Warming up a cold apheresis donor

[Deb]

We are struggling with finding an effective way to keep our apheresis donors warm enough to minimize the vasoconstriction and draw pressure alerts. We've tried the chemical hand-warmers you can purchase but they don't seem to be very effective.

I received a suggestion to use a heating pad which I think might be the ticket...but, as we are a hospital blood center, we are encouraged to use 3-prong (grounded) electrical plugs.

Most heating pads I see have only the two prong plug.

Does anyone have a vendor suggestion ... and/or any other suggestion for keeping our donors warm?

Thanks!

P.S. .... It's no wonder we have difficulty it was well below zero F today....

[Auntie-D]

Might sound like a really daft idea but one way is to get the patient to go for a short jog beforehand. Believe me it works. Only if the patient is fit and well of course...

[Cliff]

It's a rather expensive option, but we have a blanket warmer. It's like a small fridge, but it heats the blankets up to ~ 160F. That way we always have a nice warm blanket to give to a donor.

[heathervaught]

We use heating pads under the donor's arm plus blankets at the donor's request. I usually ask for 2 blankets at the beginning of the procedure. I've heard that our Director of Blood Collections would like to move to the XXL towels (aka Bath Sheets) that are placed in a towel warmer.

[L106]

I always get extremely cold when I donate plateletphereses. The nurses actually cover me with an electric blanket. Works great!

Donna

[GbreadMan]

I get cold, too, and the draw pressure drops like a rock (I suppose I'm a high-maintenance donor). However, I was worried that exercise before donation will activate the platelets and make them less effective (I have heard that ADP will cause platelet activation in the bloodstream).

[Auntie-D]

However, I was worried that exercise before donation will activate the platelets and make them less effective (I have heard that ADP will cause platelet activation in the bloodstream).

It does a little, but non-cardio excercise shouldn't raise ADP to a level that will interfere with platelet function. In the past I've just suggested a brisk walk or a short job for a few minutes

[jhicks]

We use blankets, but we also warm 100 mL bags of saline in the microwave - we place them in the donor's hands (before beginning the procedure) and then wherever the donor requests: behind their neck, on their shoulders, arms...you get the idea. We, too, cannot use the heating pads and the blanket warmers are too expensive.

[Tom Neish]

We use a blanket warmer (Pedigo P-2010-s) i is small and relatively inexpensive. We also use a T-Pump by Gaymar for a recirculating water heating pad. We are not allowed to use electric heating pads. We have found that using a hand exerciser that can be warmed up in a microwave (Action products) helps keeps the donors hand very warm.

[Mabel Adams]

Fill cloth bags with plain raw white rice and sew closed. Microwave for a minute or 2 (depending on size) and they will stay toasty for quite awhile. Put some disposable cover over them, like a plastic grocery bag, since multiple people would use them. Or maybe a washable cover to change between people. Keeps my toes warm in bed on winter nights anyway.

[Smarty pants]

ASI (American Scientific) makes medical grade heating pads. They are large, and blue vinyl (easily wiped), and generally sit from tailbone to shoulder on the donor bed.

I like them because they are warm and really help.

I don't like them because they're too big to cover an arm (the part that's the coldest), and if the donor has a reaction... it's tough to remove the heat source quick enough.

Rice (corn) bags and warm blankets may be a better option.

[OCrowley]

Greetings all.  I came across this forum while trying to show my research into just this very question.  Please permit me...  I had worked with CaridianBCT / Terumo BCT for over 10 years.  Some of you may be familiar with Trima, Spectra, Optia, 2991, and Elutra.  Maybe even Mirasol.  I have built and tested all of these machines.  I know of the problem with trying to keep a donor warm during procedure.  I would like to share what I have found. 

 

Hidaka, T., Suzuki, K., Okada, M., Takamizawa-Matsumoto, M., Kawakami, M., & Hayashi, T.,

et al. (1999).  Forearm heating band used in apheresis therapy that employs a positive-

temperature coefficient polymer heater.  Journal of Clinical Apheresis, 14(2), 63-68.

Abstract:  For standard apheresis therapy, blood is withdrawn from the ante-cubital vein of one arm and processed blood is returned to a vein of the opposite arm. For low-

density lipoprotein apheresis or for the treatment of patients with Guillain-Barré

 syndrome, a sufficient quantity of blood is readily obtained by this method. In some patients with collagen diseases, however, it may be difficult to secure a reliable vein due to vasospasm or it may not be possible to obtain sufficient blood flow. We constructed a forearm heating band by employing a positive-temperature coefficient heater and evaluated the device to determine whether the application of heat to the forearm is effective in securing a sufficient quantity of blood in those patients with collagen disease. Both forearms were heated by using this heating band, in addition to systemic warming with an electric blanket, starting 30 minutes before apheresis. The body surface temperature was sequentially monitored by employing a needle-type thermometer. The surface temperature of the heated area became constant at 37.6 ± 0.3°C within approximately 20 minutes (34.7 ± 1.3°C at the control site, P < 0.001). It was found that this heating band makes it possible to obtain the quantity of blood that is necessary for apheresis and reduce the time required for the treatment. No adverse effects attributable to heating of the forearm were recognized.

[OCrowley]

This is an invention I came up with when doing my senior project for a Business Degree.  I want to share it because I believe it is needed and no one else will do it.

 

 The Arm-warming sleeve is a simple device made of durable cotton.  The cotton material allows it to be washed and sterilized multiple times allowing multiple uses.  It is designed to either hold a heating pad or pack in a pocket that wraps over the arm. (See Figure 1.)  A loop for the hand helps to hold the sleeve in place when it’s worn.

 

 

 

Figure 4 Front side of sleeve.

           

On the back or outside of the sleeve, a pocket is provided to insert a thin board or cushion for added support while in use.  This is more helpful for critical care patients. (See Figure 2).

 

Figure 5 Backside of sleeve.

 

The thin board can be made of wood or plastic.  A strip of Velcro is attached on the back to aid in holding the needle’s tubing in place without the use of tape.  It is stitched together on the bottom end to prevent any pulling on the tubing after the needle is in place. 

 

Proper wear of the sleeve

            The sleeve can either be worn one of two ways with the arm in the palm up or palm down position.  For best results, the sleeve should be worn at least a few minutes before the needle is inserted into the arm.  If the thin board is needed, insert it into the long center pocket before use.  The heating pack should be inserted into the square pocket just before fitting the sleeve to the patient or donor’s arm.  For the palm up position, insert the hand into the loop until the loop crosses the center of the palm. (See figure 3).  The side with the Velcro is facing downward. 

Figure 6 Hand is inserted into loop.

            Wrap the side with the heating pad over the arm first, tucking in any extra material around the forearm for comfort. (See figure 4).  The arm should now remain stationary until the medical procedure is completed.

 

 

Pocket with heating pad wraps first.

 

Figure 7 Heating side wraps first.

Next, wrap the opposite side with the Velcro over the first so that the Velcro strip sits on top of the arm.  This second side of the sleeve helps to hold in the heat from the heating pad keeping the lower arm warm. (See figure 5).  A squeeze ball or hot water bottle can now be put into the hand, if needed.  If the hot water bottle is too hot for the hand, a napkin can fit under the loop and around the bottle protecting the hand from excessive heat. 

 

 

Velcro side wraps second.

Figure 8 Velcro side second.

            Let the sleeve warm the arm for a few minutes before cleaning the insertion site and sticking the needle.  Once the needle is in, the tubing is horizontally looped and held in place with the Velcro strip. (See figure 6).  Should the arm become too warm during the procedure, the sleeve can be opened carefully and the heating pad removed without completely removing the sleeve or disturbing the tubing.  At the end of the procedure, the Velcro is opened and the tubing removed before removing the needle.  Once the needle is out, the sleeve can be completely removed.  Once it is washed and disinfected, it can be used again.

 

 

Tubing is held in place here.

Veins exposed for needle insertion.

Figure 9 Donor’s veins left exposed.

            For critical care patients, nurses favor using the veins on the back of the hand.  This is where the added support in the center pocket helps.  The support provides a stiff flat surface that extends from the just below the knuckles, on the underside of the hand and arm, to the upper part of the forearm. (See figure 7). 

 

 

 

Critical care vein area exposed.

Figure 10 Critical care veins exposed.

The added support aids with keeping the hand and arm in alignment during the medical procedure.  The method for putting the sleeve on with the arm in the palm down position is the same as the palm up position.  The injection site on the back of the hand remains easily accessible.

Please let me know if this helps.

 

Bill

[David Saikin]

We always used warm blankets