title: A comparison of flow rates and warming capabilities of the Level 1 and Rapid Infusion System with various-size intravenous catheters.
abstract: Cases involving massive blood transfusion may require the use of specialized blood warmers, such as the Level 1 (L-1) (Level 1 Technologies, Inc., Rockland, MA) or the Rapid Infusion System (RIS) (Haemonetics Corp., Braintree, MA). In this in vitro study, we compared the infusion and warming capabilities of the L-1 (model 1000) versus the RIS using pediatric- and adult-sized IV catheters. The time to infuse 2 L of lactated Ringer's solution and the end temperature after infusion through 20-, 18-, 16-, and 14-gauge catheters, and 4-, 5-, 6-, 7-, and 8.5-French catheters using both the L-1 and RIS were measured. The flow rates of both systems were similar for 18- and 20-gauge catheters; however, the flow rates with the RIS were progressively faster than the L-1 as catheter size increased to >18 gauge. The heating capabilities of the RIS were superior to the L-1 for all catheters >or=16 gauge. We conclude that the RIS was superior to the L-1 for both flow rates and warming capacity for all IV catheters >18 gauge, i.e., those used for cases with massive blood loss. The RIS provided no advantage (with regard to heating and flow) when used with typical pediatric-sized catheters.
  
  
  CONCLUSIONS
  The rapid infusion system is superior to the Level 1 for warming and flow of crystalloid for IV catheters >18 gauge in vitro. The rapid infusion system provides no advantage with catheters typically used in small children (<or=18 gauge). Safety and cost are additional factors to be considered when choosing one system over the other.
authors.affiliation: *Department of Anesthesiology, Northwestern University, The Feinberg School of Medicine; and †Department of Pediatric Anesthesiology, Children's Memorial Hospital, Chicago, Illinois.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Barcelona
authors.forename: Fatima
authors.initials: F
authors.lastname: Vilich
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Coté
mesh_terms: D001803:Blood Transfusion / Q000295:instrumentation*; D002404:Catheterization; D066298:In Vitro Techniques; D007262:Infusions, Intravenous / Q000295:instrumentation*; D007552:Isotonic Solutions / Q000008:administration & dosage; D012212:Rheology; D000077325:Ringer's Lactate; D013696:Temperature
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate