Temperature of IV Transfusions

Almost all operative patients and around 25% of emergency department (ED) patients receive intravenous fluids (IV) as a part of their hospital treatment (1). Transfusions of IV fluids, typically infused at room temperature, are often initiated to improve hydration and volume status. While hospital room temperature lies around 20°C, our body temperature lies around 36-37.5°C. Thus, patients will often experience chills, shivering, and mild discomfort during a transfusion (2). Warmed IV infusions have been studied in perioperative patients to improve patient comfort and prevent perioperative hypothermia, but few studies have investigated warmed infusions for ED patients.  

Warming IV fluids requires inserting the bag of fluid into an insulated warming jacket. An electronic thermometer can be placed at one end of the IV tubing to monitor the temperature of transfusions. Some devices contain sodium acetate heat packs within the warming jacket, which can be activated to then warm the fluid (1). In one study that tested warming infusions in ED patients, the temperature of the fluid with the warming device was 36°C, or body temperature, but when the warmer was off, the fluid was 22°C, around room temperature. They found that warming infusions to core body temperature was associated with improved comfort for ED patients compared to those who received room temperature IV transfusions (1). 

In perioperative patients, hypothermia, or a drop in core temperature below 36°C, can occur for many different reasons. These include anesthetic drugs which affect body temperature regulation, extended periods of having exposed skin, as well as large volume infusions of fluids (4). By warming IV fluids, it is possible to prevent some of this heat loss and thus prevent hypothermia. A systematic review found that warmed IV fluids kept the core body temperature of patients almost half a degree warmer than those who received room temperature transfusions throughout surgery at 30-minute intervals until the end of surgery (4). Shivering was considered the main outcome for measuring subjective body temperature and comfort in patients. One study that looked at women receiving warmed fluid infusions prior to epidural anesthesia found that they experienced less shivering than those receiving room temperature fluids (2). It remains unclear if the effects of warming fluids are clinically meaningful beyond patient comfort, and if there are any risks that warming IV fluids poses to patients. However, for patients who may be at higher risk of perioperative hypothermia, such as those who have less body fat, the elderly, burn victims, or patients with hypothyroidism, exploring the clinical benefits of warmed fluids may improve their overall outcomes postoperatively.  

As technology and research evolves, medicine has been moving more towards patient-centered care, focusing on patient comfort and satisfaction (3). Thus, while it is unclear of the clinical benefit of warming fluids, it is a simple technique to improve patient comfort both in emergency rooms and operating rooms.  

References  

1. Self, Wesley, et al. “Warming Intravenous Fluids for Improved Patient Comfort in the Emergency Department: A Pilot Crossover Randomized Controlled Trial.” Western Journal of Emergency Medicine, vol. 14, no. 5, 17 Sept. 2013, pp. 542–546, www.ncbi.nlm.nih.gov/pmc/articles/PMC3789921/, 10.5811/westjem.2013.1.13303.  

2. Workhoven, M. N. “Intravenous fluid temperature, shivering, and the parturient.” Anesthesia and analgesia vol. 65,5 (1986): 496-8. 

3. Govindarajan, Prasanthi, et al. “Patient-Centered Integrated Networks of Emergency Care: Consensus-Based Recommendations and Future Research Priorities.” Academic Emergency Medicine, vol. 17, no. 12, Dec. 2010, pp. 1322–1329, onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2010.00939.x/abstract, 10.1111/j.1553-2712.2010.00939.x.  

4. Campbell, Gillian, et al. “Warming of Intravenous and Irrigation Fluids for Preventing Inadvertent Perioperative Hypothermia.” Cochrane Database of Systematic Reviews, no. 4, 13 Apr. 2015, www.cochrane.org/CD009891/ANAESTH_warmed-fluids-for-preventing-hypothermia-during-operations, 10.1002/14651858.cd009891.pub2.