Objective: Numerous studies support the use of warmed intravenous fluids in hypothermic patients. The most effective method to accomplish this goal in a cold prehospital, wilderness, or combat setting is unknown. We evaluated various methods of warming intravenous fluids for a bolus infusion in a cold remote environment.
Methods: One liter and 500 mL bags of intravenous fluid at 5 degrees C were heated using various methods in a 5 degrees C cold room. Methods included attachment of 3 types of chemical heat packs and heating the fluid in a pot on a camping stove. For all methods, fluids were run at a wide-open rate through an intravenous line with an 18-gauge catheter attached to the end to simulate a bolus infusion. The temperature of the fluid at the end of the intravenous line was measured. Each method was tested twice. Equipment weight and setup times are reported. Mean infusion temperatures for the various methods are compared.
Results: Equipment weights ranged from 19 to 665 gm. Setup times ranged from 5 to 11 minutes. The 2 methods which achieved the desired mean infusion temperature of 35 to 42 degrees C without excessive maximum temperatures were 1) 2 Meal Ready to Eat hot packs attached to a 500 mL bag of fluid for 10 minutes prior to infusion, and 2) a camping stove heating the surface of a 500 mL bag of fluid to 75 degrees C prior to infusion. Other methods, including the use of commonly available heat packs and a commercially available IV fluid warmer were ineffective, with mean infusion temperatures ranging from 7 to 12 degrees C.
Conclusions: Heating of cold intravenous fluids in a cold environment is possible using either Meal Ready to Eat heat packs or a camping stove. Further study is needed to evaluate the ability of either method to consistently produce an appropriate fluid temperature given various ambient and initial fluid temperatures.