title: In-line pressure within a HOTLINE® Fluid Warmer, under various flow conditions.
abstract: Roller pump infusion devices are widely used for rapid infusion, and may be combined with separate warming devices. There may be instances however, where the pressures generated by the roller pump may not be compatible with the warming device. We assessed a commonly used roller pump in combination with a HOTLINE® Fluid Warmer, and found that it could generate pressures exceeding the HOTLINE® manufacturers specifications. This was of concern because the HOTLINE® manufacturer guideline states that not for use with pressure devices generating over 300 mmHg. Pressure greater than 300 mmHg may compromise the integrity of the HOTLINE® Fluid Warming Set. The aim of this study was to compare in-line pressure within a HOTLINE® Fluid Warmer at different infusion rates of a roller pump using various sizes of intravenous cannulae. The rapid infusion system comprised a 500 mL-normal saline bag, roller pump type infusion device, HOTLINE® Fluid Warmer (blood and fluid warmer system), and six different sizes of intravenous cannulae. In-line pressure was measured proximal to the HOTLINE® (pre-warmer) and proximal to the cannula (post-warmer), at flow rate of 50-160 mL/min. The in-line pressures increased significantly with increasing flow rate. The pre-warmer pressures exceeded 300 mmHg when the flow rate was ≥120 mL/min with 20-gauge, 48 mm length cannula, 130 with 20-gauge, 25 mm cannula, and 160 mL/min with 18-gauge, 48 mm cannula. However, they were <300 mmHg at any flow rates with 18-gauge, 30 mm cannula and 16-gauge cannulae. The post-warmer pressures exceeded 300 mmHg at the flow rate of 140 mL/min with 20-gauge, 48 mm cannula, and 160 mL/min with 20-gauge, 25 mm cannula, while they were <300 mmHg at any flow rates with 18 and 16-gauge cannulae. The in-line pressure within a HOTLINE® could exceed 300 mmHg, depending on the flow rate and size and length of cannula. It is important to pay attention to the size and length of cannulae and flow rate to keep the maximum in-line pressure<300 mmHg when a roller pump type infusion device is used.
authors.affiliation: Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan, midoriko@kuaccm.med.kyushu-u.ac.jp.
authors.forename: Midoriko
authors.initials: M
authors.lastname: Higashi
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaura
authors.forename: Yukie
authors.initials: Y
authors.lastname: Matsubara
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukudome
authors.forename: Sumio
authors.initials: S
authors.lastname: Hoka
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D006361:Heating / Q000295:instrumentation*; D007260:Infusion Pumps; D008365:Manometry / Q000379:methods*; D011312:Pressure; D012212:Rheology / Q000295:instrumentation*
references.citation: Lancet. 1996 Feb 3;347(8997):289-92
references.pmid: 8569362
references.citation: Anesth Analg. 1995 Mar;80(3):552-6
references.pmid: 7864424
references.citation: Anesth Analg. 1996 Mar;82(3):517-24
references.pmid: 8623954
references.citation: Anaesthesia. 2014 Feb;69(2):111-7
references.pmid: 24383681
references.citation: Ann Emerg Med. 1985 Oct;14(10):966-9
references.pmid: 4037476
references.citation: Lancet. 2000 Jul 29;356(9227):355-7
references.pmid: 10972364
references.citation: Anesth Analg. 2004 Sep;99(3):788-792
references.pmid: 15333412
references.citation: JAMA. 1997 Apr 9;277(14):1127-34
references.pmid: 9087467
references.citation: N Engl J Med. 1996 May 9;334(19):1209-15
references.pmid: 8606715