Heel Warmers

[tkrahn]

Hey NICU friends. So our NICU doesn't use heel warmers for lab draws. A long time ago 1 baby got burned so they took them away. We've had many traveling NEOs ask why we don't use them. Our policy states to put warm water in a diaper and place that on the foot. The large problem is that our unit struggles with even having warm water. By the time the diaper is removed from the foot, the foot is cold. And we haven't seen a difference in our lab results. Typically we only attempt to warm the heels to keep our potassium results lower.

However, by nursing requests and physician requests were are looking at using heel warmers again. We have had some travel nurses come through here and they swear by them. We do have them in the hospital because lab and postpartum use them. We are mainly wanting them for our bigger hypoglycemic kids. Long story short, what is your experience? Do you like them, do you not like them? I'm also having trouble finding some evidence based articles supporting their use. Of course I can find support literature from the company that makes them. So if anyone has any articles, that would be great too. Thanks!!

[NICU Guy, BSN, RN]

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.

[adventure_rn, MSN, NP]

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...