Serious IV Question

[Thin Black Line]

This is something that wasn't covered in my Army CLS class:

What are the storage temps for IV fluids such as ringers, sodium, etc?

I know direct sunlight on anything isn't good (especially when it's 130
outside), but how hot is too hot, and how cold is too cold? Can these
fluids be frozen, dethawed, and still used safely? This later has been a
thought since I returned home to the great white north.

[grover13]

Ideal ranges are going to vary slightly by manufacturer, but a good rule of thumb for IV crystalloid solutions (like NS or LR) is don't freeze it and don't get it hotter than the human body. The manufacturers are going to have a much narrower acceptable range, you can bet, but this should work out OK for you with ringers or saline. The main thing to keep in mind is that cold fluids will equal a cold patient and vice versa. On the ambulance, we discard any fluids that were inadvertently frozen, but in an emergency you could probably use them with the following caveat: after thawing, make sure the bag is still intact with no leaks and that there is no discoloration or precipitate (crap floating around in the bag.) Again, the manufacturers will absolutely not recommend using previously frozen fluids, but if it's all you have, it's generally what you use. (Go to war with what you've got? Hmmm, I've heard that somewhere before. Like in a nightmare or something.) Hope this helps. Of course, my lawyer would like to add that this discussion is for academic purposes only, if you kill anybody with this crap forget you heard my name, etc., etc.

[Grape Ape]

I don't know if the concern is precip or that the bags will rupture (my guess is the later since they are pretty full). But last time I ordered some ringers the case case came marked "Do not Freeze" and had a really cute (no symbol over a penguin) ideogram.

[chopinbloc]

hard not to freeze stuff headed to issaquah. i used to live in north bend. anyway, back on topic. shows how different army courses can be. in my cls course they told me that i should never give a ringer because i haven't been trained properly. as cls i am only to give saline and only for rehydration or replacement of blood volume. anyway, they told us to try to keep the bags as close to our body in the pack, though this isn't normally possible. as the post above mentions, you definitely don't want to give fluids to a patient that are much hotter or colder than they are. as far as being spoiled by heat or cold, i was given a cls refresher course while in country and all they said was to check the expiration date, check for leaks and look for floaties. if all the above was good, they said to stick 'em. this was in fob anaconda in afghanistan and we experienced everything from about 120 to 0 degrees farenheit. i keep a cls bag in my truck so if you're concerned about freezing the bags during the winter while they're in your vehicle, you should probably take your cls bag inside the house when you park unless you can garage your vehicle.

[SMLE]

The NS bag I have here suggests "room temp." or 25 degrees C. Also says to protect from freezing but has no upper limit temp. indicated. I don't have the package insert that comes in the case handy, but I can get my hands on one Monday.

Also, under what med control would you be starting an IV as part of first aid? IV solutions ARE prescription drugs by law, so be sure you know the legality of using them. If you have that base covered, then carry on and do what you gotta do to care for your patient.

[Thin Black Line]

Chopin --I was told the exact same thing by instructors at LSAA, Iraq.
My team and I traveled around for a couple months without even a
CLS bag in our 998. We had a couple very helpful BASs who pushed
stuff to us. One of my team members was given a blackhawk medic
backpack!

When I redeployed, I left all my goodies, including two CATS (one
aluminum the other plastic), to my replacement (their unit had also
been sent in without CLS and Medic bags). I've spent some
time back home now reaccumulating all my CLS gear --ironically,
WITHOUT a prescription! We all also redeployed home with a new
individual firstaid kit in each of our possession which, lo and behold,
had the plastic velcro CATS hermetically sealed inside.....

Thanks all and hope I don't see any floaters ;)

[James T Thomas]

I came back to your post several times, and want to relate to you the following incident that occured with our brave medic in Vietnam, 3 Dec. 1968.

After much exposure to combat, previously, I had discussed the critical situation with our medic that precluding being killed outright, the factor leading to death amoung our wounded was blood loss. And though we could obtain the Medevac most times without delay, the deciding factor while waiting for evacuation was the drop in blood pressure to the point where the medic could not puncture the veins or arteries due to their collapse.

I suggested he carry plasma or one of the solutions you mentioned, and he did pack them. They were carried in the back pack, in the jungle heat; mostly shade, and I don't know how often he replaced them, but I do know that they were used to success in maintaining life.

I've posted this before, but it warrants repeating. The last I saw this medic alive was during a particularly fierce battle. Danny Maudsley was running across the battlefield to save the wounded who were crying out for him.
Out of his backpack were streams of plasma flowing out of the bullet holes that punctured the bags! God bless him and all the brave medics.
The combat medic badge deserves a salute when you see one.

To the corpsmen, medics, paramedics, etc. who are reading this; a question.
In one of our battles we were in the sun and you develop a tremendous thirst in that situation. We consumed all of our water and soon became dehydrated.
I was later told that the wounded who had suffered blood loss; excluding stomach wounds, the unconscious, and so forth, should not be given water as this would promote bleeding.

Is this medically sound? I am supposing it is a pre surgical precaution rather than the effect on blood clotting.

[hirundo82]

To the corpsmen, medics, paramedics, etc. who are reading this; a question.
In one of our battles we were in the sun and you develop a tremendous thirst in that situation. We consumed all of our water and soon became dehydrated.
I was later told that the wounded who had suffered blood loss; excluding stomach wounds, the unconscious, and so forth, should not be given water as this would promote bleeding.

Is this medically sound? I am supposing it is a pre surgical precaution rather than the effect on blood clotting.
I guess it could serve to promote bleeding to some extent by diluting tha clotting factors; I do not believe it would be significant though. You would have to give the person a large amount of water to make an appreciable difference. Unless you are giving them upwards of half a gallon of water to drink, the volume will pale in comparison to the volumes the medical personnel will be giving them to replace lost volume. Although there is still controversy over how aggresive fluid replacement should be, especially in a combat situation. There is evidence, mostly from the Falklands war, that those who did not recieve large amounts of (IV) fluids did better, possibly because of an increased ability to clot.

Your supposition is most likely correct--it is standard protocol to withhold anything taken orally from anybody who might be going to surgery, to decrease the risk of vomiting and the resultant complications while under anesthesia.

[Davo]

Preferably within 10 degrees farenheit of body temp. I work on a box in one of the warmest regions in the country-If NS is administered when too warm it can cause severe phlebitis, and may cause cardiac irritability. Ive seen this in field IV's that were started on an ambulance out in the sun all day-it was nasty. Solution that is too cold can cause the same problem. The problem is made worse when fluids are administered quickly. NS stores the best of all IV fluids.
I believe that isotonic crystalloid IV fluids do not typically work in trauma as well as previously thought. Keeping up a BP only to have the pt die post op gets you nowhere. I see promise in hypertonic colloids like 7.5% Saline w/Dextran. From a combat medic POV, you dont need to carry liters of solution, and it stays intravascular much longer.
No matter how you look at it, the "cure" for trauma is rapid transport and surgery...period. Bilateral 14's, blankets, bandages, and salt water MAY buy a few minutes, but usually not.

Any patient with severe injury should recieve NOTHING orally. An empty stomach makes ventilations easier, with less risk of aspiration.