Our Level I trauma center was told by JCAHO last year that we can no longer keep bags of IV fluids in "fridge style" warmers on the unit (like where blankets are kept but separate compartment).
As a result, I think we're using warmed IV fluids much less often than we should & am looking for opinions from other EDs.
Management says we should use the rapid infuser & our "Ranger" warmers (YES: we continue to use for traumas), but we end up using them in far fewer situations than we could - perhaps due to no more speed & simplicity of just pulling out room temp fluids.
It was nice to use readily avail warm fluids for all kinds of pts - dehydrated little old ladies, babies, even a kidney stone pt who might feel chilled after a few liters.
I'm tired of making my patients (mildly) hypothermic/increasing their oxygen demand & decreasing their comfort...
I warm mine in the microwave. When the bag starts to melt, I know it's done.
I laughed so hard at this. What a perfect response!
We keep ours in a fridge style warmer. Fluids in top (seperate) compartment, blankets in bottom compartment. They are individually controlled so different temp ranges are not a problem.
Wonder why they had such an issue with it? They should have given an explanation as to why in the report.
Specializes in clinical pathways - ED, home infusion, IT, lab.
HAPPY ENDING: We got single dedicated small counter-top warmer & put in 0.9 & LR (labeled with date put in & date expires) so now I have the warm stuff whenever I want it when using rapid infuser isn't appropriate but still don't want to chill my patient
Interesting responses, I've recently brought this up in my dept.; they're response was to submerge the bag in warm water until the bag is warm. We have a level one fluid infuser, but I was told not to use it as it will infuse the fluids too quickly? What is everyone's opinion on using the Level 1 rapid infuser / warmer with patients who are not hypovolemic, but are hypothermic?
A lot of hospitals seem to have 'reasons' not to use the Level 1, but only one I've worked in was honest enough to tell me that its because the infusion lines for it are insanely expensive!
My last hospital had a great solution, we kept 6-10 bags within the resuscitaire, which was alway warmed to 38 celsuis, and whenever we used one we replaced it.
Other alternative is the Bair Huggers which have facility to run the line thru the heated blanket, they work well.
Specializes in Adult and Pediatric Vascular Access, Paramedic.
We use a small nap sack type warmer on my ambulance, but It only holds 2 liter bags and one half liter bag at a time, so it may be to small. I would look into that though, I am sure they sell larger ones. You can even hange the bag inside and hang the warmer so the fluid doesn't cool.
Specializes in Spinal Cord injuries, Emergency+EMS.
We use a small nap sack type warmer on my ambulance, but It only holds 2 liter bags and one half liter bag at a time, so it may be to small. I would look into that though, I am sure they sell larger ones. You can even hange the bag inside and hang the warmer so the fluid doesn't cool.
Happy
as opposed the the old classic of the fluid bags put on the demisters ...
Screw the Joint Commission. I mean, really, let them come and do actual patient care for a while. There is absolutely no doubt about the comfort benefits of warmed IV fluid for the vast majority of patients, and it really should be considered the standard of care for trauma patients. Most of the docs in our ER say to give everyone warmed fluid unless we're trying to lower their temperatures aggressively, e.g. those with heat stroke or malignant hyperthermia. Low to medium grade fever isn't necessarily a bad thing, it's a defense mechanism after all, and forcing an alrealy sick patient to have to overcome a 30º temperature gradient (such as with room temp fluids) isn't doing them any good. We have one of those upper/lower warmers, with blankets in the lower compartment kept at 110ºF and fluids in the upper at around 100ºF. JCAHO has been through every year since we started using it five years ago and have never said a peep, but I'm not sure they've actually looked at it.
I bet what they didn't like was a lack of a lock. These fluids are technically medications and TJC loves for all mess to be locked. A simple code lock on the warmer door could fix your issue;) Good luck!
80sNurse
35 Posts
thanks, all!
yes, we have & use level 1 & ranger; but we don't pull out the gear for as many non-trauma pts as I'd like.
yes, we did date our fluids & keep in sep compartment from blankets, but JCAHO still nixed it.
trying to see if JCAHO is inconsistent, AND trying to do increased use of (cost effective) warm fluids.
keep those comments comin!