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Selecting the right blood/fluid warmer

Selecting the right blood/fluid warmer for your organization is a critical decision. Nowadays, due to multiple recent recalls of aluminum warmers — that according to the FDA’s warning their aluminum leaching levels “may cause serious adverse events including death”– decisionmakers should be fully aware of what’s inside their warmers of choice. The last thing you want is to face a recall situation just after you have invested considerable funds in procuring new warming devices.

A study published in 2019 expressed concerns regarding non-coated aluminum solutions. At the same time, the authors stated that “Even in a coated warming device, aluminum concentrations are detectable, but remain below the limit of quantification, LOQ (i.e. our methodology does not have the ability to differentiate between the concentrations we measured and the FDA threshold)[1]. Of note, some of the recent devices that were recalled are based on coated aluminum. Similarly, in TCCC’s recent Management of Hypothermia in Tactical Combat Casualty Care guidelines (2020), the authors also raised a concern regarding the utilization of aluminum warmers.

The risk of aluminum toxicity is nonexistent with the Warrior line, which is utilizing commonly-used medical-grade stainless steel coil for the fluids path and heat exchange functions. Our compact disposable unit (CDU) also includes PVC line with standard luer lock connection, to fit common blood/IV lines. A few temperature sensors are attached to the coil and report the blood/fluid temperature hundreds of time per second to the controller. Based on these readings, the controller regulates the energy distribution so as to ensure 38 degree Celsius output temperature.

Our technology is packaged in a compact and lightweight Expanded Polypropylene (EPP) casing. As per the British Plastic Federation, EPP “is a highly versatile closed-cell bead foam that provides a unique range of properties, including outstanding energy absorption, multiple impact resistance, thermal insulation, buoyancy, water and chemical resistance, exceptionally high strength to weight ratio and 100% recyclability”. With its excellent thermal insulation properties, the EPP casing ensures that heat is not dissipating; thus, allowing unmatched efficiency which is then translated into top warming performance.

Our technology is designed to address risks that may be associated with blood/fluid warming:

  • Hemolysis. Hemolysis might be accelerated by suboptimal design of the fluid path of the warming element. You expect your blood/fluid line to be smooth and homogeneous, then why make exceptions for the warmer’s fluid path (or as it is often called, the cassette)? In other words, preferably the fluid path of the warmer should be designed in an ‘undisrupted’ fashion. That is, and to the extent possible, the fluid path design should avoid for example abrupt turns, connection points, and flow changes (e.g. from a wide to narrow carrier and vice versa) in order to minimize sheer force, turbulence, cavitation, and air bubble formation, to name just a few potential complications associated with high flows and elevated pressure. Our fluid path has been designed in an undisrupted fashion so as to address the complications listed above.
  • Over/under heating. Another risk is over/under heating the blood/fluid being infused. Under heating is a more common issue especially with high flows and with rapid intermittent (bolus) flow methods, since most warmers cannot keep up with the job. If the warmer is unable to warm the fluids to body temperature at the rate being infused, you are introducing hypothermic fluids into your patient. Even room temperature fluids are far below body temperature, especially for severely sick patients suffering from shock. Our technology has been designed to support high flow rates and rapid intermittent (bolus) flow methods.
  • Aggressive heat transfer process. It seems logical that a relaxed heat transfer process from the heat exchanger to the blood/fluid is safer than an aggressive heat transfer process. Therefore, why not add this to your evaluation criteria? The most relaxed heat transfer mechanisms require a warming surface of 15-20 ml. We all love solutions with small priming volume, but we need to acknowledge that this may come at a ‘price’. And the price is a potentially aggressive heat transfer process from the heater to the blood, especially at elevated flows. With its 19ml priming volume, our heat exchange process is amongst the most relaxed heat exchange processes in the industry.
  • Unavailability. One of the most prominent risks associated with your blood/fluid warmer over the past years is that you will not be able to use it since there is a shortage of disposable sets or (as explained in the first part of this mail) due to a recall of the device. Ask users of enFlow, Level 1, ThermaCor, Thermal Angel, and several others to understand how frustrating this can get. And if there is one thing that COVID taught us, it is that complex solutions lead to complex supply chains and therefore to many months of lead times when the unexpected strikes. Therefore, make sure that the consumable of your solution of choice is simple enough to manufacture in large quantities, fast! Make sure that there are no chips that need to be placed into this consumable, otherwise you will be at the mercy of the market availability of chips, which is currently experiencing significant shortages. Our CDU has been designed for mass production and we have not experienced any shortage due to the adverse impact of COVID on global supply chains.

Finally, it should be noted that not only that our technology delivers unmatched performance, but also our per-use price is very affordable, especially compared with other modern warming solutions. A true win-win solution.

For more information click below,

Team Bell Medical

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An Evolving New Paradigm in Blood Warming: “A Bridge To Rapid Infusers”


Initially created on JANUARY 15, 2022 BY ARIEL KATZ, CEO QINFLOW

Rapid infusers are a great option for treating patients with severe hemorrhage. However, they require significant commitment from the hospitals: they are expensive to purchase, expensive to operate, and expensive to maintain. As importantly, they require significant ongoing investment in training so as to keep the staff adequately comfortable using them. Too often emergency personnel would avoid using their state-of-the-art rapid infusers simply because they are overwhelmed with their complex operation and time-consuming troubleshooting. In today’s environment, that requires hospital to rely on ‘travelling nurses’ to complement their staff. The situation is worsened since continuous education on rapid infusers is simply impractical.

Therefore, a growing number of hospitals are approaching us with a similar request: “we need a bridge to the rapid infusers”, they say. Indeed, there are other more practical solutions to transfuse warm blood fast. When used with flow-inducing devices such as pressure bag, hand pump, push-pull, electro-mechanical pump, or LifeFlow infuser, the Warrior line of next-generation blood warmers is an excellent bridge to the rapid infusers.  The following paragraphs introduce some of the key benefits of the Warrior over rapid infusers.

  • Speed. It is important to note that in over 95% of the cases rapid infusers are not required.  The patient will receive anywhere between 1 and 3 units of blood and rushed to the OR. In such instances, we celebrate that the Warrior delivers 1-3 units of warmed blood to patients much faster than rapid infusers, simply because set up time is reduced to just a few seconds.
  • Simplicity. Moreover, unlike rapid infusers, anyone can be trained to operate the Warrior. This removes the pressure that only a few expert nurses can operate the device flawlessly, as is often the case with rapid infusers. In addition, and unlike rapid infusers, troubleshooting the Warrior is fast and easy.  The Warrior’s simplicity has even greater value in situations of a mass casualty event since a stretched medical staff will greatly struggle to operate multiple rapid infusing devices concurrently.
  • Portability. One additional key advantage of the Warrior over rapid infusers is its portability. With rapid infusers, warm blood cannot be administered during a patient’s transfer to the next level of care, whereas the Warrior has been designed to facilitate patient’s transports (from field to ED, trauma, OR, and ICU). Unlike rapid infusers, the Warrior can be simply attached to the bed during patient’s transfer from ED to OR, thus freeing the hands of caregivers to perform more important stuff.
  • Unique Continuum of Emergency Care Proposition. The portability aspect enables a unique continuum of care proposition, whereby the same consumable can be used across the entire continuum of emergency care, thus simplifying patient handoff between emergency settings and reducing costs. If fully adopted by the hospital, further ROI benefits can be attained by streamlining training efforts, reducing dependency on dedicated staff, reducing spare part inventory, and eliminate monthly service calls and calibration endeavors that raid infusers typically require. If the hospital has a critical care transport team, treatment with the Warrior can commence even prior to the arrival of the patient to the ED.
  • Pediatric Applications. Another benefit of the Warrior is its ability to operate even with small-size catheters, designed for pediatric patients. Rapid infusers are limited to larger catheters which is part of the reason that a growing number of pediatric hospitals have adopted the Warriors along with the LifeFlow infusion device.
  • Maintenance Free. The Warrior does not require any routine service or any annual calibration.  It requires just one inspection every 5 years. Rapid infusers typically demand monthly service and calibration endeavors that overload the biomed team.
  • Aluminum Free. The Warrior is aluminum free; some rapid infusers contain aluminum in their fluid path.
  • Improved ROI. Finally, cost — both capital and consumables — is another huge benefit of the Warrior over rapid infusers.  A rapid infuser may cost $30k. At this price you can get approximately 8 Warrior AC devices…  A rapid infuser’s consumables are in the range of hundreds of dollars, considerably higher than the Warrior’s Compact Disposable Unit. There are also significant benefits related to reduction of indirect costs, such as simplified training, elimination of spare inventory, and elimination of complex service requirements, to name just a few.

To summarize, even the best-equipped medical centers are too often reluctant to use their rapid infusers due to their complexity. In such cases, therefore, the patients will get cold blood/fluid. While the Warrior is not a rapid infuser, it will outperform rapid infusers in greater than 95% of the cases, when just a few units of blood/fluid are required. In such cases, the Warrior will perform the job faster, more effectively, and more economically than the over-sized, complex, and expensive to operate rapid infusers.  Even in those few cases that rapid infusers are required, the Warrior can be used initially so as to accelerate the delivery of the first few units of blood to the patient.  In all these cases, the Warrior acts as an optimal bridge to the rapid infusersContact us for more information.

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Good News Line is OPEN!

Good news line is OPEN for Air Purification!

Lindsay Public School system in Oklahoma orders $284,000 worth of Novaerus Nano Strike air purifiers for school district.  They are installing 111 NV900s for their classrooms and 22 NV200s for offices and 4 NV400s for their practice gym and 4 Defend 1050s for their large gym and concession area. 

Schools systems are protecting their students and faculty with Nano-Strike technology.  Watch our 2 minute video on Nanostrike:  Novaerus Nanostrike Air Purifier and Disinfection Technology – Bell Medical, Inc

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Good News Line is OPEN!

Northeast Georgia Medical Center in Gainsville, GA has ordered and received 10 Warrior AC systems from Bell Medical and QinFlow for use in their operating rooms. 

This is our third order in the last 3 months for Warrior fluid warmers.  Children’s of Alabama, Birmingham, AL purchased 8 Warriors including the Warrior Hybrid and Warrior AC including the Warrior base unit with battery operation.  Kings Daughters Children’s hospital in Norfolk, VA. Has also invested in the Warrior with 8 systems. 

Warrior uses medical grade stainless steel tubing and state of the art micro processing to automatically adjust and control the temperature of fluids.  Warrior delivers 38 degrees C consistently regardless of flow rates from KVO to 290ml/min. The Warrior is perfect for the operating room, ED and Trauma but also has battery option offering unique portability for patient transport to ICU or use on Helicopter.  Combat hypothermia with the Warrior!   WE ARE ON A ROLL WITH WARRIOR!  Why:  Because Smith’s Level One is on recall for aluminum leaching and Smith’s Hotline is having warming set supply shortages AND the Warrior is amazing!  The Warrior is the only fluid warmer approved to work with the LifeFlow rapid infuser and the only warmer that excels in handling intermittent flow rates.  Bell Medical has the GOOD STUFF!