3M Ranger Blood-Fluid Warming System Model 245 Principles and Competency Checklist

3M™ Patient Warming Solutions

3M Ranger TM

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Blood and Fluid Warming System Model 245 Indications for Use

The 3M Ranger blood and fluid warming system is designed to warm blood, blood products and intravenous infusion fluids and deliver these at flow rates from KVO to 500mL/min (30 L/hr). The 3MTM RangerTM Warming Unit can be used with 3MTM RangerTM Paediatric, Neonatal, Standard Flow and High Flow Disposable Sets.

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Positioning of the Ranger Warming Unit • When mounting the warming unit to an IV pole, position it at patient height, but no higher than 112cm (44”) off the ground, onto a heavy based five footed IV pole. This will reduce the risk of the IV pole tipping and potentially causing injury to someone. • The warming unit is designed to be mounted on an IV pole, using the IV pole clamp situated on the side of the warming unit. When mounting the warming unit, ensure the clamp is tightened securely.

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The Ranger blood and fluid warming unit • The warming unit is a compact, lightweight, liquid-resistant device. • A carrying handle on the top of the unit makes it easy to transport. • A bubble trap holder is located on the side, to support the bubble traps incorporated into all 3M™ Ranger™ Disposable Sets. • The ON/OFF power switch is located on the side of the unit, below the bubble trap holder. • The unit uses dry plate technology to warm the fluids during transfusion. •  3M™ Smartheat™ Technology ensures fluids are warmed efficiently by maintaining a 41±1°C plate temperature, irrespective of infusion rate or pre-infusion fluid temperature.

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Warming Unit Display • An alphanumeric display on the front of the unit indicates the plate temperature during normal operation. • There is an alert indicator light, that illuminates should an over or under-temperature condition occur.

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Alert Settings • The primary over-temperature alert is set to 43°C. If an over-temperature condition occurs, the alphanumeric display will flash “HI” and an audible alert will sound. The power to the heaters will be cut until the temperature falls below 43°C. The audible and visual alerts will also stop when the temperature falls below 43°C. If the temperature does not return to 41±1°C, then discontinue use of the warming unit. • An independent backup over-temperature alert is set to 44°C. If the temperature should reach or exceed 44°C, the alphanumeric display will alternately display the temperature and “HI” or go blank. An audible alert will sound, even if display is dark. Power to the heating plates is shut off. Turn unit off and contact a qualified technician. •  The under-temperature alarm is set to 33°C. If an under-temperature condition occurs, the alphanumeric display will alternately display the temperature and “LO” and an audible alert will sound. The alert stops when the temperature rises above 33°C. If the temperature does not rise above 33°C, discontinue use of the warming unit.

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Operating the Warming Unit •  Connect the warming unit to a power source. • Slide the disposable cassette into the warming unit. 3M™ Ranger™ Disposable cassettes are designed to fit into the warming unit one way. Raised tracks on the cassette, need to be aligned with the slots in the upper plate. • Prime the warming set •  24200 & 24250 Standard Flow Sets and 24450 Neonatal/Paediatric Set: Connect a fluid administration set to the inlet luer of the warming set and ensure luer connection is secure. Ensure clamps are open and then prime the line using the roller clamp on the administration set. Invert the bubble trap and fully fill to purge all air out of the trap and patient line. Place bubble trap into the holder on the warming unit and close all clamps. • 24355 High Flow Set: Ensure all luer connections are tight and clamps closed, before priming. Spike fluid bags, invert drip chamber and using the roller clamp fill two thirds full. Place the auto-venting bubble trap into the holder on the side of the unit and close the clamp beneath it. Open the roller clamp and begin to prime the warming set. Flow will stop when set is fully primed. Open clamp below bubble trap and continue to prime the patient line. Close any clamp to stop flow. •  24365 & 24370 High Flow Set: Connect a fluid administration set to the inlet luer of the warming set and ensure luer connection is secure. Place the auto-venting bubble trap into the holder on the side of the unit and close the clamp beneath it. Open the roller clamp and begin to prime the warming set. Flow will stop when set is fully primed. Open clamp below bubble trap and continue to prime the patient line. Close any clamp to stop flow. •  Turn the warming unit on, using the power switch located below the bubble trap holder. It will take less than two minutes for the warming unit to reach its operating temperature of 41°C. Once reached, the warming unit is ready for use.

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Removing Warming Set After Use •  When primed, the 3M™ Ranger™ Warming Set expands within the warming unit, to ensure optimum heat transfer, through contact with the warming plates. After use, a few drops of fluid needs to be drained from the set to aid removal. • Stop flow to the warming set by closing administration line clamp. • Open distal patient line clamp, allowing a few drops of fluid to drain. • Remove warming set from warming unit and dispose of according to hospital protocol. • Unplug the warming unit from the power source and store.

Transferring the Warming Set from one 3M Ranger Warming Unit to Another TM

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• W  hen primed, the Ranger warming set expands within the warming unit, to ensure optimum heat transfer, through contact with the warming plates. To transfer the warming set from one Ranger warming unit to another, a few drops of fluid needs to be drawn from the set to aid removal. • Stop flow to the warming set by closing administration line clamp. • Squeeze the bubble trap and while still squeezing, close patient line clamp distal to the bubble trap. • Release bubble trap. This will draw sufficient fluid from warming set, to allow its removal. • Keeping clamps closed, transfer to another warming unit. • Open all clamps and resume infusion.

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Storage and Maintenance • • • • •

Disconnect the warming unit from the power source before cleaning. Wipe the outside of the warming unit with a damp, soft cloth and a mild detergent or a hospital approved hard surface disinfectant. Wipe with a dry cloth. Cleaning the labels with alcohol will over time cause the labels to fade. Do not use solvents. These will damage the case and labels. • Unplug the warming unit from its power source. • Unfold the cleaning tool and wet the foam pads with non-abrasive detergent or cleaning solution. • Insert the tool from the back of the unit until it protrudes from the front of the unit. • Pull the cleaning tool all the way through from the front of the unit. • Rinse the tool with water and repeat, passing it through the warming unit 3 times. • Wipe any excess fluid from the warming unit.

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The 3M Ranger Blood and Fluid Warming Sets TM

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• Six styles of warming set are available in the UK: One neonatal/paediatric (KVO-6L/hr), two styles of standard flow (KVO-9L/hr) and three types of high flow (KVO-30L/hr) disposable sets to meet your fluid warming needs. • A ll warming sets incorporate an air capture system, to reduce the risk of an air emboli being infused into the patient. Intravascular air embolism through intravenous infusion, is one of the Department of Health 2011 “Never Events”* • A ll high flow sets are equipped with an auto-venting bubble trap, that is capable of venting up to 3 litres of air per minute. • Sets can only be inserted into the warming unit one way, this prevents incorrect placement. • All sets can be pressurised to 300 mmHg. • All sets are packed sterile and are manufactured from latex free materials.

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Stand alone Pressure Infuser •  When mounting the pressure infuser to an IV pole, position it no higher than 142cm (56”) off the ground, on to a heavy based five footed IV pole. This will reduce the risk of the IV pole tipping and potentially causing injury to someone. • Secure the infuser to the IV pole by tightening the two clamps on the back of the unit and the power cable, using the hook-and-loop strap.

 ever infuse fluids if air N bubbles are present in the fluid line, air embolism may result. The pressure infuser can be used with all 3M™ Ranger™ Blood and Fluid Warming Sets, as well as 3M™ Ranger™ Irrigation Sets and will accept fluid bags from 250mL to 1000mL in volume.

nine - continued Operating the Pressure Infuser • Connect the pressure infuser to a power source. • Turn the pressure infuser on, using the power switch located under the unit. The power button on the control panel will illuminate amber. The pressure infuser is now in standby mode. • Open the pressure infuser door. • Place IV solution bag inside the pressure infuser, ensuring it is located between the metal fingers, with the bag port hanging below the fingers. • Securely close the pressure infuser door. • Press the power button on the control panel that corresponds to the chamber being used. The power button will illuminate green, indicating the infuser chamber is active. • Open clamps and commence flow.

Changing a Fluid Bag • • • •

Press the power button on the control panel corresponding to the chamber in use. This will put it into standby mode. Open chamber door and remove the empty IV solution bag. Replace the empty IV solution bag and place it inside the chamber as described above. Securely close the infuser door and activate chamber by pressing the corresponding power button on the control panel.

Control Panel Indicators • The High pressure indicator illuminates amber and an audible alarm notifies the user, should the pressure in the chamber exceed 330 mmHg. The alarm will continue as long as the pressure is above 330 mmHg. Discontinue use and seek biomedical engineering support. • The “In Range” pressure indicator flashes green when the pressure in the chamber is increasing and will remain a solid green once the target pressure range of 230 – 330 Pressure Infusor mmHg is achieved. • The Low pressure indicator illuminates amber and an audible alarm notifies the user, should the pressure in the chamber fail to reach 230 mmHg, within 30 seconds, or drop below this level during use.

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Good Practice •  If infusing fluids under pressure, do not exceed 300 mmHg. • Do not infuse fluids if air is within the tubing, as air embolism may result. • Ensure all luer connections are tight before priming the set. • Ensure the bubble trap of all standard flow and neonatal/paediatric sets are completely filled and placed in the bubble trap holder. • Do not mount the Ranger warming system higher than the patient, as air embolism may result. • Change the blood filter on the 24355 disposable set, when it becomes clogged. • Do not use disposable warming sets, if packaging has been damaged or previously opened. • Remove excess air from IV fluid container before use. • Place disposable cassette in warming unit before you commence priming. • Do not continue use if the over-temperature alert continues to sound and the temperature display does not return to set point temperature (41±1°C). • Only clamp the 3M™ Ranger™ Warming Unit to a suitable IV pole at patient height but no higher than 112cm (44”). This will reduce the possibility of the device toppling over • Ensure warming unit is cleaned as regularly as your hospital cleaning protocol requires. This will help minimise the risk of cross-contamination. • Dispose of all warming sets in accordance with your hospital protocol for clinical waste. • Store disposable sets at room temperature between 15 - 30°C. • Change the disposable set according to your hospital protocol for intravenous infusion lines. • Only use the 3M™ Ranger™ Blood and Fluid Warming System in accordance with your hospital protocol for the warming of intravenous fluids and blood products.

3M™ Patient Warming Solutions

Competency

Checklist

Using the 3M™ Ranger™ Blood and Fluid Warming System - Model 245 The purpose of this checklist is to ensure you are able to demonstrate: An understanding of the warming unit / Correct and safe set-up of the equipment. How to operate the equipment correctly and safely / Knowledge of good practice.

Name: Job Title: Competency Checklist

Assessed By:

Explain and demonstrate the correct way to safely mount the warming unit Describe what is displayed on the alphanumeric temperature display Describe what Smartheat technology ensures Describe the primary over-temperature alert; what happens to the warming unit in a over temperature condition and what action should be taken Describe the back up over-temperature alert; what happens to the warming unit and what action should be taken Demonstrate how to set up the Ranger warming system and prime a standard flow disposable warming set Demonstrate how to set up the Ranger warming system and prime a high flow disposable warming set Demonstrate how to remove the set on completion of therapy and dispose of consumable Demonstrate how to transfer the set to another warming unit To what pressure can Ranger warming sets be pressurised to? Describe how to safely use the Ranger blood and fluid warming system and why? Demonstrate how to operate the Ranger pressure infuser Describe the function of the buttons and indicators on the Ranger pressure infuser control panel Information about you that you disclose to 3M Health Care will be kept confidential. We will only use the details provided for the purposes of generating a customer report. Since 3M Health Care is part of the global 3M company, the information that you will provide us with will be stored on 3M’s servers outside of Europe and other 3M companies or business partners may process this information on 3M Health Care’s behalf, but always under strict conditions of confidentiality. 3M Health Care will keep this information to enable it to properly and effectively administer and monitor the customer relationship it has with you.

* Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. Primary care trusts are required to monitor the occurrence of Never Events within the services they commission and publicly report them on an annual basis. Source: http://www.nrls.npsa.nhs.uk/resources/collections/never-events/

Infection Prevention Division 3M Health Care Limited

3M House, Morley Street Loughborough Leicestershire LE11 1EP Tel: 0845 873 4164 Fax: 01509 237288 Email: [email protected] Web: www.3m.co.uk/healthcare www.3m.co.uk/patientwarming

3M Ireland

The Iveagh Building The Park Carrickmines Dublin 18 Tel: 00 353 (01) 280 3555 Fax: 00 353 (01 280 3509 www.3M.ie

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