Cath toes

[ncbeachgrl]

This may be a dumb question, but can someone accurately explain why the opposite foot is warmed if a baby has cath toes, and never the affected foot? As a new grad, I was taught warming the opposite foot is correct, but am working somewhere now that puts heel warmers on both feet. I thought this process was wrong, but wanted to be sure of my theory before saying something.

[Mags4711, RN]

Interesting you are being taught to warm both feet, the NIH and an articale on MedScape just list warming the opposite foot to cause a reflex vasodilatation. Wonder if it's the result of a new study?

[Jolie, BSN]

If you apply a warmer to the affected foot, you are increasing the metabolic demands of that extremity at a time when the circulation is less than optimal. That could theoretically lead to tissue damage.

By applying a warmer to the opposite foot, you get the benefit of increased blood flow to the affected extremity (by way of reflex vasodilation) without increasing its metabolic demands.

[dawngloves, BSN, RN]

I've heard both, but really, I've only had warming the foot work a couple of times.

[prmenrs, RN]

I think it may be more imp't to fix the line placement than to warm feet. (I, too, was taught to warm only the unaffected foot. You might also try a position change for the baby to see if that affects where the line is lying.)

[Gompers, BSN, RN]

If you apply a warmer to the affected foot, you are increasing the metabolic demands of that extremity at a time when the circulation is less than optimal. That could theoretically lead to tissue damage.

By applying a warmer to the opposite foot, you get the benefit of increased blood flow to the affected extremity (by way of reflex vasodilation) without increasing its metabolic demands.

Great answer!

[KRVRN, BSN, RN]

Plus warming the unaffected foot lets the affected foot be uncovered and visible.

[lovemyjob]

I was reading an article, think it was in Advances in neonatal care, that talked about the risks of losing the toes/foot/limb and suggests that if ther is any question, the line should be pulled. I know that is in a perfect world, sometimes the risk outweighs the benefit..

Jolie, I appreciate your answer...always wondered why warming the affected foot was a bad idea.

[ncbeachgrl]

Thanks for the responses! I too, had often wondered about not warming the affecting foot, but knew I had only been taught to warm the unaffected foot. You're right, if the baby really does have "cath toes", the best thing to do is pull the line.

[KRVRN, BSN, RN]

We also put a thin dab of NitroPaste on the affected toes to try to avoid D/C'ing the line.

[danissa, LPN, LVN]

Have been a nicu midwife for a LONG time, but in scotland! So, maybe a lost in translation thingy, but what do you mean by "cath toes"???

[Jokerhill]

We also protect the feet by placing a cover over them in a tent fashion if the baby is under a radiant warmer. With poor circulation the heat will not be transfered away and can be burnt by the warmer.

Cath toes is poor circulation/toes turning purple, with a UAC/UVC being the most logical cause.