Radiant Warmer Ppt j6qj

CARE OF NEW BORN UNDER RADIANT WARMER SUBMITTED TO : MRS. VANDNA LECTURER UCON, FARIDKOT PRESENTEE : TARUNI MSC.NSG 1ST YR

RADIANT WARMER

INTRODUCTION An understanding of neonatal thermoregulation led to significant decreases in morbidity and mortality in neonates, especially sick preterm infants requiring intensive care. Since the first incubator used, many advances in design have been made. Nursing is closed incubators was initially standard practice and provided reasonable control over the neonate’s immediate environment. Subsequently, open care cots incorporating radiant warmers were introduced to provide easier access to the baby receiving intensive care.

HEAT LOSS:  Evaporation  Radiation  Conduction  Convection

DEFINITION…  Radiant warmer are used to maintain

the body temperature of newborn infants. This is best done so that the energy expended for metabolic heat production is minimized.

ADVANTAGES : Quick and Easy accessibility .  Easy to connect the tubes of ventilated    

baby and do procedures . Better monitoring specially if baby has respiratory distress . Can be used as resuscitation trolley in the labor room Good for performing procedures. Rapid re-warming.

DISADVANTAGES OF RADIANT WARMER:  More insensible water loss .  Not uniform heating as compared to

closed system .  More risks of episodes of hypothermia.  Increase risk of infection.

INDICATIONS :to use manual mode of Radiant  When you are anticipating a new baby to warmer: be brought under warmer care .  Keep warmer on with 100 % heater

output, once the baby is arrived shift to servo mode.  If baby is having fever , move to manual mode and make heater output minimum . If the baby continues to be in servo mode alarm will get activated time and again.

INDICATIONS cont…..  When rapid warming of hypothermic

baby has to be undertaken do using manual mode.  In Labour room when attending delivery , the manual mode alarms every 10 to 15 minutes indicating the bed is warm and ready .If alarm is silenced, again it will reactivate after another 10-15 minutes.

TIPS TO :  Warmer should be used with servo control     

only. Manual control is not recommended. Ensure O2 Air is delivered at same temperature normally 36 ° - 36.5°C . Ensure alarms are on and functioning. Keep warmer away from cold walls, windows, sunshine. To further ↓ heat loss, dress infant in booties, hat and diaper. Don not place oily substances on skinmay burn.

PRECAUTIONS: for safety of the equipment:  Do not use the Warmer in the presence of

flammable anesthetics; a possible explosion hazard exists under these conditions.  Use caution when rotating the cabinet to avoid damage to the drawers. Always ensure the drawers are fully closed before rotating the cabinet.  Never oil or grease oxygen equipment. Oils and grease oxidize readily, and in the presence of oxygen, will burn violently.  Do not move the warmer by pushing or pulling on the bed side s. This action may lead to the deterioration and breakage of the components which form a safety barrier around the infant.

PRECAUTIONS: for safety of patient under radiant  Do not place any accessories including warmer phototherapy lights directly over the bed surface. This may block radiant heat and lead to cooling of the infant.  Do not place items on top of the heater assembly. Items placed on top of the heater assembly can fall and injure the patient, prevent adequate ventilation of the heater assembly, and may pose a fire hazard.  Do not perform the Checkout Procedures (Mechanical and Control Unit) while a patient occupies the Warmer.

Cont……  Inspect all patient connected tubes or wires before

and after moving or tilting the bed. Tilting or moving the warmer bed up or down can pull on tubing or leads connected to the patient. This may disconnect tubes or leads, restrict gas or liquid flow, or move sensors out of position.  Prolonged exposure to the light emitted by the observation lamp in this unit may harm the unprotected eyes of the infant. For safety, cover the infant’s eyes.  When using intravenous tubing systems for delivery of blood components to patients occupying a warmer, shield any tubing with aluminum foil.

Cont….  When using a radiant warmer, change

the patient’s diapers frequently. Radiant energy causes more rapid urine evaporation, and may lead to inaccurate urine diagnostic test/analysis and inaccurate weight measurements.  Ensure that the bedside s are locked in position when a patient occupies the bed.  Do not leave the patient unattended when the side s are lowered.

PRECAUTIONS: for safety of yourself while using  Do not touch the protective grill under the radiant warmer: radiant heater or the top of the heater assembly. These surfaces may be hot and a burn could result.  Disconnect power to the Warmer and allow the heater rod to cool before cleaning to avoid the possibility of a burn.  Disconnect the Warmer power cord and allow the unit to cool before replacing the alarm or observation lights.

CARE OF BABY :  Vital signs  I/v fluids  Skin care  Weight monitoring  Breast feeding & KMC

NURSING ASSESSMENT:  AT RISK GROUPS:  Neonates, especially if premature or

small for gestational age.  Burns patients  Trauma patients  Post operative patients

HYPOTHERMIA: may result in MILD ( 32 – 36 °C )  Constant shivering  Tiredness  low energy  Cold or pale skin  Tachypnea  feed intolerance

CONT… MODERATE ( 28 – 32 ° C )  Drowsiness  slow, shallow breathing  shrill cry  loss of coordination

CONT… SEVERE ( < 28° C)  Unconsciousness  shallow breathing/ apnea  weak, irregular pulse  dilated pupils

HYPERTHERMIA: may result in  Vasodilatation  Increased metabolic rate  Increased fluid loss  Poor feeding  Nausea and vomiting  Headaches  Decreased blood pressure  Dizziness

HEAT STROKE : may result in  Confusion  Tachycardia  Tachypnoea  Decreased blood pressure  Seizures

PARTS OF RADIANT WARMER:  Parts of open care system  Bassinet For placing the neonate  Quartz rod Provides radiant heat  Skin probe When attached to the

baby’s skin, displays skin temperature  Control Has a collection of display and control features/knobs

PARTS CONT…  Heater output display Indicates how much is the    



heater output. Heater output control knobs For increasing or decreasing the heater output manually . Temperature selection - Select either set temperature or skin temperature. Temperature selection knobs - Select a desired set temperature. Temperature display -Display temperature as selected, either of the baby’s skin (via skin probe) or the set temperature. Mode selector - Selects manual or servo mode

STEPS FOR USE OF RADIANT WARMER  1. Connect the unit to the mains.

Switch it on. 2. Select manual mode.  3. Select heater output to 100% for sometime to allow quick prewarming of the bassinet covered with linen.  4. Select servo mode.  5. Select the desired set temperature of baby as 36.5°C..

STEPS CONT…  6. Place the baby on the bassinet.  7. Connect skin probe to the baby’s

abdomen with sticking tape.  8. If you want the manual mode to be used, select the desired heater output.  9. In the manual mode, record baby’s axillary temperature at 30 minutes and then 2 hourly.  10. Respond to alarm immediately. Identify the fault and rectify it

APPLICATION OF SKIN PROBE: Do’s 1. Prepare the skin using an alcohol/spirit swab to ensure good adhesion to the skin. 2. Apply probe over the right hypochondrium area in the supine position. 3. Apply probe to the flank in the prone position. 4. Check sensor probe regularly so as to ensue that it is in place. Ensure that skin probe is free of with bed. 5. Cover probe with a reflective cover pad, if available (foil covered foam adhesive pad)..

CONT… Don ‘t : 1. Do not apply to bruised skin. 2. Do not apply clear plastic dressings over probe. 3. Do not use fingernails to remove skin surface probes. 4. Do not reuse disposable probes

DISINFECTION:  When the equipment is in use, all

approachable external surfaces should be cleaned daily with an antiseptic solution like 2 % bacillocid or gluteraldehyde. Spirit or other organic solvents must not be used to clean the glass side s or display . For disinfection of reusable probe, isopropyl alcohol swab should be used. Every seventh day, after shifting the baby to another cot, the used equipment should be cleaned thoroughly, first by light detergent solution and then by antiseptic solution. All detachable assemblies, are to be treated similarly.

CONCLUSION:  Radiant warmer are used to maintain the body

temperature of newborn infants. Radiant warmer result in decreased rate of mortality and morbidity of newborns but it also increase the insensible water loss as compare to incubators. Therefore , it may necessary to increase the calculated fluid requirement . This may appear to give the use of incubators an advantage over radiant warmers since the fluid requirement does not have to be altered, but the restrictions of access to the infant nursed inside an incubator is a major hindrance in present- day newborn care.

SUMMARIZATION:  To define the term Radiant warmer.  To explain the advantages and disadvantages of       

radiant warmer. To discuss the indications of radiant warmer. To describe the tip to use radiant warmer. To explain the precautions for baby under radiant warmer. To discuss the nursing assessment of baby under radiant warmer. To describe the parts of radiant warmer. To explain the steps to use radiant warmer. To explain the disinfection of radiant warmer.

BIBLIOGRAPHY:  Ghai .OP, “Essential pediatrics”, Edition 8 th ,   

 

Published by CBS (2014)Page no.175-176. Singh Meharban , “Care of the Newborn’’, Published by Sagar ,Page no. 21,265-267. SharmaRimple, “Essentials of Pediatric Nursing”, Published by Jaypee brothers, Page no. 167,207. Jacob anamma,R.Rekha, Tarachand SonaliJadhav, “Clinical nursing procedure;the art of nursing practice,”Edition 2nd , Published by jaypee (2010), Pg.no.629-630 en.m.wikipedia.org/wiki/Radiant-heating. www.pediatricon call.com/for doctor/medicalequipment.

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