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 Table of Contents  
LETTER TO EDITOR
Year : 2015  |  Volume : 4  |  Issue : 1  |  Page : 58-59

A novel fluid-and blood-warming technique for the developing world


Department of Anesthesia and Surgical Intensive Care, Rajiv Gandhi Cancer Institute and Research, Rohini, New Delhi, India

Date of Web Publication13-Jan-2015

Correspondence Address:
Uma Hariharan
BH 41, East Shalimar Bagh, New Delhi - 110 088
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.149278

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How to cite this article:
Shah SB, Hariharan U, Bhargava AK. A novel fluid-and blood-warming technique for the developing world. Int J Health Allied Sci 2015;4:58-9

How to cite this URL:
Shah SB, Hariharan U, Bhargava AK. A novel fluid-and blood-warming technique for the developing world. Int J Health Allied Sci [serial online] 2015 [cited 2024 Feb 28];4:58-9. Available from: https://www.ijhas.in/text.asp?2015/4/1/58/149278

Sir,

Intravenous fluid (IVF) infusion as well as blood transfusion to any patient, whether in the operation theater (OT), intensive care unit (ICU) or in the emergency room (ER), needs to be warm to prevent hypothermia. Even mild hypothermia can cause several complications, from delayed wound healing to cardiac arrest. [1],[2],[3] It has important cost and clinical implications, especially in emergency situations and the critically ill patient.

We present a novel indigenous method to warm IVF, including blood and blood products, out of commonly available material in the OT. A latex glove is filled with tap water heated (in the boiler or autoclave machine) to 42°C. The IVF tubing is coiled around the water-filled glove in a spiral fashion making at least 5-6 loops. The thumb and index finger of the glove are tied together in a knot to secure the loops of the IVF tubing [Figure 1]. The sensor of a temperature probe/thermometer is fixed to the glove with adhesive tape. The whole assembly is wrapped in cotton to prevent heat loss and is placed in the arm-rest of the table or near the covered palm, close to the entry point of the venous cannula. It is not uncomfortable for the patient as both the patient's hand and the glove pack is covered in thick layer of cotton and/or plastic. Once the temperature of the glove falls to 37°C, it is replaced by a fresh glove filled with warm water.
Figure 1: Two photos showing the novel fluid warmer: Loops of the blood containing intravenous line wrapped around the water-filled gloves

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To prevent loss of time in changing the glove and wrapping the tubing, it is prudent to be ready with a couple of water-filled gloves. Wrapping it the same number of times as done previously and at the same site of IVF tubing will not alter the flow rate of infusion.

There are several commercially available fluid warmers, which are being routinely used in the OT and ICU. Most of them are expensive, as they have a one time purchase cost, cost of disposables, and costs of maintenanceof equipment. Even battery-operated fluid warmers incur the cost of frequent battery change plus the ever present risk of environmental pollution with the use of lead batteries. Our technique is unique, as it is inexpensive, user-friendly, safe, quick, and effective. The merits of our technique include the following:

  1. Highly effective: Delivers warm fluid at 37-41°C
  2. Less time to set-up and disconnect: User-friendly
  3. Eliminates patient line cool down since it is placed just proximal to the patient's intravenous access site
  4. Almost free of cost as compared to commercially available hot plates, water tank systems, hotline fluid warmer with countercurrent flows, and other fluid-warming devices
  5. Safe: No electricity required, no airlock, free from infection risk or biomedical hazard, whereas a breach between re-circulating solution path and IVF path may occur in water tank systems [4],[5]
  6. No risk of electrical or fire hazard in the presence of flammable anesthetic mixture with oxygen, unlike electrically heated fluid warmers
  7. No risk of patient injury as compared to hotline fluid warmer which is mounted on a IVF pole (above 100 cms) that may result in instability of the pole, tipping, and injury to patient or user [5]
  8. Water-filled glove pack is magnetic resonance imaging (MRI) compatible, whereas most other warming devices are not
  9. No maintenance as compared to water tank based or hotline devices which require regular servicing (monthly or annual) [1],[5]
  10. No flow rate limitations as compared to water tank devices, which allow a flow rate of 48 ml/min.


The possible contraindications to its use include: Latex allergy, platelet, or cryoprecipitate transfusion. Care must also be taken to prevent puncture or bursting of the water-filled glove. Sudden leakage of glove and mechanical injury can be prevented by avoiding over-filling of the gloves, wrapping the patient's arm with plastic and the glove with cloth. Sharps and needles must be kept away from the glove assembly and it must be not be frequently disturbed. If used properly, it can be an excellent and practical tool for fluid warming in all patients. Warming of blood is usually required in the OTs where ongoing blood losses have to be replaced fast and multiple transfusions may be required.

Fluid warming is an essential requirement in pediatric cases as well in the setting of trauma care in the ER and ICUs. Induction of anesthesia and exposure to cold atmosphere causes fall in core temperature in all patients both in the OT and ICU. This can be managed by active warming measures as well by warming all fluids, so as to prevent hypothermia and its deleterious effects.

 
  References Top

1.
Horowitz PE, Delagarza MA, Pulaski JJ, Smith RA. Flow rates and warming efficacy with Hotline and Ranger blood/fluid warmers. Anesth Analg 2004;99:788-92.  Back to cited text no. 1
    
2.
Winkler M, Akca O, Birkenberg B, Hetz H, Scheck T, Arkiliç CF, et al. Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg 2000;91:978-84.  Back to cited text no. 2
    
3.
Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997;277:1127-34.  Back to cited text no. 3
    
4.
Hazard report. Greater vigilance urged in use of SIMS Level 1 Hotline fluid warmers to detect leaks in warming set. Health Devices 2000;29:478-80.  Back to cited text no. 4
[PUBMED]    
5.
Hotline fluid warming set: Ref L-70 (package insert). Rockland MA: Sims Level 1, Inc.; 1998.  Back to cited text no. 5
    


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