# Keeping IV Solutions and Medications At Proper Temperature



## nsmedicman (25 Jan 2007)

I am looking for advice from the experienced members of this forum. Does anyone have suggestions on how to keep IV fluids and medications at a proper temperature during the colder times of the year? I am specifically referring to those that may be deployed in a tactical setting, either on exercise, or on an operation.


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## old medic (25 Jan 2007)

The low tech solution for the IV bags is put them into your inside pockets and use your body heat.


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## medaid (25 Jan 2007)

+1 the same advice from our RSM on ex last weekend. Another thing you could do, is well, sleep with it. When your inside crew is down, have them put a few in their sleepy bags. When they get out, leave them there, the heat from the sleepy bag will keep it warm for a while. If not  needed immediately.


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## medicineman (25 Jan 2007)

I was taught at a platoon/company level, have the people with a lighter load carry one inside their parka or around their neck (obviously use the 500cc bags  ).  When I was a field pharm guy, I kept the solutions/freezable meds close to the outlet of the kero-jet in the tent.  If that's not an option, cabs or heated boxes of vehicles if it's a light enough load.  Again, body heat is always an option.

MM


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## Donut (25 Jan 2007)

I've got an IV kit that's designed to hold 1L bags, I've swapped that out for a 500ml and added a couple of hot packs around the solution, but if you don't have anywhere warm to hang a bag, or if it's cold enough, it'll freeze (or seriously chill) in the line.  I never used those on a pt, but I figured if the solution passed the "Baby bottle" test, I'd use it. 

All we use in Whistler on the mounain appears to be saline locks for pain meds (never seen solutions hung on the mountain before a patrol hut) and get 'em somewhere warm.  Kinda like TCCC  ;D

As for the drugs, small pelican case or similarly shock/water-proof are carried in inside pockets by the MD and ACP patrollers.

DF


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## Armymedic (25 Jan 2007)

Its not so much the bag as keeping the fluid in the bag warm. As stated


			
				ParaMedTech said:
			
		

> I've got an IV kit that's designed to hold 1L bags, I've swapped that out for a 500ml and added a couple of hot packs around the solution, but if you don't have anywhere warm to hang a bag, or if it's cold enough, it'll freeze (or seriously chill) in the line.  I never used those on a pt, but I figured if the solution passed the "Baby bottle" test, I'd use it.


Even if your bag is warm in subzero temps, the fluid in the line will get righ cold if exposed. A trick there is to wram it around something warm (hot pack, ration heater, another buddy's arm) and cover it with kling or gauze.


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## kj_gully (26 Jan 2007)

Really, there is no requirement to keep *most* (probably all the drugs you use, but I won't say that) thawed. Obviously you can't put cold meds into a pt, but for storage, not a big issue. We wrap IV tubing around a hot pack to warm fluids, and sometimes use a pressure infuser so we can keep the IV bag in the pts casualty  bag. a Casualty bag, if you don't know is a cool (like the dudes say, not temperature) sleeping bag that we place our victims in, reinforced on the bottom, zippers on both sides, lots of velcro access points and 6 handles for carrying/dragging .


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## medicineman (26 Jan 2007)

There are a fair number that precipitate once frozen then thawed out - before taking that advice, research those meds.

MM


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## baudspeed (26 Jan 2007)

+1 to previous post

and one thought was i have had to keep electrical gear warm for 6+ hours while not wearing it inside etc. One idea might be to use the so called 'hot hands' or 'hot pockets'. They are basicly a iron oxidizing hand warmer that brings the temp up to approx 30 degrees depending on the environment. Works great on keeping GPS, camera and batteries at an okay temp for immediate use in the cold. Dont know if it will fit your needs, though it is a cheap solution for the problem. Just have to remember to check on it once and a while since you need to give the package a shake once and a while to get air inside.

But it depends on what you are keeping *shrug*


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## DartmouthDave (27 Jan 2007)

Hello,

From my experience in cold conditions starting a line is counter productive.  Even if the solution has been warmed somehow it will get too cold and the line will freeze.  We have a hard time getting a patient from an heated ambulance to the heated plane without everything freezing up (usually takes only 2-4minutes).  A pressure bag around an IV an in a sleeping bag works OK.  However, the line usually won't flow well or the excessive pressure will blow your line.  

David


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## Gunner98 (27 Jan 2007)

My Amb-based Med Techs have used dry ice, ice and cooler packs for keeping things cool.  For keeping things warm in the ambs they keep some IV fluid bags in the front windshield and let sun and cab heater do the job.  Slipping some fluids bags under the Bearhugger before insertion into patient may allow them to pass the baby bottle test as well.


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## daftandbarmy (27 Jan 2007)

Claymore bag or spare respirator bag with the saline & IV kit in it around your neck inside  your jacket. Or two wool socks, or rucksack side pouches,  tied together with paracord, slung around your neck, saline bag in each. If you use self-heating packs to warm them up, avoid putting them right next to the skin of the saline bag. Remember to keep the IV kit warm too. Nice to have one per section when dismounted and more than 1 hour away from help, and not just to treat gunshot wounds etc, but also for shock/ dehydration. Also need to have good drills for setting up a tent and getting a stove on fast in cold weather so you can treat casualties in a warm environment, or have the tents up with S. Bags and ready to go at the LD for the Coy Medic at the CAP. I'm no medic but, in cold weather, you also need a way of getting to a good vein. I've not seen it, but it might require making an incision to get a line going. There is a school of thought that says you can administer an IV rectally but it's controversial - especially to the patient (!). Used in the Falklands War with mixed results apparently.


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## Armymedic (27 Jan 2007)

daftandbarmy said:
			
		

> I've not seen it, but it might require making an incision to get a line going.


I have done a venous cutdown. You don't want to even think about it outside a warm hospital setting. its difficult and really invasive. And in cold weather, less advisable then trying to start an IV.



> There is a school of thought that says you can administer an IV rectally but it's controversial - especially to the patient (!). Used in the Falklands War with mixed results apparently.



Completely and utterly false. It was studied in theory and never tried practically. In truth the rectum, while able to absorb some fluid thru enema, can not absorb enough fluids be clinically significant. This is an urban legend and not ever tried in Cbt.  If you even think it works, let someone else pressure infuse a liter of NS up your butt and see if you can hold it until it is absorbed.

In winter, try oral rehydration in a conscious cas (esp one who is dehydrated). If decreased LOC, then just travel faster to hosp. In trauma and military medicine, IVs do not save lives, medical intervention does. And to keep a cas NPO in the field (less abd trauma/inj) is just to convenience the OR staff, and not beneficial to the cas what so ever.

If you are a dismounted medic during cold weather (+5 and below) carry one 500 ml IV of your choice either NS or RL. Leave the rest at home. Keep it and your tubing warm.

Any question feel free to pm me.


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## daftandbarmy (27 Jan 2007)

Ummm... without trying to risk strating a bun fight, they did administer IV fluid rectally in the Falklands War. I personally know one Parachute Regiment Officer and one Royal Marine officer who were treated this way, and one medic from 2 PARA who administered fluids this way at the Battle of Goose Green. It was a technique taught by the doctors with 3 Cdo Bde. Reports on the technique were included in various AARs that came out of the war. It has been documented in various war books on the market. I'll hunt around and see what I can find. 

This was not an ideal option as the absorbtion rate was far less than by vein, as mentioned. However, in some cases it took 10 to 12 hours to evacuate casualties given the air parity situation, lengthy fight throughs as well as the rough terrain, so they had to come up with alternatives. It's a good example of why the infantry needs to be trained and prepared to deal with 'worst case' scenarios. Having said all that, you are right, the best option is rapid evacuation to a fully staffed, warm hosptial facility of some kind. 

This site has some more details on keeping fluids warm (inside your jacket, as described earlier in this thread).

http://www.hypothermia.org/Hypothermia_Ed_pdf/Hypothermia-Rescue-Field..pdf

Another article on medical aspects of the Falklands War. One key learning was that the fitter your troops are, the less likely they are to die of shock. "Fatties flake first" was a favourite saying I seem to remember!

MEDICAL ASPECTS OF SUPPORTING A LOW INTENSITY CONFLICT IN A COLD ENVIRONMENT: THE BRITISH EXPERIENCE IN THE FALKLANDS CONFLICT - Colonel (then Captain) Cliff Cloonan, USA, MC

 http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/MilitaryMedicine/falklnd.doc


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## old medic (27 Jan 2007)

Lets try and stay away from the tangents.  The original question already has a stack of very good
answers in the thread.


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## daftandbarmy (27 Jan 2007)

Ack! Mea culpa.....


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## kj_gully (27 Jan 2007)

Great posts, and exactly why I troll this forum.


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## nsmedicman (27 Jan 2007)

Thanks folks....I have a few good ideas to try...err...except for the rectal saline administration....


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## nsmedicman (29 Jan 2007)

What I was specifically looking for was ideas to keep fluids and meds warm when dismounted (I.E. a long patrol), or on a weekend ex without an amb. In civi life, our patients do not get fluid, unless they really need it (dehydration/hypotension). Most patients get IVs, but most tasks are completed via NaCl lock. Thanks again for the ideas.


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