Abstract
Purpose
To determine the effect of infusion rate, tubing length and fluid composition on the temperature of the infusate reaching the distal end of an infusion tubing with and without active fluid warming.
Methods
Warmed normal saline (W-NS) and packed red blood cells (W-PRBC), were infused with a fluid warmer through a modified infusion set. The fluids were delivered at eight infusion rates from 50 to 999 mL·hr−1. The infusate temperature was monitored at 20 cm intervals on theiv tubing. The same temperature monitoring protocol was applied to PRBC without warmer (NoW-PRBC).
Results
In W-NS and W-PRBC groups, there was a decrease in the infusate temperature, at each flow rate, from the drip chamber to the distal end of tubing (P < 0.001). In NoW-PRBC group, there was a rapid increase in the infusate temperature from the bag to the drip chamber (P < 0.001). Thereafter, there was no change in temperature, except at the 999 mL·hr−1 infusion rate, where a slight increase in the infusate temperature throughout the tubing was shown. In W-NS and W-PRBC groups increasing the flow rate produced a significant increase in the infusate temperature, at each measurement point (P < 0.001). In the NoW-PRBC group, increasing the flow rate did not alter the infusate temperature. The fluid composition did not influence the infusate temperature.
Conclusion
There is an important heat exchange within the tubing, which is aggravated at low flow rates. At infusion rates appropriate for pediatric anesthesia the clinical and economic value of fluid warming without the use of heated extension tubing is questionable.
Résumé
Objectif
Déterminer l’effet de la vitesse de perfusion, de la longueur de la tubulure et de la composition du liquide sur la température de la solution intraveineuse à la partie distale de la tubulure, le liquide étant soumis ou non à un réchauffement actif.
Méthode
Une solution salée (SS-R) et un concentré de globules rouges réchauffés (CGR-R) ont été perfusés avec un ensemble à perfusion modifié comprenant un réchauffeur de liquide. Les liquides ont été administrés selon huit vitesses de perfusion, de 50 à 999 mL·hr−1. La température du soluté a été mesurée à des intervalles de 20 cm sur la tubulure iv. Le même protocole de surveillance de la température a été appliqué au CGR non réchauffé (CGR-NonR).
Résultats
Dans les groupes SS-R et CGR-R, la température du liquide perfusé a baissé pour toutes les vitesses de perfusion, entre la chambre compte-gouttes et la partie distale de la tubulure (P < 0,001). Dans le groupe CGR-NonR, elle a augmenté rapidement, entre le sac et la chambre compte-gouttes (P < 0,001). Par la suite, il n’y a pas eu de changement de température, sauf à 999 mL·h−1, où on a noté une légère hausse au travers de la tubulure. Dans les groupes SS-R et CGR-R, l’augmentation de la vitesse de perfusion a produit une augmentation significative de la température de la solution intraveineuse, à chaque point de mesure (P < 0,001). Dans le groupe CGR-NonR, l’augmentation de la vitesse d’écoulement n’a pas modifié la température du liquide. La composition de la solution n’a pas changé la température.
Conclusion
Il se produit un important échange de chaleur à l’intérieur de la tubulure, échange qui est augmenté aux basses vitesses de perfusion. à des vitesses de perfusion appropriées à l’anesthésie pédiatrique, la valeur clinique et économique du réchauffement du liquide sans l’utilisation d’une extension chauffante est discutable.
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Bissonnette, B., Paut, O. Active warming of saline or blood is ineffective when standard infusion tubing is used: an experimental study. Can J Anesth 49, 270–275 (2002). https://doi.org/10.1007/BF03020526
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DOI: https://doi.org/10.1007/BF03020526