Warming up extremities for nerve conduction studies

[dc2md]

How are you guys warming up extremities for NCS? And what is your temp goal?

For upper extremities, I like it above 30oC, but I know that 32 is ideal. For the hands, I just have them put them under warm/hot water.

But for the feet, what temp do you look for, and how the heck do you warm them up?

Thanks

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[PMR2008]

In residency we used a Thermometer gun ( http://www.amazon.com/HDE-Temperature-Infrared-Thermometer-Laser/dp/B002YE3FS4/ref=pd_bxgy_hi_text_y) to measure the skin temp. We found it to be very accurate, fast and convenient (no more tape temperate reading or extra wires).

Ideal temp per literature is 32 for UE as you mentioned and 30 for lowers. Per Kimura velocity decreases 5% per 1 degree. So if you are off by 1-2 degrees I personally think it is not that big of a deal unless your velocities are borderline.

- As soon as you enter the room measure the temperature so that while you setup the software and take a brief hx they can warm up the limb. Lower extremities need longer to heat up so we would usually do them last.
-We used to keep the room temperature at between 72-75 degree Fahrenheit. Kimura recommends that as well.
- For rapidly warming limbs we had a hydrocollater( http://www.amazon.com/E-1-HYDROCOLLATOR-STATIONARY-HEATING-UNIT/dp/B000GHYADAhttp://www.massagewarehouse.com/products/thermalator-with-4-standard-packs/). It can be a little messy but moist heat works well and the patient does not have to leave the room or mess around with the sink. Another option that is much cheaper is a hair dryer. Having the patient actively close and open wrist or DF/PF foot while heating the limb can help.

 

[PMR 4 MSK]

Hot water for hands - running them under the water in the sink. I have a small heating pad I use for feet, but sometimes it does not help enough. Some people just have icy feet.

Also, according an episode of Mythbusters, fear really can give you cold feet! Many of out patients are anxious and fearful when they come in.

 

[Jitter Bug]

I just puked a little bit in my mouth just thinking of the nasty hydrocollators I had to use in residency.I keep the hands and feet at least 32C and I have a really old heat lamp that gets it done. The only downside is I get really hot too.

There are conversions you can do to correct values if you just can't keep someone warm but I try to avoid using them. Sometimes you just have to or the EMG will take 4 hours.

 

[PMR2008]

I just puked a little bit in my mouth just thinking of the nasty hydrocollators I had to use in residency.

haha I know exactly what you mean!!

 

[dc2md]

- For rapidly warming limbs we had a hydrocollater( http://www.amazon.com/E-1-HYDROCOLLATOR-STATIONARY-HEATING-UNIT/dp/B000GHYADAhttp://www.massagewarehouse.com/products/thermalator-with-4-standard-packs/). It can be a little messy but moist heat works well and the patient does not have to leave the room or mess around with the sink. Another option that is much cheaper is a hair dryer. Having the patient actively close and open wrist or DF/PF foot while heating the limb can help.

I bought a temp gun this week. It shows readings 1-2 degrees C above what the temperature probe from Cadwell Sierra Wave shows.

A hydrocollator sounds like a horrible idea. Those are for moist hot packs to sit in. Putting a patient's hands in their would work great, but the hygiene of multiple hands seems disgusting.

For the feet, how the hell do you get their feet in the hydrocollator? An infrared heat lamp sounds like a good idea. I was planning on having my MA check the hand/feet temps with the gun, and if too cold, have them warm them up until I'm ready for them in the EMG room.

Just thought of a possible good idea, though obviously more expensive than warm water under the faucet. Paraffin for the hands while they wait. Then, the MA takes off the paraffin, brings them over to me, and bam, nice quick test. Maybe work for the feet too. But the heat lamp is probably more practical...and may feel good in the winter up here in STL.

 

[PMR2008]

Use the moist hot backs to heat the limbs. Putting hands or feet IN the hydrocollators is without a doubt a bad idea. You should give the heat lamp a shot. You should be able to buy a nice one for less than a hundred bucks. Interesting idea about the Paraffin but it is contraindicated for patients with neuropathy or edema so atleast with the heat lamp you have more control over the temperature.

 

[arvanmed]

Right now we are doing a clinical trial on effect of 3,4 DAP for Lambert Eaton , and research criteria for both upper and lower extremities is 32-36. Protocol insists that warming process should be at least 10 minutes. It takes a while for the heat to pass the skin and reach the nerve.