How can chills be prevented during intravenous fluid administration?

Preventing Chills During IV Fluid Administration

Warm intravenous fluids to body temperature (37-41°C) before administration to prevent chills and maintain normothermia, as room temperature fluids cause significant heat loss and increase shivering risk. 1, 2

Evidence-Based Warming Strategy

Primary Recommendation: Pre-Warm IV Fluids

• Pre-warming IV fluids to approximately 41°C significantly reduces hypothermia and shivering compared to room temperature fluids in surgical patients 1
• Warming fluids to 37-41°C maintains core temperature approximately 0.5°C higher than room temperature fluids at multiple time points during administration 2
• The incidence of postoperative shivering is significantly lower (7% vs 31%) when pre-warmed fluids are used 1

Practical Implementation

• Store IV fluids in a warming cabinet for at least 8 hours to achieve consistent warming to 41°C 1
• Administer warmed fluids at body temperature or slightly above to prevent heat loss 2
• Insulate IV tubing to prevent heat loss during administration, as the most significant temperature drop occurs through the tubing itself 3

Critical Considerations for Fluid Temperature

Heat Loss Through IV Tubing

• Temperature drops most rapidly within the first 5 minutes of administration through standard IV tubing 3
• In cold environments, fluid temperature can drop by an average of 28.7°C after 30 minutes if tubing is not insulated 3
• Fluids must be administered very rapidly (>100 mL/min) to avoid heat gains in standard IV tubing when maximal effectiveness is needed 4

Warming Methods

• Warming cabinets are the most practical method for pre-warming fluids to 37-41°C 1
• Microwave heating can warm 1-liter bags from room temperature (21°C) to 40-42°C in 3 minutes without altering electrolyte composition 5
• Blood warmers or on-site warming ovens are viable alternatives 5

Important Caveats

When NOT to Use Cold Fluids

Avoid rapid infusion of large volumes of cold IV fluids (4°C), particularly in the prehospital setting, as this practice:

• Provides no mortality or neurologic benefit 6
• Increases risk of cardiac re-arrest (RR 1.22) 6
• Increases risk of pulmonary edema (RR 1.34) 6
• Is specifically contraindicated by American Heart Association guidelines (Class III: No Benefit) 6

Exception for Therapeutic Hypothermia

Cold fluids (4°C saline or Hartmann's solution at 30 mL/kg) may still be reasonable when:

• Patients are well-monitored in controlled hospital settings 6
• A lower target temperature (33°C) is the specific therapeutic goal 6
• Used as part of targeted temperature management protocols 6

Clinical Algorithm

1. For routine IV fluid administration: Pre-warm fluids to 37-41°C using warming cabinet 1
2. Insulate IV tubing when administering warmed fluids, especially in cold environments 3
3. Administer fluids promptly after warming to minimize heat loss 4, 3
4. Monitor core temperature during fluid administration 1, 2
5. Never use cold (4°C) fluids for routine resuscitation outside of specific therapeutic hypothermia protocols 6