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FIGURE 7  Outlet fluid temperature as a function of tubing length   materials under standardized cold exposure protocols, opti-
          and insulation thickness.                          mization studies to determine the clinical acceptability of
                                                             reduced IV tubing lengths, and comprehensive evaluation of
           Outlet Fluid Temperature (°C)
                                                             proposed solutions with respect to kit portability and deploy-
                                                             ment logistics.
                                                             Author Contributions
                                                             All authors participated in the study design, analysis, and man-
                                                             uscript drafting.

                                                             Disclaimer
                                                             The views and opinions expressed herein are those of the au-
              Tubing Length (m)            Insulation Thickness (mm)  thor and do not purport to state or reflect the position of the
                                                             United States Government or any agency thereof, including the
          FIGURE 8  Outlet fluid temperature as a function of thermal   United States Military Academy, the Department of the Army,
          conductivity and tubing length.                    or the Department of Defense.
            Outlet Fluid Temperature (°C)
                                                             Disclosures
                                                             The authors have nothing to disclose.

                                                             Funding
                                                             This research was supported by the Army Research Labora-
                                                             tory (ARL).

                                                             References
                                                              1.  Rossaint R, Bouillon B, Cerny V, et al. The STOP the Bleeding
                                                                Campaign. Crit Care. 2013;17(2):136. doi:10.1186/cc12579
                                                              2.  Butler FK Jr, Holcomb JB, Schreiber MA, et al. Fluid resuscita-
                                                 Tubing Length (m)  tion for hemorrhagic shock in Tactical Combat Casualty Care:
                Thermal Conductivity (  !  )
                          "#$                                   TCCC guidelines change. J Spec Oper Med. 2014;14(3):13–38.
                                                                doi:10.55460/DPOC-JWIY
                                                              3.  Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Holcomb
          physiologically appropriate temperatures. This research study   JB.  Warm fresh whole blood is independently associated with
          presents a comprehensive heat loss analysis of the IV tubing   improved survival for patients with combat-related traumatic
          component within the FWB transfusion kit, revealing signif-  injuries. J Trauma. 2009;66(4 Suppl):S69–S76. doi:10.1097/TA.
          icant thermal energy dissipation. The observed heat loss re-  0b013e31819d85fb
          sults in suboptimal fluid temperatures, which could potentially   4.  Stegall S. Valkyrie: emergency fresh whole blood transfusion en-
                                                                hances 15th MEU medical capabilities. Marines. Published Febru-
          lead to unsafe flow rates, given the established relationship   ary 2, 2021. Accessed August 1, 2024. https://www.marines.mil/
          between fluid temperature and viscosity.              News/News-Display/Article/2489777/valkyrie-emergency-fresh-
                                                                whole-blood-transfusion-enhances-15th-meu-medical-capa/
          Insulation is proposed as a primary method for mitigating   5.  Singleton W, McLean M, Smale M, et al. An analysis of the tem-
          heat loss through the IV tubing. However, the thermal analysis   perature change in warmed intravenous fluids during administra-
          of the IV tubing indicates that insulation alone is insufficient   tion in cold environments. Air Med J. 2017;36(3):127–130. doi:
                                                                10.1016/j.amj.2016.07.032.
          to maintain adequate fluid temperatures under extreme cold   6.  Snyder GK. Influence of temperature and hematocrit on blood
          conditions. The results demonstrate that additional measures,   viscosity.  Am J Physiol. 1971;220(6);1667–1672. doi:10.1152/
          such as reducing the length of the IV tubing, must be imple-  ajplegacy.1971.220.6.1667
          mented in conjunction with insulation to produce a functional   7.  Ghosh I, Haldar R.  Blood warming in trauma related trans-
          and practical solution. The heat loss mitigation analyses in   fusions-precepts and practices.  J Cardiovasc Med Cardiol.
                                                                2019;6(4):94–97. doi:10.17352/2455-2976.000101
          this study are mainly theoretical heat transfer calculations. It   8.  Blakeman T, Fowler J, Branson R, Petro M, Rodriquez D. Perfor-
          is important to validate these results through experimentation   mance characteristics of fluid warming technology in austere en-
          under actual field conditions. Also, the theoretical analysis did   vironments. J Spec Oper Med. 2012;21(1):18–24. doi:10.55460/
          not fully account for real-world factors such as wind expo-  0C2R-LNPH
          sure, moisture, handling procedures, and equipment durability   9.  DeClerck  MP,  Lipman  GS,  Grahn  DA,  et  al.  A  chemical  heat
          in military environments. The findings outlined in this paper   pack-based method for consistent heating of intravenous fluids.
          serve as a foundation for future research aimed at developing a   Wilderness Environ Med. 2015;26(3):412–416. doi:10.1016/j.
                                                                wem.2015.02.004
          definitive solution for military medical personnel to effectively   10.  Bissonnette B, Paut O. Active warming of saline or blood is ineffec-
          mitigate heat loss through IV tubing and ensure the delivery of   tive when standard infusion tubing is used: an experimental study.
          FWB at clinically appropriate temperatures to trauma patients   Can J Anaesth. 2002;49(3):270–275. doi:10.1007/BF03020526
          in cold environments.                              11.  Holt JP.  The effect of  insulating blood warmer  output tubing
                                                                on the temperature of packed red blood cells at low flow rates.
          For future studies, experimental validation of these theoretical   The  Defense  Technical  Information  Center. Published  August
          predictions through controlled laboratory studies and subse-  1989. Accessed August  6,  2025.  https://apps.dtic.mil/sti/tr/pdf/
                                                                ADA218002.pdf
          quent field testing under simulated operational conditions will   12.  Safeguard Medical. Fresh  Whole Blood  Transfusion Recipient
          be performed. Priority investigations will include compara-  Set. Safeguard Medical. Accessed June 10, 2025. https://safeguard
          tive thermal performance measurements of various insulation   medical.com/products/circulation/fresh-whole-blood-recipient-set/

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