Cold IV fluid through Picc line..?

brownbook · May 1, 2010

Hi, I am no expert. The cold fluid will cool the patient even going directly into the vena cava. Certainly patients can feel the coolness from a peripherial IV that is not direct from the fridge, one that is just kind of cool, room temp. I would think the amount of IV fluid would be important, a 100 ml cold bag, vs. a 250 or 500 ml cold bag. I would check with the pharmacy but we have always taken medications out of the fridge 1 - 1/2 hour prior to infusion. But I don't know if any harm would be done to a patient getting refigerator cold IV fluid close to the vena cava?

pookiesmom · May 4, 2010

Hi, thanks for the info. I only had a 100 ml bag, but your comment makes sense.

fiveofpeep · May 17, 2010

Ive heard that that can happen with rapid fluid administration at room temp, but I havent heard of it happening with just the IVPB abx.

iluvivt, BSN, RN · May 22, 2010

Small volumes get warmed by the blood pretty quickly.....large volumes and cold blood can cool the patient and they sometimes can sense a feeling of coolness

IVRUS, BSN, RN · May 25, 2010

It is never a good idea to hook something up to a patient that has just come out of the refrigerator. Cold IVF can cause venous spasms, vasoconstriction and in large amounts, cardiac arrythmias especially if going into a catheter was has been centrally placed.

We advocate this rule of thumb:

50-250cc bag = remove from the frig 30 minutes prior to infusing

500 cc-1 Liter bag = One hour

2L = 2 hours

3L = 3 hours

Always allow these refrigerated meds to come to room temp in a clean dry area of the med room. Never put in a warm water bath or microwave. :lol2:

Sydlit · Oct 8, 2016

I asked this question because it frequently happens to me. I've just had a TAVR procedure where my aortic valve was replaced. The cold IVPB gives me chills, makes my right hand and arm cold( PICC inserted right upper arm) depending on size of bag the rate is 200-250 cc/hr. Just having recent surgery, I'm concerned with the cold fluids causing some kind of shock to my heart.

la_chica_suerte85, BSN, RN · Oct 8, 2016

I work with kids and they feel the PIV flushes as cold, too, and some complain of it as pain, especially when they're new and haven't gotten their central lines put in yet. Even if it's room temperature, that's a significant difference from core temp (i.e. 22 C to 37 C) and it will definitely be sensed. Because of the spec heat of water, blood is stubborn at changing its temperature too much so it's not going to make their temp drop significantly (excluding massive transfusions, however, and then blood warmers are used).

la_chica_suerte85, BSN, RN · Oct 8, 2016

Sydlit said:
I asked this question because it frequently happens to me. I've just had a TAVR procedure where my aortic valve was replaced. The cold IVPB gives me chills, makes my right hand and arm cold( PICC inserted right upper arm) depending on size of bag the rate is 200-250 cc/hr. Just having recent surgery, I'm concerned with the cold fluids causing some kind of shock to my heart.

This is mostly a concern of trauma patients receiving massive transfusions of cold blood (and by massive, that's defined as your total blood volume being transfused in 24 hours or more than half of that volume within an hour -- I.e. way more than 200-250 ml/hr). The purpose of a PICC is to put fluids into a vessel that is comparatively huge and can significantly dilute the fluids that would otherwise be very damaging to smaller vessels. You definitely feel cold because, like I posted above, the difference between what was in the fridge and what your core temp is is huge (even at room temp it's huge). But, because so much more blood is flowing through that central part of the circulatory system, not only does the blood dilute the concentration of the fluids being infused but also their cooler temps as well. I mean, it only takes a slight change in body temperature to actually feel cold.

For what it's worth, cold also helps reduce inflammation which can help with healing. At the extreme end of things hypothermia is used to help with the metabolic catastrophe that occurs from a heart attack. At the milder end of the spectrum this is why ice is gaining much more evidence in support for healing injured muscles as opposed to heat.