title: An Evaluation of Induced Failure Modes in the Belmont® Rapid Infuser.
abstract: BACKGROUND
  Rapid infusers are vital tools during massive hemorrhage and resuscitation. Sporadic reports of overheating and shutdown of the Belmont® Rapid Infuser, a commonly used system, have been attributed to 1-sided clot blockage of the fluid path. We investigated multiple causes of failure of this device.
  
  
  METHODS
  Packed red blood cells and thawed fresh frozen plasma with normal saline solution were used as base fluids for serial 10-minute trials using standard disposable sets in 2 Belmont devices. Possible contributors to device failure, including calcium-containing solutions and external leakage currents, were evaluated. Thermographic images of the heater and disposable cartridges were recorded. The effects of complete unilateral clotting were modeled by sealing half of the disposable cartridge with epoxy.
  
  
  RESULTS
  Clotting on the surface of the heat exchanger coil increased with calcium concentration and was only observed at calcium concentrations >12.0 mmol/L (P < 0.0001) in a 1:1 plasma:red blood cell mixture, resulting in high-pressure downstream occlusion alarms and interruption of flow.
  
  
  CONCLUSIONS
  Clot-based occlusion can be induced in the Belmont Rapid Infuser under unrealistic conditions. In the absence of complete unilateral flow blockage, we did not observe any significant overheating of the infuser under extreme operating conditions.
authors.affiliation: From the *Vanderbilt University School of Medicine, Nashville, Tennessee; †Vanderbilt University, Nashville, Tennessee; ‡Vanderbilt University Medical Center, Nashville, Tennessee; and Departments of §Anesthesiology, ‖ Surgery, and ¶Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Boyer
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Hocking
authors.forename: Garrett S
authors.initials: GS
authors.lastname: Booth
authors.forename: James M
authors.initials: JM
authors.lastname: Berry
authors.forename: Travis W
authors.initials: TW
authors.lastname: Spain
authors.forename: Damon R
authors.initials: DR
authors.lastname: Michaels
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pilla
mesh_terms: D004868:Equipment Failure; D004912:Erythrocytes; D005440:Fluid Therapy / Q000379:methods / Q000592:standards; D006801:Humans; D007260:Infusion Pumps / Q000592:standards*; D010865:Pilot Projects; D010949:Plasma