fluid warmer - products

[anes121508]

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Anybody have a resource that gives evidence about what you can and can't put through the fluid warmer? (Ranger)

What's your practice?

 

[deleted171991]

Anything but cryo and platelets, and some include even the latter.

 

[psychbender]

I use a warmer with any blood product. Platelet function is not inhibited by warming. The recommendations not to warm platelets were not based on data, but rather theory, which has not born out in practice or small studies looking for a decrease in function.

http://www.ncbi.nlm.nih.gov/pubmed/23921655

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[anes121508]

I use a warmer with any blood product. Platelet function is not inhibited by warming. The recommendations not to warm platelets were not based on data, but rather theory, which has not born out in practice or small studies looking for a decrease in function.

http://www.ncbi.nlm.nih.gov/pubmed/23921655

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This is exactly what I thought and was looking for.

 

[anes121508]

Anything but cryo and platelets, and some include even the latter.

This is exactly what I've been taught, without any rationale other than heating will destroy/inactivate the platelets and cryo.

 

[Arch Guillotti]

Every bag of platelets I have ever seen seems pretty warmed up already.

 

[deleted171991]

This is exactly what I've been taught, without any rationale other than heating will destroy/inactivate the platelets and cryo.

My logic is that giving cryo and platelets through an unwarmed line will not generally affect temperature (small volumes), so I don't really care. 🙂

 

[psychbender]

My logic is that giving cryo and platelets through an unwarmed line will not generally affect temperature (small volumes), so I don't really care. 🙂

You're right. The volume of those two units is low, and platelets are already at room temperature, so they are unlikely to significantly decrease core temperature (at least, less than unwarmed PRBCs or FFP). When I have to give platelets or cryo, my warmer(s) is usually already in use with RBCs and/or plasma, so I just give then unwarmed. However, if you do warm them, it will not decrease their effectiveness.

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[deleted171991]

Cryo can be at room temperature, too, 20-24C, for up to 4-6 hours, if not given immediately.

 

[deleted162650]

I was never told not to give PLTs through the warmer, but I was taught you should not "squeeze" them in, but rather just let 'em drip. Any truth to that??

 

[ranvier]

Throw them all into the belmont like a big washing machine, set it and forget it

 

[Ronin786]

The reason platelets aren't approved for use on the warmer has to do more with the manufacturer never doing the proper testing than any sort of evidence-based medicine.

 

[Mman]

I was never told not to give PLTs through the warmer, but I was taught you should not "squeeze" them in, but rather just let 'em drip. Any truth to that??

I always assumed it's because of the relative high risk of allergic reaction. If they are going to have a severe reaction, you'd probably not want to squeeze the whole bag in at once. If it's dripping slowly, you can always stop the infusion if needed.

 

[Shimmy8]

Just had this discussion last night during a liver transplant.

We give platelets through our filter but no warmer. Everything else gets through ranger or the Belmont if using.

 

[Noyac]

Just had this discussion last night during a liver transplant.

We give platelets through our filter but no warmer. Everything else gets through ranger or the Belmont if using.

Why?

 

[pgg]

I was never told not to give PLTs through the warmer, but I was taught you should not "squeeze" them in, but rather just let 'em drip. Any truth to that??

Platelets are sensitive to shear stress and turbulent flow. They shouldn't be squeezed in, or especially syringe pumped in, because (in theory) doing so could activate some portion of them.

I have absolutely no idea if that's really clinically significant, but the theory seems plausible to me, so I let them drip.

 

[deleted162650]

Platelets are sensitive to shear stress and turbulent flow. They shouldn't be squeezed in, or especially syringe pumped in, because (in theory) doing so could activate some portion of them.

I have absolutely no idea if that's really clinically significant, but the theory seems plausible to me, so I let them drip.

Yes that's the reasoning I was taught as well but wondering if there any clinical truth to it or not.

 

[Noyac]

Yes that's the reasoning I was taught as well but wondering if there any clinical truth to it or not.

Exactly!
Is this dogma or real as in, does it have a real clinical effect?

 

[anes121508]

Platelets are sensitive to shear stress and turbulent flow. They shouldn't be squeezed in, or especially syringe pumped in, because (in theory) doing so could activate some portion of them.

I have absolutely no idea if that's really clinically significant, but the theory seems plausible to me, so I let them drip.

Throughout residency I've been told:

Platelets: sheering + warming = bad (don't squeeze in or put through warmer)
- one paper above says that warming the platelets is fine
- squeezing in....sounds plausible, haven't seen any evidence though

Cryo...Different components...are .vwf and fibrinogen sensitive to sheering and heat? (We already put the factors through the Belmont and warmer)

I get that they are already warm so they don't need to go through the warmer, but it's just ease of administration when I have multiple products and drips going at once.