title: A Chemical Heat Pack-Based Method For Consistent Heating of Intravenous Fluids.
abstract: BACKGROUND
  Transfusion of cold intravenous fluids (IVF) can exacerbate hypothermia. Civilian and military guidelines recommend heated IVF for hypothermic patients; however, there is currently no ideal IVF heating system for use in resource-limited settings.
  
  
  OBJECTIVE
  Development of a system that uses flameless ration heaters (FRH) and an insulated sleeve for the consistent delivery of IVF at physiologically appropriate temperatures (40°-42°C) over the range of ambient conditions typical of the prehospital and wilderness environments.
  
  
  METHODS
  The temperatures of 0.9% normal saline (NS) 1-L bags were measured under 3 ambient conditions: 3°C, 10°C, and 20°C. The IVF was placed in an insulated pouch along with a predetermined number of activated FRH (5 FRH for 3°C, 4 FRH for 10°C, and 3 FRH for 20°C) for 10 minutes before removing the FRHs. The insulated IVF bag was drained through 280 cm of intravenous tubing at a flow rate of 77 mL/min. Raw temperature data for internal and delivery temperatures were collected and analyzed.
  
  
  RESULTS
  The temperature of the IVF throughout the delivery of 1 L of NS under the 3 ambient conditions was as follows (mean ± SD): at 3°C ambient, 47° ± 2.1°C internal and 42.6°C ± 1.4°C at delivery; at 10°C ambient, 52.3° ± 2.7°C and 45.2° ± 1.6°C; and at 20°C ambient, 45.5° ± 1°C and 39.7° ± 0.7°C.
  
  
  CONCLUSIONS
  The IVF heating system described here reliably delivered physiologically appropriate temperature intravenous fluids in 2 of the 3 ambient treatment conditions. With the appropriate number of FRH for the ambient conditions, this system enables the delivery of warmed IVF to provide active warming, which may be clinically beneficial in the prevention and treatment of hypothermia.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine (Drs DeClerck and Lipman). Electronic address: mpdeclerck@gmail.com.
authors.forename: Matthieu P
authors.initials: MP
authors.lastname: DeClerck
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine (Drs DeClerck and Lipman).
authors.forename: Grant S
authors.initials: GS
authors.lastname: Lipman
authors.affiliation: Department of Biology, Stanford University (Drs Grahn and Heller, and Messrs Cao, Wieland, and Troxel), Stanford, CA.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Grahn
authors.affiliation: Department of Biology, Stanford University (Drs Grahn and Heller, and Messrs Cao, Wieland, and Troxel), Stanford, CA.
authors.forename: Vinh
authors.initials: V
authors.lastname: Cao
authors.affiliation: Department of Biology, Stanford University (Drs Grahn and Heller, and Messrs Cao, Wieland, and Troxel), Stanford, CA.
authors.forename: Mark
authors.initials: M
authors.lastname: Wieland
authors.affiliation: Department of Biology, Stanford University (Drs Grahn and Heller, and Messrs Cao, Wieland, and Troxel), Stanford, CA.
authors.forename: Tom
authors.initials: T
authors.lastname: Troxel
authors.affiliation: Department of Biology, Stanford University (Drs Grahn and Heller, and Messrs Cao, Wieland, and Troxel), Stanford, CA.
authors.forename: H Craig
authors.initials: HC
authors.lastname: Heller
mesh_terms: D006358:Hot Temperature; D007035:Hypothermia / Q000628:therapy*; D007262:Infusions, Intravenous; D055813:Wilderness Medicine / Q000379:methods*
keywords: hypothermia; improvisation; intravenous fluids; prevention; resuscitation; treatment