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Equipment Demonstration

Radiant warmerUpon completion of this section the participant

should be able to:

> Describe the parts of a radiant warmer

> Demonstrate the working of the warmer

> List the dangers associated with its usage

> Identify minor trouble shoot and correct

> Manage minor maintenance

Parts

> Bassinet (for placing the neonate)

> Radiant heat source (Quartz/ceramic or similarheating rod)

> Skin probe (for sensing baby's skintemperature)

> Air probe

> Control panel (Displays and control knobs)

o Mode selector ^selects manual or servomode)

o Heater output control key/knob(to increaseor decrease the heater output manually)

o Heater output display (indicates heateroutput)

o Temperature selection key/knob (select thedesired skin temperature)

o Temperature display (displays temperatureof baby's skin, the set temperature and airtemperature)

o Alarm display for power failure, systemfailure, skin probe failure, skin temperaturehigh/low and heater failure.

Working

> Connect to mains and switch on

> Select the manual mode and keep heateroutput to maximum for 15-20 minutes for

pre-warming the bassinet and linen.

> Select servo mode and set the desired skintemperature to 36.5°C. Heater output adjustsautomatically to keep baby at set temperature

> Place baby in the bassinet. Cover head withcap, feet with socks and hands with mittens.

> Connect skin probe to baby's abdomen with askin friendly tape

> If baby is hypothe: mic one may use themanual mode.

> In manual mode, record baby's axillarytemperature every 30 minutes tillhypothermia is corrected. Do not leave thebaby unattended when operating in thismode. Switch to servo mode oncetemperature is 36.0°C

Cleaning and disinfection

Bassinet

> Soap/detergent - daily

> Clean using disinfectant like 2% Bacillocid or

glutaraldehyde when the bassinet isunoccupied or weekly (move the baby while

using disinfectant)

Probe

> Clean using Isopropyl alcohol swab beforeand after each use.

Do's and Don'ts

> Place skin probe in the right upper abdomen

in the supine position and in the flanks if babyis prone.

124,

> Use skin friendly adhesive tape to secure theprobe in place. Do not place probe on bonystructures.

> Ensure that the skin is dry or else prepareusing alcohol/spirit swab to ensure goodadhesion to the skin.

> Check repeatedly to ensure that the sensorprobe is in position.

> Check temperature manually at least once pershift.

> Always respond to alarms promptly and takecorrective measures.

> Do not apply probe to bruised skin.

> Do not reuse disposable probes.

Trouble Shooting

1. No power on switching - check power supply,on the instrument plug, fuse

- if all the above okay,call engineer

2. Power on, heaternot on

3. No skin temperaturedisplay

- call engineer

- faulty skin sensor(replace sensor/callengineer)

4. Display temperature - needs calibration, calland baby temperature engineervariation > 1°C

Side effects and dangers

> Hyperthermia (especially in the manual mode

if temperature is not monitored or in theservo mode when the probe gets displaced).To prevent hyperthermia, ensure probe isproperly attached and the temperature ofbaby is monitored when the warmer is used inmanual mode.

> Hypothermia (due to equipment failure). Toprevent hypothermia the equipment should

be maintained in good condition and alarmsshould be attended to immediately.

> Increased insensible water loss (IWL) occurs

To prevent IWL

> Clothe the baby and use caps and socks.

> Apply emollients/oil to the skin.

> Maintain ambient temperature and humidity.

Maintenance

> Calibration every 4-6 months as permanufacturer's manual

> Comprehensive warranty for 5 years at thetime of purchase and thereafter Annual

maintenance contract

Phototherapy unit

Objective

Upon completion of this section the participant

should be able to

> Describe the types and parts of aphototherapy unit.

> Demonstrate the working of a phototherapyunit

> Manage a baby under phototherapy unit

Types of phototherapy units

All phototherapy units have a designated light

source to provide irradiance ranging from 6-40

uw/cm2/nm in the wavelength of 420-460 nm. The

various types available are Conventional, CFL and

LED units.

Parts

Source of Light

1. Fluorescent lights (Conventionalphototherapy)

> 6-8 white fluorescent lights OR

> A combination of 2 special blue and 4-6 whitefluorescent lights with a plexiglass shield.

o White tubes (Philips TL 20 W/52)

o Blue tubes (F 20 T12/BB)

125

> '.h^d-aric; presided

o 6-8 uw/cm2/nm (White light)

o 8-12 uw/cm2/nm (Blue + White light)

2. Compact Fluorescent Lights (CFL)

> Compact high intensity bulbs (4 blue and 2white) enclosed in the unit with reflectinggrills

> Irradiance provided 12-18 uw/cm2/nm

> Lamp life is 2000 - 3000 hours

3. Light emitting diode (LED)

> Multiple high intensity gallium nitrate LEDencased in a unit

> Irradiance provided 20-40 uw/cm2/nm

> Bulb life is 20000-30000 hours.

Other parts

> Radiator fan (as applicable)

> Hour meter (as applicable)

Working

> Connect to mains.

> Switch on the unit and check that all

tubes/lamps are working.

Cleaning

> Soap/Detergent once daily

> Clean with disinfectant once a week

> Keep the lamps, the covering shield and thegrill clean

Do's and don'ts

> Cover eyes with an eye patch

> Place baby naked with just the eye shades andnappy to cover the genitalia

> Place baby as close as possible to light sourceavoiding hyperthermia

> Check temperature every 4 hourly to monitor

for hypo/hyperthermia

> Check weight daily

> Frequent breastfeeding

> Increase in allowance for fluid if there is anyevidence of dehydration

>• Change position frequently after each feed

> Measure serum bilirubin every 12 hours or

earlier if required.

> Do not put anything on top of the^phototherapy unit (this may block the air

vents)

> Low birth weight babies can have their socks,

caps and mittens on while underphototherapy for preventing hypothermia.

> Use Fluxmeter to check for and ensureoptimal irradiance.

Problem

Trouble Shooting

Action

1. No power on switching - check power supply,on the instrument plug, fuse

2. Fan not working

3. Timer not working

4. Standard Blue units- Tubes not coming on- Blackening of ends/

flickering of tubes

- if all the above ok,call engineer

- call engineer

- call engineer

- tubes faulty/chokeneeds changetubes need change

Ineffective phototherapy

> Baby covered or frequently removed fromphototherapy

> Low irradiance (tubes old, flickering, black

ends, bulbs covered with dust or reflectorsdirty)

> Distance between phototherapy lights and

baby is more than recommended

> Hemolytic conditions can cause bilirubin to

rise in spite of phototherapy

Side Effects and Dangers

i. Transient maculopapular rash on the trunk

126 Equipment Demonstration

ii. Hyperthermia/Hypothermia

ill Increased insensible water loss and dehydration

iv. Loose stools

v. Bronzing of the skin in the presence of direct

hyperbilirubinemia. If this happens stop

phototherapy and evaluate the baby.

In all other situations (i-iv) continue phototherapy

Maintenance>• Change lights if

o Irradiance as measured with flux meter is

less than lower limit of normal range for

the type of phototherapy in use.

o Lamp life >1000 hrs of use for fluorescent

tubes, for LED >20000-30000 and for CFL

2000-3000 hours/as per manufacturer's

instruction manual

o If Flux meter and hour meter are not

available, then change fluorescent tubes

every 3 months

o Tube ends are black or flickering or not

working

> Comprehensive/Annual Maintenance contract

Suction machine»

ObjectiveUpon completion of this section the participant

should be able to

>• Describe the parts of a suction machine

> Use a suction machine and

> Clean, disinfect and maintain a suction

machine

Parts> Suction tubing

> Suction bottles

> Pressure gauge

Types> Electrical

> Mechanical: Foot operated

>• Wall Cll/-ti/-in

Working

Electrical

> Connect to the mains

> Switch on the unit and occlude distal end with

your thumb to check the suction pressure.

Ensure it does not exceed 100 mm of Hg

> Use disposable suction catheters

> Connect the desired size disposable suction

catheter to suction tubing

> Perform suction gently and intermittently

> Switch off the suction machine

Foot operated

> Pedal to build the desired level of suction

pressure




> Switch off the suction machine

Wall suction

> Turn knob to 'ON' position.

> Check and adjust the pressure gauge




>• Switch off the suction machine


> Wash suction bottle and tubings with soap

and water daily.

> After cleaning soak the tubings and the bottle

in 2% glutaraldehyde solution for 20 minutes

daily.

> Take out from glutaraldehyde solution and

wash under running water.

> Connect to the machine after placing

disinfectant solution (3% phenol or 5% Lysol)

in the bottle.

> Flush the suction tubing by suctioning with

clean water after each use.

127

Do's ^;.J don'ts

> Suction gently and intermittently

> Do not perform vigorous and deep suction

> Use only disposable suction catheters and

discard them after single use

> Check adequacy of suction pressure prior

to use

Trouble Shooting

Problem | Possible Cause I Action

Machine not Check power Ensure powerstarting supply, fuse and supply change

cord, plug and fuse, cord, plug orsocket socket if needed

No suctionPressure

Check for Replace tubes/leakages in the bottles, ensure airbottle, tubing tight connections,and manifold Rectifyroom for malfunctioning inmalfunctioning manifold roomwall suction

Side effects and dangers of auctioning

> Local trauma

> Bradycardia

>• Apnea

> Infection

Maintenance

> Check suction pressure daily

> Change tubing for leaks or cracks

> Comprehensive/Annual maintenance contract

Bag and mask

Objective


should be able to

> Describe the parts of a bag and types ofmasks

> Use the bag

> Describe cleaning of a bag and mask

Parts of a Self inflating ffug

> Bag

> Oxygen inlet

> Air inlet

> Patient outlet

>• Valve assembly

> Oxygen Reservoir

Safety feature

Pressure release valve (also called as the pop-off

valve) or the pressure gauge.

Types of mask

Rounded silicone cushioned mask for preterm (size

0) and term (size 1)

Anatomical mask for preterm and term

Working

>• Assemble bag

> Check bag (For this, occlude the patient outlet

tightly with your palm and then squeeze thebag and look for the release of the pop-off

valve, the pop-off valve goes up along with ahissing sound- this indicates that the bag is

functioning normally)

>• Connect to oxygen source, if required

> Attach the reservoir, if required

> Fix appropriate size mask (00 for extremelypreterm, 0 for preterm and 1 for term, the rim

of the mask should cover the tip of chin, themouth and the base of the nose, but not the

eyes)

> Apply mask. Ensure adequate seal

> Perform PPV-Check for adequate chest rise

Indication

To provide positive pressure ventilation

Contraindication

> Congenital diaphragmatic hernia

128 Equipment Demonstration

> Meconium aspiration syndrome (relative

contraindication)


> Disassemble all parts, wash thoroughly with

warm water and soap.

> For disinfection, soak in glutaraldehyde 2% for

30 minutes and for sterilization, soak for 6 hrs

> After removing from glutaraldehyde rinse with

clean water, dry with sterile cloth and then

reassemble

> Clean mask with spirit between patient use

Do's and don'ts

> Check bag prior to resuscitation

> Choose the appropriate sized mask

> Look for adequate chest rise

> Make sure that the airway is patent

> Ensure adequate seal

> Don't perform overzealous PPV

Trouble shooting

Chest doesnot rise withBandMventilation

Bag doesn'tgeneratepressurewhen testedon palm

Leakage aroundmaskBlocked airways

Mouth closed

Pop-off valvegives way dueto loose springNeeds higherpressure

Leakage/cracked bagLeakage at airinletPop-off valvedefective

Provide tight seal

Re-suction,repositionTry BandM V withmouth openChange bag

Use higherpressure

Change bag

Baby doesn't Needs higherimprove leveldespite resuscitationeffectiveBandM

Based on HR-Perform ChestCompressionsfollowed bymedications

ventilation Needs oxygen Ensure O2 supply

Maintenance

> Replace if damaged or leaking

> Do not place/leave it lying under radiant

_ warmer

Weighing machine(electronic/mechanical)

Objective


should be able to

> Demonstrate the use of the weighing machine

> Calibrate the machine

Parts

> Pan or baby tray

> Weight scale dial or digital display

> Machine proper (base)

Working

> Clean the pan before each use with spirit

> Place a sterile towel or paper (one for each

baby and discard after use) on the pan to

reduce chances of hypothermia and cross

infection

> The machine should always display zero every

time before weighing

> Place baby naked on the middle of the pan

and wait till the display stabilizes (Do not

record blinking or changing values)

> Record weight. Remove and clothe the baby.

> Switch off the machine


> Clean with soap and water daily

• 129

Do's and Don'tsX

> Always look for and adjust 2ero error, in

mechanical machines it is done by adjusting

the knob and in electronic by using the

Tare/Zero switch.

>• Regularly (weekly) calibrate using a known

weight

> Weigh baby naked

> Do not stack up linen or other objects on the

weighing pan when not in use

> The machine should be placed on a flat stable

surface during use.

Maintenance

> Check with a standard known weight at least

once a week; request engineer for calibration

if incorrect weight


Pulse oximeter

Objective


should be able to

> Describe the parts of pulse oximeter.

> Demonstrate the working of the pulse

oximeter

> Interpret the pulse oximeter readings.

> Describe daily maintenance, cleaning and

troubleshooting

Parts

> Display panel

o Numeric display

o Graphic display

> Control buttons

o Power/standby button

o SpO2 alarm setting button

o HR at^rm setting button

o Set button (alarm, volume, trend)

o Alarm silence button

> An electric cable

> An extension cable for attachment of the

patient sensor

> A patient sensor which is to be connected to

the extension cable

Working

> Connect to the mains.

> Switch on the machine

> Set the alarm limits for heart rate 100 - 160

bpm

> Set saturation alarm limits - 89 - 95%

> Connect the patient sensor to the patient by

wrapping it around the baby's hand or foot.

> Pulse oximeter starts detecting signal from

the patient and displays heart rate and

saturation in a few seconds

> The values displayed may not be reliable in

the presence of shock, cold peripheries,

excessive movement, electrical interference

and exposure of probe to bright ambient light

> Values are reliable when the

plethysmographic waveform or bar signal is

good

> Values are reliable when the display is

constant and not blinking or repeatedly

changing.

Cleaning and Disinfection

> Clean display panel with moist soft cloth

> Clean body with soft cloth dampened with

soap water followed by moist soft cloth

> Clean reusable sensors with spirit after each

patient use.

" Equipment OembristfaliQn

Trouble Shooting

Alarm/Display! Possible cause 1 Correctivemessage JactKm

Check sensor

Check probe

Pulse search

Motion, low Reposition,perfusion, wrong relocateposition

Probe not Connect probedetected Check probe

connection

Interferencedetected

Low battery

Sensor failure

System failure

Ambient light

Pulse notdetectedInitialisingLow perfusion/movement/edema

Erratic signalwithelectromagneticwaves in vicinitylike TV, .mobilephone

Low internalbattery

Broken cable,faultyphotodiode,sensor damage

Internalcomponentfailed

Excessive lighton sensor

Change sensorsite

Removeinterference

Connect to ACpower

Replace sensor

Unit needsservice/change

Relocate, coverwith opaquepaper/cloth

Do's and Dont's

> Inspect sensor site every 2 to 4 hours for anyerythema or discoloration

> Change sensor site every 4 -6 hourly

> Do not apply sensor too tightly

> Do not apply probe to edematous or bruisedsites.


> Failure of operation.

> Explosion hazard in presence of any

flammable anesthetic mixture.

> Local reddening, blistering, skin discoloration,burn etc. because of the sensor placement.

Maintenance

> Cleaning the Oximeter as necessary.

> Recharging the battery as necessary.

> Replacing the fuses in power module asnecessary.


> Do not knot, pull or apply traction to sensorcable or extension cable.

> Handle carefully and gently.

Pulse Oximeter

Display monitor

Oxygen saturationin percent

Plethysmograph

Heart ratein bpm

Patient sensor

Infusion pump(syringe pump)

Objective


should be able to

> Describe parts of a Syringe pump

> Demonstrate the working of a syringe pump.

> Set proper rate for fluid administration

131

Parts

> Syringe barrel clamp

> Pusher and push guard/flange guard

> Handle assembly bolt

> SWING lock clamp

> ON/Off

> Screen.

> Silence alarm

> Bolus OR Prime

> Value selection

> Pre alarm and alarm warning

>• Stop - Infusion stop

> Menu

Working

> Connect to Mains. Observe indicator lightcomes on.

> Press the* 'ON' key to turn the pump on. Allsignals on display panel will glow at once orone by one.

> Select the type of syringe and the appropriatesize of syringe as 10ml or 20ml or 50ml, (somepumps may do it automatically)

> Press OK to confirm syringe.

> Install syringe loaded with desired amount offluid with intravenous tubing attached andprimed with the required fluid.

> Select the flow rate in ml/hour.

> Connect the tubing to the patient.

> Start the infusion. Check arrow indicatormovement to ensure that the fluid is beingdelivered.

> Check IV site regularly to avoid inadvertentextravasations.

> To give a BOLUS, press the bolus key andcontinue to keep it pressed till the desiredamount has been infused.

> Press STOP to stop the infusion.

> Prime the line with the fluid to *-:•.- infusedevery time you change the type of fluid


Use a cloth soaked in soap water for cleaning

Do's and dont's

> Cross check the flow rate to assure noinadvertent medication/fluid administrationerror (e.g 5 ml/hr-instead of 0.5ml/hr)

> Label the syringe with the drug/fluid name

> Respond to alarms and take corrective actionimmediately

Trouble Shooting

Intern

1. 'No power' onswitching on theinstrument

2. Alarms

3. Occlusion alarm withno block in line (easyfluid infusion whenmanually pushed)

Action

- check power supply,plug, fuse

- if all above are okay,call engineer

- check syringe positionand clamps

- call engineer


> Inadvertent IV extravasation if IV cannuia isdisplaced.

> Medication/fluid administration errors.

Maintenance


Oxygen delivery systems

Following oxygen delivery devices are used in

neonates

132. Equipment Demonstration

> Nasal prongs: Nasal prongs provide FiO2

between 25 to 45% with flow rates of 1-2L/min. among the various types of nasal

prongs available, short bi-nasal prongs are

most commonly recommended. They come invarious sizes and the appropriate neonatalsize prongs should be used. These are themost preferred mode of providing oxygen.

> Oxygen hoods: The flow rates in the oxygenhood should be maintained between 3-5L/min. These are capable of providing FiO2

between 30 to 90%. They have occludableportholes on the sides. With one port hole

opened it provides a Fi02 close to 40-50%,while with both opened it provides 30-40%.With both port holes closed, 80-90% FiO2 canbe achieved.

> Nasal cannula: Nasal cannula can provide aFio2 ranging from 25 -45 % with flow rates

between 1-2 L/min. It mainly comprises of acatheter or a feeding tube inserted few cms (=distance between the nostril and medial

canthus) into the nostril and then connectedto oxygen. Nasal cannulas are not the

preferred mode of providing oxygen.

Precautions

> Prewarm and humidify oxygen especiallywhen the flow rates are >2 L/min

> Oxygen saturation should not cross 95% in

preterm infants as hyperoxia leads towidespread free radical injury. Set appropriatealarm limits on pulse oximeter.

> Use oxygen analyzer to check the FiO2 whenOxygen therapy is initiated and thereafter,

whenever a change in the flow rate is made ora change in the respiratory status of theneonates has occurred.

Humidification

Humidification of gases is very important as dry

gases cause drying and damage to the airway

mucosa. The minimum recommended temperature

at the level of nostrils is 33 degree Celsius.

alone humidifiers and heat and moisture

exchangers (HME/HMEF). The target is to achieve 33

- 42 mg/L of absolute humidity with a relative

humidity of 70-100%.

Oxygen Concentrators

An oxygen concentrator is a device providing

oxygen therapy to a patient at minimally to

substantially higher concentrations than available in

ambient air. Oxygen concentrators are less

expensive than liquid oxygen and are the most cost-

effective source of oxygen therapy and more

convenient alternative to tanks of compressed

oxygen.

Room air contains 21% oxygen combined with

nitrogen and a mixture of other gases. A

miniaturized compressor inside the machine

pressurizes this air through a system of chemical

filters. This chemical filter is made up of silicate

granules called Zeolite. The Zeolite will sieve the

nitrogen out of the air, concentrating the oxygen.

Through this process, the system is capable of

producing medical grade oxygen up to 96%

consistently. Most of the portable oxygen

concentrator systems available today provide high

concentration of oxygen and also maximize the

purity of the oxygen,

Safety

> The concentrator's instruction manual

indicates as to what maintenance is necessary;

here are some general guidelines to follow:

> The concentrator needs good, clean air tooperate properly. Hence, operate theconcentrator in a well-ventilated area.

> Wash the filters periodically (at least once in aweek).

> Replace the filters periodically (at least once ina year).

X EnSUrp pyaminatifMi

Equipment Demoi 133

There /if: -<-.so some very important safety issues to

be kept in mind. Oxygen is most dangerous in the

presence of fire. Keep flammable materials safely

away, and do not allow any heat sources to be near

a working oxygen concentrator. In both clinical and

emergency-care situations, oxygen concentrators

have the advantage of not being as dangerous as

oxygen cylinders, which can, if ruptured or leaking,

greatly increase the combustion rate of fire.

Oxygen concentrators are considered sufficiently

foolproof to be used in neonatal units. They can be

used for more than one patient by using flow

splitters. However, they need a power source.

Parts

> Machine with compressor

> Flow meter with/without splitter

> Humidification bottle

Working

> Plug onto the power supply.

> Switch on the concentrator using the ON/OFFbutton.

> Once the concentrator is on, a yellow light willcome up.

> Next, adjust the flow to 3-4 liters. This lightwill be on till the desired concentration ofoxygen is achieved, which in mostconcentrators is nearly 90-93%, after which itgoes off.

> Every manufacturer has its own way ofshowing the achieved desired concentration,In some concentrators this yellow light willbecome green after achieving the desiredconcentration.

Maintenance

> Coarse filter- Ensure it is dust free, wash daily

> Zeolite granules - Change every 20,000 hrs

> Bacterial filter - Change every year

Trouble Shooting

P'roblem

Machine toonoisy

Machine orroom getsheated

1 Possible cause

Coarse filter.blocked by dust

Machine is nearthe wall

j Corrective . .]faction j

Wash filterdaily

Keep awayfrom wall oroutside the

Yellow light isnot going off

Compressorheats up

room for freecirculation ofair

Desired oxygen May be due toconcentration high humiditynot reached or the flow rate

is more, whichexceeds thecapacity ofzeolitematerial.Decrease theflow rate.

Malfunctioning Look at theof compressor fan, it may be

jammed, andhence mayneed repair.

f^rrxf · 2017. 11. 20. · tubes, for led >20000-30000 and for cfl 2000-3000 hours/as per...

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