Preventing Chills During IV Fluid Administration

Evidence-Based Recommendations

• The American Heart Association recommends avoiding rapid infusion of large volumes of cold IV fluids (4°C), as this practice provides no mortality or neurologic benefit and increases risk of cardiac re-arrest (RR 1.22) and pulmonary edema (RR 1.34) 1, 2, 3, 4, 5, 6
• The American Heart Association guidelines (Class III: No Benefit) contraindicate the use of cold IV fluids for routine resuscitation outside of specific therapeutic hypothermia protocols 1, 2, 7
• Cold fluids (4°C saline or Hartmann's solution at 30 mL/kg) may still be reasonable when patients are well-monitored in controlled hospital settings and a lower target temperature (33°C) is the specific therapeutic goal, as part of targeted temperature management protocols 4, 5

Clinical Considerations

• Administering cold IV fluids increases risk of cardiac re-arrest (RR 1.22) and pulmonary edema (RR 1.34), with no mortality or neurologic benefit 4, 5, 6
• The use of cold IV fluids is specifically contraindicated by American Heart Association guidelines (Class III: No Benefit) for routine resuscitation outside of specific therapeutic hypothermia protocols 1, 2, 7