Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Germany.
Department of Anesthesiology, University Medical Center Goettingen, Germany.
Anaesthesia. 2019 Jun;74(6):708-713. doi: 10.1111/anae.14601. Epub 2019 Feb 21.
The use of fluid-warming systems is recommended for infusion rates > 500 ml.h to avoid peri-operative hypothermia. Some fluid-warming devices use disposable aluminium-heated plates for heat transfer, but there is no protective coating to separate the fluid from the heated aluminium surface. It is unknown if this could promote release of aluminium into infusion fluids. We investigated a coated (Fluido compact) and an uncoated (enFlow) fluid-warming device using normal saline or balanced electrolyte solution as infusion fluids, pumped through the heated disposables at flow rates of 2, 4 and 8 ml.min for 60 min each. Aluminium concentrations in the fluid samples were analysed using graphite furnace atomic absorption spectrometry. With saline the coated and uncoated devices yielded aluminium concentrations below the level of quantification (< 128 μg.l ). Similarly, balanced electrolyte solution in the coated device yielded aluminium concentrations < 128 μg.l . However, balanced electrolyte solution in the uncoated device yielded aluminium concentrations of up to 6794 (3465-8002 [1868-7421]) μg.l . Repeating this last study at a flow rate of 2 ml.min resulted in quite high aluminium concentrations when the uncoated device was not heated (~1000 μg.l ) and higher concentrations after the device was heated. We conclude that using uncoated aluminium plates in fluid-warming systems can lead to a risk of administering potentially harmful concentrations of aluminium when balanced crystalloid solutions are used. The mechanism is unclear, but heat is in part involved. Coating for aluminium within medical devices in direct contact with infusion fluids should be recommended.
建议在输注速度大于 500ml/h 时使用液体加温系统，以避免围手术期低体温。一些液体加温设备使用一次性铝加热板进行热传递，但没有保护涂层将液体与加热的铝表面隔开。目前尚不清楚这是否会促进铝释放到输注液中。我们使用生理盐水或平衡电解质溶液作为输注液，通过加热的一次性用品以 2、4 和 8ml/min 的流速分别泵入 60min，研究了一种有涂层（Fluido compact）和一种无涂层（enFlow）的液体加温设备。使用石墨炉原子吸收光谱法分析液体样本中的铝浓度。使用生理盐水时，有涂层和无涂层的设备产生的铝浓度低于定量下限（<128μg.l）。同样，涂层设备中的平衡电解质溶液产生的铝浓度也低于 128μg.l。然而，无涂层设备中的平衡电解质溶液产生的铝浓度高达 6794（3465-8002[1868-7421]）μg.l。当无涂层设备未加热时（约 1000μg.l），重复进行最后一项研究时，在 2ml/min 的流速下会产生相当高的铝浓度，而当设备加热后，铝浓度更高。我们得出结论，在使用平衡晶体溶液时，在液体加温系统中使用无涂层的铝制加热板可能会导致给予潜在有害浓度的铝的风险。其机制尚不清楚，但热量是部分原因。应推荐在与输注液直接接触的医疗设备中使用铝涂层。
