Background
A 16 y/o male with a history of irritable bowel disease presents to the Emergency Department vomiting blood. He has an ostomy in place. His initial vital signs were BP 82/59, HR 160, SI 1.95. He was ill-appearing, with skin gray and ashen. The staff placed a 20-gauge peripheral IV and infused a 1-liter NS bolus using the LifeFlow PLUS and the QinFlow Warrior blood and fluid warmer.
After a slight improvement, he received 1 unit of PRBCs. Post-infusion, his vital signs improved to BP 99/61, HR 114, SI 1.15, and his skin went from gray to pale. The patient was admitted to the ICU for ongoing resuscitation and monitoring.
Bedside Equipment
In healthcare, we tend to focus strictly on the patient. Deliberate and careful consideration also needs to be given to the staff’s ability to use and interface with equipment at the bedside. Incompatible equipment, equipment requiring a significant training tail, or difficulty setting up and operating the devices can frustrate the team and have unintended negative consequences. One large urban children’s hospital identified an opportunity to improve patient care and make life a little easier for its clinical staff. Before using the LifeFlow PLUS and the QinFlow, the facility used the push-pull syringe method for rapid infusion. Warming of fluids and blood products was done through a large commercially available infuser. The staff was concerned about the push-pull method’s effectiveness with the warmer’s ability to maintain an appropriate blood infusion temperature during these intermittent boluses.
These devices can be frustrating and slow to set up during resuscitation, especially if it is a low-to-moderate-frequency task. Device downtime due to medical maintenance issues may preclude the use of rapid infusers currently found in hospitals. Training required to maintain user proficiency is significant.
Results
Implementing the LifeFlow PLUS and the QinFlow provided an easy-to-use compatible system. Fluid and blood products can be given warm and quickly without concern of losing temperature. With a compact design, the LifeFlow PLUS was transported with the patient to the ICU for a seamless handoff. The training for the LifeFlow PLUS takes minutes. During an active resuscitation, its design is intuitive enough to teach colleagues at the bedside. Setup and use of both devices took moments. The staff felt confident that the blood was being infused at the right temperature by feeling a consistent warmth in the IV tubing. Staff confidence in the equipment used leads to a better experience for the staff and patients.