Level One Rapid Infuser

In this video we are going to go over the ICU nursing skill of using the level one rapid infuser. This is a machine that is used when you need the rapid infusion of blood products and IV fluids… in my hospital, we call these rapid transfusion codes… this code alerts the lab to rapidly prepare blood products in the case of life-threatening hemorrhagic events. Managing the rapid infuser should be done by a trained individual who is not assigned any other task during the massive transfusion code. Because it can infuse entire IV bags and blood products in less than a minute… keeping the fluids and blood products running can be very demanding and requires a lot of attention. Before we get started, I want to give you a very basic overview of how this machine works. These two compartments are where you will hang IV fluids and blood products. These compartments take the place of a pressure bag by mechanically pressurizing the bags and quickly infusing the fluids. As the IV fluids and blood products travel down the tubing, they will be warmed. You can hang the normal saline in the fluid compartment. To hang the normal saline, you open the fluid door like this. When you open the door, you will see several hooks to hang fluid and blood products on. Saline will go all the way to the top, right here. Blood products will do on the lower hooks… for example your FFP and cryo would probably fit on the lowest hook and then your RBCs would probably go on the middle hook. Now, you are ready to insert the tubing, it is a 4-step process which you will see laid out on the machine itself. Let's first go through the steps and their location, then we will place the tubing. Now that you have your tubing primed and inserted, now it's time to turn the machine on… once you turn it on, it will start the warming process. It takes some time to get to the ideal temperature of 41, but if you have a patient who is bleeding out, you can start infusing immediately if needed… especially if you're using warmed fluids or blood products. At this point, you are ready to infuse the ordered products. Here we have an example of PRBC’s so we are going to connect them to the primed tubing, making sure the correct side is unclamped. On the top here we are going to go from the - Minus which means depressurized to the plus which means pressurized… Once the pressure has started, we want to see it get to about 300… You can see how fast the fluid goes in… at this time, you should be working on the next bag… so that the next ordered product is ready to infuse. Once you're finished, then release the pressure, clamp this side of the tubing and let's do the same thing to the other side… here we have some pretend FFPs… so we're going to hang the bag, close, the door change, then go from minus to positive and unclamp… So you can see how fast these products are infusing. You will need someone bringing you the units in a cooler from the lab… Make sure as you are infusing that you are using the 1:1:1 ratio of 1 RBC’s to 1 FFP to 1 6 pack of platelets, this will be as close to whole blood as you can get. Make sure you follow your hospitals protocol. The blood bank should issue you units in accordance to that protocol. Once you are finished, you can release the pressure, clamp the tubing and then turn the machine off. Just like blood product tubing, you can use it for 4 hours… However, if the tubing is sitting with blood products not running, you can only let it sit there for 30 minutes. Sometimes, the patient will stabilize and you can stop the MTP, but then 20 minutes later, you need to restart it… in that case, you can use the same tubing. Thanks so much for watching! For more ICU videos, please like and subscribe. See you soon!