Warming cabinets let us have several days' worth of irrigation fluid on hand at just the right temperature when procedures begin. But unless you organize your warming cabinet, you're going to waste fluid or, worse, jeopardize patient safety. Here's how to keep track of what irrigation fluids you've warmed, how long they've been warmed and what fluid you can't rewarm.

Color-coded
After we inventoried our fluid warming cabinets, we contacted our fluid manufacturers to find out their parameters for warming temperature and duration. We soon saw that it made sense to follow just one set of regulations for irrigation fluids we'd place in warming cabinets; that is, to buy fluids through a single manufacturer.

We use color-coordinated stickers to indicate status, required rotation and removal procedures. We use a different color sticker for each day of the week. Our patient care techs affix the stickers as they stock the cabinet. They place newer fluid bottles to the rear of the cabinet, so older bottles will be rotated forward and used first. At the end of the day, techs pull out and write a big "X" on the bottles that have been in the warmer for three days, per our policy. While we can no longer rewarm this fluid, we can use it at room temperature until the manufacturer's posted expiration date.

How warm?
One big question we faced was determining the maximum termperature at which our warming cabinet could be set. Our research showed that 120?F was the maximum temperature at which various fluids should be warmed for their best use. That meant we could stick to our three-days-and-out rule, rather than monitoring every bottle separately. Our techs monitor the temperature of the fluid warmer weekly to ensure that it's calibrated properly. They also update a weekly log, noting the date and temperature and ensuing the temperature stayed within the acceptable 104?F-to-120?F range.

The biggest logistical challenge is obvious: How to stock an appropriate amount of supplies, enough for OR cases each day, but not so much that there is an overabundance of fluid that can't be rewarmed. With the help of our sticker system, our techs have been meeting that challenge.

Warming several days' worth of liquids at once creates several other challenges, too:

• Sustained warming past a certain point changes the liquid's chemistry, creating a safety issue.
• You can't rewarm liquid that has been warmed too long, but you can still use it at room temperature.
• The length of time you can warm a liquid varies by manufacturer. The same is true of the temperature to which you must heat the solution. (Your fluid warmer's temperature can affect how long you can keep fluid in the warming cabinet).
• You can't microwave fluids for the same reason you can't microwave a baby's bottle. Microwaving causes hot and cold spots in a solution.