Heel Warmers

We use them on all lab draws. We have never had a burn from a heel warmer (at least the brands that we have used). They don't get hot enough at the peak of the reaction to cause a burn, maybe a micro preemie.

Just make sure they're designed to be used as heel warmers. I've seen burns in PICU from instant heat packs that are 'medical grade' but were never designed to be placed directly against the skin, so they get way too hot. Heel warmers are designed never to surpass a certain temperature, so they shouldn't cause burns even when placed directly against the skin. The manufactuers themselves should be able to provide safety information.

If you were really worried about the micros getting burned, why not jut put a 4x4 piece of gauze between the foot and the heat pack? The only other thing I can think of is that the heat from the heat pack might react with other substances on the foot, like old residual CHG, to cause a burn. Maybe the solution is to be sure you wipe micros' feet down really well with water/saline after using CHG and before applying heat packs. I've never personally seen a heat pack aggravate a CHG burn, but I have worked in a unit that routinely wipes micros down after any CHG wipe is applied in an effort to prevent this problem.

This is the data I'd focus on: heel warmers should actually give you more accurate results for all of your labs compared to your current method since the blood will flow more freely. With a heel warmer, you should have less hemolysis and fewer problems with interstitial fluid diluting down the sample (hence why you never check a blood glucose from a cold extremity). Again, I'm guessing the manufactures could provide you with this data.

I've done the 'pack it with a warm diaper method' when our heel warmers were back ordered, and it was the worst, most frustrating lab experience I've had in NICU. Honestly, I feel like you run an even higher risk for burns since there's no way to regulate how hot you make the 'hot diaper,' vs. the heat packs which never surpass their maximum engineered heat. In addition, having the diaper get cold also puts the kiddos at risk for cold stress (and inaccurate labs).

It sounds like a really silly idea as a long-term solution. Granted, every NICU I've ever worked in has had that one weird, quirky, kind of dumb practice that they do because they had a random bad outcome once...I guess there are worse quirks to have...