For those of you who visit the AABB forums please forgive the redundancy but I wanted to reach as wide a group as possible.

Apparently one of our Intensivists has decided that all transfusions occurring in our ICU, with the exclusion of platelets, are to go through a blood warmer. Has any one else encountered this as a standard practice or seen any recent literature advocating this practice? I've spent the morning searching and not been able to find anything.

Thanks

John

According to the latest AABB Technical Manual, (which I was reading lately), I remember seeing that blood warmers were used in the context of hypothermia. As I recall, that was the only time Blood Warmers were mentioned. I could be wrong.

It is interesting to see how institutions use blood warmers and what the process and procedures are at any any given institution.

My last Bloodbank Job was at a moderate sized open heart facility and there was question as to running blood warmers in Surgury where the patients body temp was brought down. I think the new Blood Bank Supervisor at the time did reserach and came to the conclusion that blood warmers are not needed, even in the event of the patient haveing a cold auto.

Again I could be wrong. Please confirm that.

Definitely falls into the "abuse" category. There are very few true indications for the use of blood warmers.

Unless your ICU patients are all at risk for cardiac arrest, there's no need for routine blood warmer use.

See the AABB Technical Manual 15th ed. pg.529. It talks about cold blood that is rapidly (ie: trauma or O.R.) infused may lower the temp of the SA node and cause arrhythmia. But it also goes on to say that there is no evidence of patients receiving 1-3 units over several hours being more susceptible to arrhythmias, so they conclude that "routine warming of blood is not recommended".

I'd be more worried about a faulty warmer frying the red cells as they're being infused. It's well known that nursing is intensively trained and up-to-date on transfusion practice and would know exactly what to do in case a blood warmer alarm was going off.:cool:

I'd like to see where this person found this information, because I don't think it exists.

On one of my last observations before I changed careers (again), I noticed that the ICU nurse transfused not only through a blood warmer, but also through a rapid infuser. A unit of RBCs was squeezed into a normovolemic patient in about 15 minutes. I happened to get there just as the transfusion was ending. I questioned the nurse, and she said it was common practice in the ICU to transfuse through a warmer and using a rapid infusion. I told her all the reasons why both practices were dangerous, and my warnings were duly noted using the nursing method (in one ear, out the other). About an hour later, her patient went into acute respiratory distress. We worked up the reaction, and the medical director called it circulatory overload due to rapid infusion, with moderate hemolysis due to rapid infusion and use of a blood warmer. I am SURE this was an isolated incident. ;-)

BTW- I have already had my first surprise FRA inspection. Just as with my FDA inspections, I knew the inspector well, and I knew the regulations well. As we say on the railroad, "No defects found."

BC

Our pediatric trauma service is adamant about the use of bloodwarmers. Evidently in trauma, it has been shown that all the cold fluids infused has caused physiologic issues. So, all our infusions in trauma cases are warmed. There are no other abuses of warming that I am aware of.

Obviously they misinterpreted the literature if they warm all blood for traumas. Too bad.

BC

Would you provide those references?

About the only things I saved when I resigned were the SOPs I wrote and my teaching materials. However, there is mention of not using blood warmers routinely in the AABB Transfusion Primer, which can be downloaded from the AABB site.

BC

Thanks anyway. I believe in their "beloved" Trauma literature, the data clearly (to them) indicate warming improves outcomes. We even keep the trauma room (in the ED) at 80 degrees!

A warm environment could cause the patient's body to want to increase peripheral blood flow away from the core to aid in cooling. This in turn may be good for the blood bank business in a trauma patient.

Interesting that in heart surgery they want it cold. I guess the old "some like it hot, some like it cold" philosophy must appply.

I wonder how the trauma data square with cardiovascular surgery data that suggest improved outcomes when you chill the patient? Mark Twain had it right about statistics.

BC

There are also the spinal injury patients who may benefit from cooling.

I'm reading the forum from home, so I only have a very old AABB Technical manual (1985), which states "Patients receiving refrigerated blood at rates faster than 100mL/min for 30 minutes have an increased risk of cardiac arrest..." "There is no evidence, however, that patients receiving one to three units of blood over several hours are at a similar risk of arrhythmias. Routine warming of blood is unnecessary."

Gil

Gil, isn't that the Tech Manual that also said that there is no evidence that AIDS is transmitted via blood transfusion? :-)

BC