Blood Warmer Fluid Warmer

Procedure for use of multiple types of blood and fluid warmers

Assessment and Preparation
  1. Perform hand hygiene and apply gloves. 
  2. Obtain baseline vital signs, including temperature, to monitor for fluid overload, transfusion reaction, and hypothermia during and post infusion. 
  3. Verify the patient's identity in accordance with institutional policy. 
  4. Establish venous access with a large-bore catheter. If the patient has a preexisting IV site, assess the site for signs of infiltration or phlebitis. 
  5. Attach a short (20 cm or less) extension set to the IV cannula.

Level 1® Fluid Warmer

  1. Push the bottom of the heat exchanger into the socket labeled "1." 
  2. Insert the heat exchanger into the guide. Slide the top socket, labeled "2," down over the top of the tube until it clicks. 
  3. Insert the filter/gas vent into its holder, labeled "3." 
  4. Plug in and turn on the machine. The display panel should have a green "system operational" indicator light. 
  5. Ensure that all the tubing connections are tight. 
  6. When infusing fluid under pressure, remove all the air from the IV bag with a syringe and needle. 
  7. Close all the IV clamps, spike the IV bag, and hang it on the IV pole. 
  8. Open the clamp above the drip chamber and squeeze the drip chamber until it is half full. 
  9. Open the last two clamps, remove the end cap, and prime the remaining tubing. 
  10. Close the distal clamp to cause the filter/gas vent to self-prime. Gently tap the filter or gas vent against the cabinet to remove all the trapped air. 
  11. Connect the system directly to the IV catheter to achieve the optimal flow rate. 
  12. When infusing blood products, replace the filter/gas vent or tubing set every 3 hours or sooner if the filter becomes clogged or the air is vented slowly. 
  13. Activate the pressure infuser (present on model 1025 and model 1200): 
  14. To prevent an air embolism, remove all the air from the IV bag with a 20-ml syringe and a needle, or use a needle to vent the air out of the injection port while squeezing the inverted bag. Spike the bag and prime the IV tubing. 
  15. Ensure that the venous access is made with a 14-G or larger cannula. 
  16. Flip the toggle switch on the pressure infuser to the "off" position. 
  17. Open the hinged latch on the right side of the infuser and hang the solution on the post at the top of the door. For blood or 500-ml bags of IV solution, use the post mounted on the inside of the door. 
  18. Close the door and latch it. Open all the clamps in the IV tubing and close the clamp to the opposite spike tail. 
  19. Flip the toggle switch to the "+" (on) position. Observe the pressure gauge to see whether a pressure of approximately 300 mm Hg is achieved. The pressure is not adjustable. 
  20. When the fluid infusion is complete, flip the switch to the "-" (off) position and open the door. Remove the bag and repeat steps a through f. Manual decompression of the infuser bladder facilitates the insertion of a new IV bag.
  21. PF-1 blood filter: The PF-1 is a 340-micron blood filter that prolongs the life of the 170-micron filter incorporated into the Level 1 tubing. Spike the blood bag with the PF-1 filter and then spike the PF-1 filter with the spike on the tubing set. Replace the PF-1 filter with each unit of blood. 
  22. Y-30 connector: Simultaneous infusion into two different IV sites can be achieved with the Y-30 connector. The Y-30 connector is added to the distal end of the tubing set and primed. The connector may be added even if two sites are not in use. Prime both tails and clamp off one. 
  23. D-60HL tubing: Slow infusion rates increase the likelihood that much of the heat may be lost between the fluid warmer and the patient. The D-60HL tubing system, however, has a warm water jacket surrounding the full length of the tubing to allow the infusion of the warmed solution at rates as low as 75 ml/hr. 

Troubleshoot alarms: 
The "check disposables" alarm indicates that a part of the tubing is not fully inserted into the warmer. Check the tubing at the points labeled "1," "2," and "3." 
The "add water" alarm signals a low water level in the circulating bath. Turn off the machine and remove the plug from the front of the machine. Add distilled water to the reservoir until it is full, as evidenced by the window in the front. 
The "over temperature" alarm signals excessive heating. Turn off the fluid warmer and remove it from service until it can be inspected and serviced.

Level 1®H-1200 Fast Flow Fluid Warmer

The Level 1® H-1200 warmer also integrates pressure infusers, air detection, and automatic clamping in the presence of air.

  1. Insert the bottom of the heat exchanger into the block labeled "1" and push down to seat the heat exchanger firmly.
  2. Slide the "2" block up and snap the heat exchanger into the guide. Slide the top socket, labeled "2," down over the top of the tube until it clicks.
  3. Insert the gas vent/filter assembly:
  4. Open the "3" clamp slot door and slide the patient line up under the clamp slot door. Press the tubing into the clamp slot. Press the clamp slot door down to secure the tubing in the clamp slot.
  5. Align and insert the gas vent/filter assembly into the "4" block so as to prevent kinking of the tubing.
  6. Make sure the toggle switch is in the off (-) position on both pressure chambers.
  7. Press the green power on button.
  8. The air detector/clamp runs a power on test. All air detector/clamp indicators illuminate and an audible warning beeps.
  9. When the power on test is completed, the air detector/clamp enters unclamp mode; the unclamp LED lights up and the audible warning beeps every 5 seconds.
  10. The green automatic operation indicator light on the Fluid Warmer display panel lights up.
  11. If the disposable set/tubing is not correctly installed, the check disposables indicator illuminates and the audible alarm beeps. Confirm that each step of installation has been completed correctly.
  12. Test the audible and visible alarms:
  13. Press and hold the alarm test button on the Fluid Warmer's power and alarm test panel and all visible alarm indicators will illuminate while the audible alarm signal beeps.
  14. When the alarm test button is released, the over temperature alarm will continue to be active. To clear the over temperature alarm: 
  15. Turn the Level 1® off and then turn it back on.
  16. The air detector/clamp will run another power on test and go into unclamp mode. This is indicated by illumination of the yellow unclamp LED and beeping of the audible signal every 5 seconds. If the air detector/clamp does not go into unclamp mode, press the unclamp button.
  17. Prime the disposable set/tubing.
  18. Remove all the air from the IV bag with a 20-ml syringe and a needle, or use a needle to vent the air out of the injection port while squeezing the inverted bag. Alternatively, the bag can be spiked with the tubing, the spike withdrawn slightly from the bag, the air expressed, and the spike reinserted.
  19. Ensure that all the tubing connections are tight. Close all the IV clamps, spike the IV bag, and hang it on the IV pole.
  20. Open the clamp above the drip chamber and squeeze the drip chamber until it is one-third to one-half-full.
  21. Open the last two clamps, remove the end cap, and prime the remaining tubing.
  22. Close the distal clamp to cause the filter/gas vent to self-prime.
  23. Set the air detector/clamp to automatic operation:
  24. Press the unclamp button on the air detector/clamp control panel; this should cause the yellow unclamp light to go off and the alarm to stop beeping.
  25. The green automatic operation indicator lights up. Now, the air detector/clamp will clamp the patient line if air is detected in the gas vent/filter assembly.
  26. Test the air detector/clamp by pulling the top of the gas vent/filter assembly away from the air detector sensor. The following should occur:
  27. Patient line is clamped shut and flow to the patient ceases.
  28. Red clamped indicator lights up. 
  29. Audible alarm beeps.
  30. Return system to normal operation:
  31. Push the top of the gas vent/filter back into the "4" block.
  32. Press the unclamp button on the air detector/clamp. The yellow unclamp button illuminates and the audible alarm beeps every 5 seconds.
  33. Press the unclamp button on the air detector/clamp control panel again; this should cause the yellow unclamp light to go off and the alarm to stop beeping.
  34. The green automatic operation indicator lights up.
  35. Connect the system directly to the IV catheter to achieve the optimal flow rate. The Level 1® System 1000/1025 can warm fluid to between 37°C and 42°C at a rate of up to 1 L/min (60,000 ml/hr).
  36. When infusing blood products, replace the filter/gas vent or tubing set every 3 hours or sooner if the filter becomes clogged or the air is vented slowly.
  37. Activate the pressure infuser (present on model 1025 and model 1200):
  38. To prevent an air embolism, remove all the air from the IV bag with a 20-ml syringe and a needle, or use a needle to vent the air out of the injection port while squeezing the inverted bag. Spike the bag and prime the IV tubing.
  39. Ensure that the venous access is made with a 14-G or larger cannula.
  40. Flip the toggle switch on the pressure infuser to the "off" position. 
  41. Open the hinged latch on the right side of the infuser and hang the solution on the post at the top of the door. For blood or 500-ml bags of IV solution, use the post mounted on the inside of the door.
  42. Close the door and latch it. Open all the clamps in the IV tubing and close the clamp to the opposite spike tail.
  43. Flip the toggle switch to the "+" (on) position. Observe the pressure gauge to see whether a pressure of approximately 300 mm Hg is achieved. The pressure is not adjustable.
  44. When the fluid infusion is complete, flip the switch to the "-" (off) position and open the door. Remove the bag and repeat steps a through f. Manual decompression of the infuser bladder facilitates the insertion of a new IV bag.
  45. PF-1 blood filter: The PF-1 is a 340-micron blood filter that prolongs the life of the 170-micron filter incorporated into the Level 1 tubing. Spike the blood bag with the PF-1 filter and then spike the PF-1 filter with the spike on the tubing set. Replace the PF-1 filter with each unit of blood.
  46. Y-30 connector: Simultaneous infusion into two different IV sites can be achieved with the Y-30 connector. The Y-30 connector is added to the distal end of the tubing set and primed. The connector may be added even if two sites are not in use; prime both tails and clamp off one. This ensures fast access to warmed fluid if another IV site is obtained.
  47. D-60HL tubing: Slow infusion rates increase the likelihood that much of the heat may be lost between the fluid warmer and the patient. The D-60HL tubing system, however, has a warm water jacket surrounding the full length of the tubing to allow the infusion of the warmed solution at rates as low as 75 ml/hr.
 
Troubleshoot alarms:
  • The "check disposables" alarm indicates that a part of the tubing is not fully inserted into the warmer. Check the tubing at the points labeled "1," "2," and "3."
  • The "add water" alarm signals a low water level in the circulating bath. Turn off the machine and remove the plug from the front of the machine. Add distilled water to the reservoir until it is full, as evidenced by the window in the front. (Sterile water is commonly distilled and may be used; however, the water does not have to be sterile.)
  • The "over temperature" alarm signals excessive heating. Turn off the fluid warmer and remove it from service until it can be inspected and serviced.
  • The "air detected" alarm will automatically clamp the patient line. Close all clamps on the patient line and return the pressure chambers to the off (-) position. Locate the air and withdraw it. Note that the air or foam may have been vented through the gas vent/filter assembly. Reinstall the tubing and set the air detector/clamp to automatic operation as described in step 8 above.

HotLine® Fluid Warmer

  1. Check the water level in the tank and plug the warmer into the power outlet.
  2. Push the two extended tubes into the socket on the side of the warmer. A snap should be felt.
  3. Turn on the power switch. If the warmer is functioning properly, a green "operating" light comes on and the water temperature gauge starts to increase.
  4. The water flow should be visible in the outer lumen. Check to make sure that this lumen becomes fully primed before connecting it to the IV line.
  5. Connect the IV tubing to the warmer set and prime the inner lumen with fluid.
  6. Open and set the fluid rate with the roller clamp on the IV tubing set.
 
 
 
FloTem IIe
  1. Prime the IV tubing.
  2. Place the tubing into the indented channel on the heating plate.
  3. Close the warmer and turn on the power switch. The unit achieves the required temperature within 2 minutes.
  4. A green power light is visible on the front of the unit along with the heated temperature of the fluid.
  5. An audible alarm sounds if the temperature exceeds 41.5°C, and power to the coils is stopped. If the temperature reaches 42.5°C, the entire unit shuts off.

Warmflo® FW-538 Fluid Warmer

  1. The warmer displays specific operating instructions on the liquid crystal diode (LCD) screen. To start the warmer, press the "on" button and follow the instructions on the screen.
  2. To remove the cassette, press the "eject" button and follow the instructions on the screen.
  3. To turn the warmer off, press the "off" button and follow the instructions on the screen.
  4. To change the temperature set point, press the "t" or "s" button.
  5. Fluid may be pressurized up to 500 mm Hg. For pressurized infusion, do the following:
  6. Remove all the air from the IV bag with a 20-ml syringe and a needle, or use a needle to vent the air out of the injection port while squeezing the inverted bag. Alternatively, the bag can be spiked with the tubing, the spike withdrawn slightly from the bag, the air expressed, and the spike reinserted. Spike the bag and prime the IV tubing.
  7. Place the IV bag in the infuser compartment and close and latch the door.
  8. Turn the toggle switch on the bottom of the infuser to the "+" (on) position. The pressure infuser can then be activated by the warmer at the appropriate time.
  9. To increase the pressure, turn the regulator knob clockwise (right). To decrease infusion pressure, turn the regulator knob counterclockwise (left) one turn. Turn the toggle switch "off" and then "on" again to allow the pressure to stabilize. Repeat if necessary.

Thermal Angel® TA-200

  1. Remove the female cap from the inlet end of the warming unit and connect the appropriate IV tubing (blood tubing, pump tubing, or primary set). Tighten until resistance is met without overtightening.
  2. Remove the male cap from the outlet end of the device and connect a 9-inch IV extension tubing. Tighten until resistance is met without overtightening.
  3. Connect the assembled tubing to the IV bag and prime the line.
  4. Connect the male end of the power cable to the inlet end cap and connect the female end of the power cable to the battery. The green LED will illuminate without blinking when the battery is properly connected.
  5. Connect the extension set to the patient's IV site and begin the infusion.
  6. Each battery will supply enough energy for warming 2 to 4 L of fluid or 1 to 3 units of blood. When the battery is depleted, you can connect another battery to the device to continue the warming. The warming device will operate for up to 72 continuous hours, at which point it will not respond to new batteries.

Ranger® Blood/Fluid Warming System

Priming the Fluid Cassette

  1. Slide the fluid-warming cassette into the slot in the warming unit. Connect the short inlet line on the Ranger Warming set to the fluid source.
  2. Prime all tubing to purge air from the infusion line. Invert the bubble trap while priming and fill it completely.
  3. Turn the bubble trap right side up and continue priming the patient line.
  4. Place the bubble trap into the holder on the warming unit.
  5. Close all clamps.
  6. Turn the warming unit "on."
  7. Connect the tubing to the IV site and begin the infusion. Manual pressure bags may be used to speed the infusion.

Removing Air from the Disposable Set
  1. Close the clamp between the injection port and the patient connection.
  2. Invert the bubble trap.
  3. Insert a syringe into the injection port and aspirate air until the bubble trap and IV line are free of air.
  4. Place the bubble trap right side up in the holder.
Open the clamp and continue infusion.

Removing the Disposable Set
  1. Close the inlet clamp and open the patient line clamps.
  2. Disconnect the warming set from the fluid source.
  3. Allow the fluid to flow into the patient if desired (this may take a few seconds).
  4. Disconnect the warming set from the patient's IV and replace it with another IV line or a catheter cap.
  5. Remove the fluid-warming cassette from the warming unit and discard.

Post Procedure
  1. Discard supplies, remove gloves, and perform hand hygiene.
  2. Document the procedure in the patient's record.
  3. Monitor hemodynamic status and vital signs, including temperature, every 5 to 15 minutes or as indicated.
  4. Monitor urine output hourly.
 
Monitor laboratory data to include hematocrit, prothrombin time (PT), partial thromboplastin time (PTT), platelet count, electrolytes (including calcium), serum lactate, and arterial blood gases.

 

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