In-line blood/solution warmers.

In-line blood/solution warmers are used in many clinical procedures to warm refrigerated and room temperature fluids as they are infused into the patient. Warming fluids such as whole blood, blood products, intravenous (IV) solutions, and irrigation solutions helps to maintain the patient's core body temperature, thus minimizing adverse thermal reactions (e.g., hypothermia). In this study, we evaluated nine in-line blood/solution warmers from seven manufacturers. We tested these systems' performance and safety, human factors design, and quality of construction, focusing on how well the devices warm fluids over a variety of infusion rates common in clinical use. We rated each system according to the clinical application base for which it is primarily intended-routine-flow procedures (i.e., those that require low or moderate flow rates) or high-flow procedures. Of the six systems in the routine-flow category, we rated only two units Acceptable; the remaining four were rated Acceptable-Not Recommended because they could not warm fluids to the same temperature level as the Acceptable units. We rated all three of the systems in the high-flow category Acceptable. Within each of these rating groups, we ranked units according to the results of our testing, as well as the results of a life-cycle cost analysis that we performed. In the Technology Overview, we discuss the clinical need for blood/solution warming and outline the debate over whether and when in-line warming devices should be used. Also, we describe the technologies used in these devices, as well as the safety issues associated with their use. The Selection, Purchasing, and Use Guide at the end of the Evaluation provides guidance to help facilities (1) assess their blood/solution warming needs, (2) choose the systems that will best meet their needs, and (3) use these systems effectively. This study also includes the supplementary article, "Maximum Blood Warming Temperature-How Hot Is Too Hot?"