Warming of IV fluids with MRE heater

[kaja]

Hi

I was thinking about using MRE heaters for warming IV infusions, mainly during winter, when jut carrying them under gear won't help that much. Also, I found some suggestions that it can be done, but I'd like to ask more experienced professionals on how to do it best.

Is it preferable to just put IV bagl into heater, and during the exotermic reaction start administration, or coil tubing through the inside of heater, or just tape it side-by-side? is there any simple and field expedient way to control temperature of fluids administered this way?

I would really appreciate if you'll share your experiences!

Thanks!

 

[TLDR20]

Why don't you use an approved device like a thermal angel? Using an MRE heater could lead to fluids being too warm and potentially harming the patient.

 

[Muppet]

I agree with cback...I have tried the first years ago when we had no thermal angels and had, well, poor results. I also currently use the thermal angel with / when I work USAR and have good results BUT... First, you must make Kcals or a measurement of heat to produce warming of the blood with the fluid, if I am not mistaken. Second, warmed blood in IMHO is difficult. Why you ask. First as the docs and medics on here can attest to, permissive hypotension is considered stardard of care in the presence of intact mentation, controlled bleeding and ANY kind of fluid, warmed or cold can cause hemodilution, of course I understand the fear of cold fluids resulting in stuff like DIC / hypotension and hypothermia. I hope you understand. So, I would control fluuids by the above, cover the pt. with a blanket(s) AND spoon if needed amoung the other typical shock stuff.

F.M.

 

[kaja]

First, thanks for replies

Thermal Angel- Don't have access to them, they are not approved here, too big/ bulky for small aid bag/ CLS bag.I'd love to have these available for vehicle bag, but no joy either.

I don't plan on using it for any blood products. If I'll have blood, I'll most likely have way to warm it properly.

I understand current TCCC guidelines regarding fluid resuscitation. But I may need to get some fluids into casualty in progressed shock, with burns, dehydration or just drip to keep IV access open. I don't want to do this with cold fluids.
I, or my CLSs, don't always carry IV fluids on my/their body (body armour, layering of clothes, ... or just pure laziness and comfort prevents it) and while operating outside in winter, or just chilly night the fluids in bag can get cold enough too create serious problem when administered.

Overheating may be an issue, hence the question about temperature control. Just the feel may be enough, but maybe taping elastic thermometer may work.

I do plan to do my part and try various application methods, but wanted to first get some advices/ experiences to prevent starting from zero.

 

[pardus]

My first thought is to simply carry the bag against your body... Simple fix.

 

[Ranger Psych]

While you say you can't use them and I get that, there's room in your aid bag for one. Right now, with everything you have in there already. A thermal angel is smaller than a 1000cc bag, battery included. The size argument is pretty much a non-argument...

The other thing is that you mention burns. You're going to be pushing a large amount of fluids for burns as everyone knows... and having a TA for that patient with 1, or even 2 batteries for longer duration use for those Liters of fluid you'll be throwing at them will be a huge deal.

I've never done the MRE heater method, but if I were going to do it I would probably get the heater going, and make someone HOLD THE IV TUBING TO IT. Don't wrap it around it, just hold it against it. Cheap thermometer, basically. If someone can't hold it with the IV tubing just running past it, then you need to figure out something to put between them to buffer the heat. Meanwhile, everyone who can needs to be prepping their bags in their armpits if they're on security.

My next personal choice I would go with if I was having to go without a thermal angel, would be the IV rigs that http://www.doctordown.com/ carries.

If it's cold enough to be worried about IV temperature you might also want to be looking at a combination of Ranger Wraps from doctor down, and active patient heating solutions like http://www.chinookmed.com/cgi-bin/i...ady-Heat-Disposable-Heated-Blanket-36"x60"--- as an example.

 

[policemedic]

Are you saying you have no access to a commercial, approved heating method ?

Here are some other issues to consider when you're getting inventive, along with others previously mentioned:
-inability to heat, particularly if you're putting the heater on the drip tubing itself
-inability to heat evenly
-melting/damaging the tubing/bag


It took me 19 nanoseconds to find this poster, and I didn't even have to hit PubMed.

 

[Ranger Psych]

Well, there you have it. MRE heater's about the only way to do it other than with a stove, and the temperature varies enough on the hot end to be >130 Fahrenheit.

I'm pretty sure if I was a casualty that would wake me up enough to rip the tubing out of my arm then work on using my last breath to take yours. LOL

 

[policemedic]

By the way, are you talking about just running NSS, Hextend, etc., or also using additives e.g. mixing an epinephrine drip?

 

[TLDR20]

Last I checked CLS's were not allowed to administer IV fluid. Has this changes back? Also, by the time you are to the point in your treatment where IV fluids are needed you prolly would have had about 20 mins to warm them next to a body.

 

[Ranger Psych]

Erm, when did that change? CLS incorporated IV administration from back in the 80's when veteran buddies were in, 98 when I did it as well.

 

[pardus]

Last I checked CLS's were not allowed to administer IV fluid. Has this changes back? .

Not that I'm aware of. They are still not supposed to do IVs.

Erm, when did that change? CLS incorporated IV administration from back in the 80's when veteran buddies were in, 98 when I did it as well.

Changed about 2 years ago now, too many retard CLS guys giving hextend for dehydration, not to mention spending far too much time trying to give the magic bullet IV while the PT was dying of everything else. We have really moved away from IVs now compared to a few years back.

 

[kaja]

Regarding IV and CLS- Our guidelines allow that, but generally we are also moving away. But since there are CLS guys who take extra time to get schooled, drives ambulances and generally know what they are doing, I feel comfortable to let them administer IV fluids. But that's for different discussion....


policemedic: thanks for that poster. I'm currently on winter exercise, so I have only access to internet through my phone. And very likely I'd have problem finding it even at home...


"Are you saying you have no access to a commercial, approved heating method ?"
Yup. Actually I may try to buy it with my own wallet and pass in under the radar of superiors, but right now I have my hands full with getting everybody at least useful IFAK, not to mention that we are issued tourniquets which, as far as I know, hadn't been properly tested/evaluated.

MRE method just seemed quite functional (at least in my mind), cheap and easily packable. Of course using body heat is still preferred method, but I was looking for possible alternative way.


Although I feel like I poked hornet's nest with my dick, I'm glad for information/ recommendations I got here.

 

[The91Bravo]

Changed about 2 years ago now, too many retard CLS guys giving hextend for dehydration, not to mention spending far too much time trying to give the magic bullet IV while the PT was dying of everything else. We have really moved away from IVs now compared to a few years back.

I like the concept, and agree completely with eliminating that step (for the most part). we were running charter students through CLS at Ft Lewis in the late 80's and I often thought, "If we are training them to administer IVs we either need to extend the training so they get a better grasp on how when and why to give it or abandon that portion of the training and add more emphasis to another portion." Ya know what I mean?

We were also planning on a war with Warsaw Pact nations and the battlefield we planned to fight on never came to fruition.

 

[TLDR20]

With the hypovolemic resucitation protocols in effect now, there is very little reason for a CLS provider to give IV fluids.

 

[Totentanz]

Erm, when did that change? CLS incorporated IV administration from back in the 80's when veteran buddies were in, 98 when I did it as well.

It was shortly before Oct 2009. IV was part of CLS in Feb when I did basic, and was gone by the time I did CLS again in Oct as part of BOLC 2.

 

[policemedic]

Good move, IMHO.

 

[Ranger Psych]

Not that I'm aware of. They are still not supposed to do IVs.



Changed about 2 years ago now, too many retard CLS guys giving hextend for dehydration, not to mention spending far too much time trying to give the magic bullet IV while the PT was dying of everything else. We have really moved away from IVs now compared to a few years back.

LOL what the fuck was hextend doing in a CLS bag anyway. RFR we just focused on IV access once everything else was good. Oh well.

 

[pardus]

LOL what the fuck was hextend doing in a CLS bag anyway. RFR we just focused on IV access once everything else was good. Oh well.

I'd say at least 50% of regular medics out there are incompetent fucks who I wouldn't allow near me if I was hit, so I wouldn't trust any CLS unless I personally knew they were good to go.
IV access is good if they can keep it open (as I'm sure you know). One problem was that CLS pers and medics were concentrating on IV access at the neglect of actual life saving interventions.
The only reason for CLS to have fluids was to save lives, immediately on the battlefield and hextend was the only fluid that could really do that, hence it's issue. But being tards, they though all liquid rehydrates because... tits, where?

 

[policemedic]

I'd say at least 50% of regular medics out there are incompetent fucks who I wouldn't allow near me if I was hit, so I wouldn't trust any CLS unless I personally knew they were good to go.
IV access is good if they can keep it open (as I'm sure you know). One problem was that CLS pers and medics were concentrating on IV access at the neglect of actual life saving interventions.
The only reason for CLS to have fluids was to save lives, immediately on the battlefield and hextend was the only fluid that could really do that, hence it's issue. But being tards, they though all liquid rehydrates because... tits, where?

In my last unit I removed all the Hextend from the CLS bags. It was bad mojo, and here's why as I see it.

The CLS class, and to a great degree the 68W schoolhouse, produces people with skills e.g. IV starts but an insufficient understanding of what they're doing. Hextend is a great example; no CLS or Whiskey in my unit could explain how it works, soooo...you can't have it until you learn more. Contraindications for flu vaccine we had to administer, same same.

CLS training should focus on what you identified above--actual life saving interventions in the tactical setting--and the Whiskey schoolhouse needs to step it up.