FLUID SITUATION Warmed IV or irrigation fluids can arrest a perioperative hypothermia risk.

In a chilly room, room temperature intravenous and irrigation fluids push a patient closer to hypothermia and its clinical complications. While forced-air blankets, heating pads and other products can help to counteract this cooling risk, fluid warming prevents it entirely. Lengthy, fluid-intensive cases see the best results from the avoidance of this induced chill, of course. A recent study, however, has demonstrated fluid warming's benefits even during short surgeries.

To evaluate the effects of pre-warmed IV fluids on normothermia, Korean researchers observed their use on a group of female patients, aged 35 to 80 years, undergoing ambulatory urological surgery with monitored anesthesia care. During the course of their procedures, patients were administered up to 700mL of IV fluid, including an initial bolus injection of 10mL/kg. The fluid given to 27 of the patients had been pre-warmed to 41 ?C in a cabinet. The other 26 received room-temperature fluid.

The researchers perioperatively recorded each patient's core temperature, as well as incidents of post-operative shivering, the use of forced-air warming devices in PACU and patients' reports of thermal comfort. They found that on average, the core temperatures of the pre-warmed fluid group were significantly higher as the surgery began, at the end of the case and when they were admitted to PACU. That group also showed a lower incidence of hypothermia upon PACU admission and shivered less after their surgeries. The study appeared in the April issue of the Japanese Journal of Anesthesiology (tinyurl.com/m2sk5ky).

Stainless steel warming cabinets aren't the only option available for taking the chill off IV and irrigation fluids, though. On the following pages, we've highlighted devices ranging from bag-warming units that, stationed in the OR, provide a convenient warming solution that is immediately accessible to the surgical team, to in-line warming technologies that attach directly to fluid delivery tubing, an automatic approach when large volumes of fluid are necessary.

In each instance, a warming system's chief advantages include the ability to precisely control and accurately verify the fluid's temperature and to ensure consistency from case to case. If the system is installed close to the point of care, it can keep fluids from cooling down before they get there. The end result is maintaining perioperative patient normothermia from the inside out.

We profile 9 fluid warming systems beginning on the following page.

Belmont Instrument Corp.
Belmont Buddy Lite
belmontinstrument.com
(866) 663-0212
Pricing: $2,250 to $2,975
FYI: Designed for close placement to the catheter insertion site in order to avoid line cooling of the intravenous fluid or blood it has warmed to 38??C (+/- 2??C). The compact, lightweight, portable and disposable set can be used with any standard IV tubing and includes such built-in safety features as a one-way valve to prevent backflow, a pressure-regulating valve and an air-venting membrane. It can deliver 4.4 liters of fluid on a single battery charge, and an optional external power supply is available.

Bryton Corporation
MWC-4350 Warming Cabinet
brytoncorp.com
(800) 567-9500
Pricing: $4,350
FYI: This single-chambered warming cabinet is sized for convenient installation on the countertop, beneath the counter or on a mobile stand. The unit, available with a solid- or glass-front door, offers a capacity of 9.3 cubic feet and can accommodate 35 1,500mL bottles. It heats rapidly and uniformly to temperature settings of 90?? to 160??F and maintains temperature consistency to within 5?? of the set point. Push-button controls and a large digital display make its operation easy.

CareFusion
enFlow IV Fluid/Blood Warmer
carefusion.com
(888) 876-4287
Pricing: not disclosed
FYI: Patient-dedicated cartridge attaches in-line to standard IV fluid or blood delivery sets at the start of procedures and heats up within 18 seconds. The cartridge is easily removed from the warmer for transport and reinserted into another at the next stage of the process. Differentiated warmer sits close to the patient to prevent heat loss as fluid travels through the line. Has 8 temperature sensors to protect fluid integrity.

Ecolab
IntraTemp Fluid Warming System
ecolab.com/healthcare
(800) 824-3027
Pricing: not disclosed
FYI: Warming saline bottles in a cabinet outside the OR requires routine labeling and rotation, and once removed, the fluid quickly cools. Improve OR efficiency and patient outcomes by providing access to irrigation fluids at a known, safe, consistent temperature within the sterile field.

Enthermics Medical Systems
ivNow Fluid Warmer
enthermics.com
(800) 862-9276
Pricing: starting at $999
FYI: Eliminates the set-up time and disposable expense of in-line fluid warming. Placing an IV bag into the cradle activates the warmer, which warms fluids to 40 ?C in less than 30 minutes, displays the temperature and records the bag's shelf life. The device is available with a 1- to 6-bag capacity and can be mounted on walls, countertops, anesthesia carts or equipment stands.

Estill Medical Technologies
Thermal Angel Blood and IV Fluid Infusion Warmer
thermalangel.com
(877) 354-0286
Pricing: not disclosed
FYI: Field-tested by military and emergency response users, the Thermal Angel is a lightweight, portable, battery-powered, single-use, in-line warming device, suitable for IV infusion, irrigation fluid or blood. The Thermal Angel takes only 30 seconds to set up via standard luer connections to an infusion pump. It warms to a normothermic 38??C immediately and makes 5,000 measurements and adjustments per second to maintain temperature accuracy. The disposable unit requires no cleaning, maintenance or calibration, but the battery is rechargeable.

Medical Solutions
T??Hold
warmiv.com
(800) 435-7600
Pricing: $2,950
FYI: Ensures that the temperature of a cabinet-warmed bag remains constant from the time you hang it until the last drop drips. A curved conductive plate hooked to the top of the pole hugs the IV bags, keeping them a steady 40??C throughout the procedure. The reusable device, available in 1L and 3L bag sizes, is powered by a unit that clamps lower down the pole, to the bed rail or to a wall mount, and can travel with the patient from pre-op to PACU, preventing fluid heat loss.

Pedigo Products
P-2118 Countertop Fluid Warmer
pedigo-usa.com
(800) 822-3501
Pricing: $12,714
FYI: The 3.9-cubic-foot interior chamber of this countertop-based cabinet is warmed using radiant heat technology, a low-heat-density electrothermal cable array positioned in the floor and 2 sides of the unit. Easy-to-use precision electronic controls ensure accurate set-point temperatures. The cabinet also features a 4-digit LED display, an insulated glass window door, interior illumination, a lockout function, auto-time programming and a magnetically latched door.

3M
Ranger Blood/Fluid Warming Systemranger
fluidwarming.com
(800) 228-3957
Pricing: not disclosed
FYI: Easy to use and virtually maintenance-free, this blood and fluid warming system employs a dry-heat technology and sterile, single-use, plug-in warming sets to maintain the temperature of administered fluids and quickly react to changes in flow rate, from KVO to 500mL per minute. The warming sets are available in a range of different configurations, including high-flow sets with automatic air elimination.