Aluminium release and fluid warming: provocational setting and devices at risk

Thorsten Perl,K Kerpen,T Roy,A Bräuer,M Quintel,N Kunze-Szikszay,U Telgheder

doi:10.1186/s12871-021-01378-7

Thorsten Perl, K Kerpen + Show 5 more

Open Access

https://doi.org/10.1186/s12871-021-01378-7

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Abstract

BackgroundFluid warming, recommended for fluid rates of > 500 ml h-1, is an integral part of patient temperature management strategies. Fluid warming devices using an uncoated aluminium containing heating element have been reported to liberate aluminium resulting in critical aluminium concentrations in heated fluids. We investigated saline solution (0.9%), artificially spiked with organic acids to determine the influence of fluid composition on aluminium release using the uncoated enFlow® device. Additionally, the Level1® as a high volume fluid warming device and the ThermoSens® device were investigated with artificial spiked fluid at high risk for aluminum release and a clinically used crystalloid solution.ResultsSaline solution spiked with lactate more than acetate, especially at a non neutral pH, led to high aluminium release. Next to the enFlow® device, aluminium release was observed for the Level1® device, but not for the coated ThermoSens®-device.ConclusionUncoated aluminium containing fluid warming devices lead to potentially toxic levels of aluminium in heated fluids, especially in fluids with non-neutral pH containing organic acids and their salts like balanced electrolyte solutions.

Highlights

Fluid warming is next to active body surface warming and prewarming an integral part of patient temperature management and is recommended for fluid amounts of more than 500 ml or fluid rates of > 500 ml h− 1 [1, 2]
High aluminium releases have only been reported for anodized fluid warming devices that dispense on coating, for coated devices an aluminium release would be possible
In a second step we investigated the amount of aluminium release by two other previously not tested fluid warming devices with an aluminium containing heating element applying the previously identified risk setting with the identified artificial solution and a clinical used standard balanced electrolyte solution

Summary

Introduction

Fluid warming is next to active body surface warming and prewarming an integral part of patient temperature management and is recommended for fluid amounts of more than 500 ml or fluid rates of > 500 ml h− 1 [1, 2]. For fluid warmers using anodized aluminium as a heating element, a concerning aluminium release to fluids. Excessive aluminium release with an uncoated, anodized heating element was observed mainly for a balanced electrolyte solution and much lesser for a saline solution [4]. Identification of the fluid composition with both, clinically relevant compounds and capacity of aluminum release will allow to refine testing protocols for approval of fluid warming devices. We investigated saline solution (0.9%), artificially spiked with organic acids to determine the influence of fluid composition on aluminium release using the uncoated enFlow® device. The Level1® as a high volume fluid warming device and the ThermoSens® device were investigated with artificial spiked fluid at high risk for aluminum release and a clinically used crystalloid solution

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