vein size?

You use the largest catheter size indicated for the patient, irregardless of vein size, so long as it fits. Even if I could fit a 14g, if they don't need one that big, they won't get it.



As for drip... again, totally depends on what you're doing. TKO vs med admin vs fluid resuscitation vs whatever.

 

[Blessed187]

You use the largest catheter size indicated for the patient, irregardless of vein size, so long as it fits. Even if I could fit a 14g, if they don't need one that big, they won't get it.



As for drip... again, totally depends on what you're doing. TKO vs med admin vs fluid resuscitation vs whatever.

Aww, okay. I get what your saying.

 

[Smash]

You use the largest catheter size indicated for the patient, irregardless of vein size, so long as it fits. Even if I could fit a 14g, if they don't need one that big, they won't get it.



As for drip... again, totally depends on what you're doing. TKO vs med admin vs fluid resuscitation vs whatever.

Sorry, I tried to resist as long as I could. It's regardless, not irregardless. You mean either 'regardless' or 'irrespective' in that sentence.

 

[Blessed187]

Sorry, I tried to resist as long as I could. It's regardless, not irregardless. You mean either 'regardless' or 'irrespective' in that sentence.

I can't stand people like you.

 

[Shishkabob]

It's in Merriam-Webster AND Oxford English, as a real and legit, albeit not 'correct', written word. Heck, Webster even goes so far as to say that even though it's a real word, to not use it. They don't even say not to use swear words!

That just makes me want to use it that much more. I'm such a rebel.


So irregardless of what you say, I will continue to use real words

 

[MS Medic]

There was a thread about this sometime around 7 or 8 mths ago, which I can't find, where it was brought up that IV fluid manufacturers don't give recommendations on the use of IV bag warmers. That poster also discussed a study that was done which found that fluid warmed in the bag drastically dropped in temp, getting close to room air before leaving the line and that his service (might have been HEMS) used a device, whose name I can't remember either, which heated the fluid just above the catheters.
After that discussion, I quit using my homemade bag warmer based on the same thought process EMS49393 mentioned and won't go back to using them, and would suggest the same to others, until my company puts them on the truck and puts them in my SOP to use them.

 

[jrm818]

There was a thread about this sometime around 7 or 8 mths ago, which I can't find, where it was brought up that IV fluid manufacturers don't give recommendations on the use of IV bag warmers. That poster also discussed a study that was done which found that fluid warmed in the bag drastically dropped in temp, getting close to room air before leaving the line and that his service (might have been HEMS) used a device, whose name I can't remember either, which heated the fluid just above the catheters.
After that discussion, I quit using my homemade bag warmer based on the same thought process EMS49393 mentioned and won't go back to using them, and would suggest the same to others, until my company puts them on the truck and puts them in my SOP to use them.

I remember reading that post as well, and did a small bit of digging. That claim made sense to me at the time, and it looks like there's some evidence that it's true. Of course anyone can prove it to themselves, just stick a thermomemter in a warm bag of saline and then at the outlet and see if there is a difference.

It make sense that the temperature loss would depend on the rate of infusion, and it seems to. For example, this manufacturers study http://www.itaccs.com/traumacare/archive/winter_01/embolism.pdf showed that at slow (10-30mL/min) infusions there could be up to a 14 degrees C loss between warmer and patient. At higher flow rates the loss was more like 2 degrees C.

 

[Fox800]

Service I used to work for had a heating pad that sat underneat some of the bags, kept them at a good temperature.