24 July 2014Armando Darino Ngojo1 HOSPITAL SUPPORT SERVICES INFANT INCUBATOR TRAINING By: Armando...

24 July 2014 Armando Darino Ngojo 1

HOSPITAL SUPPORT SERVICES

INFANT INCUBATOR TRAINING

By: Armando Darino Ngojo

ContentsContentsAims & ObjectivesAims & ObjectivesIntroductionIntroductionHistoryHistoryAnatomy and PhysiologyAnatomy and PhysiologyPrinciplePrincipleApplicationApplicationOperationOperationMaintenance & CleaningMaintenance & CleaningSafety PrecautionsSafety PrecautionsTroubleshootingTroubleshooting


AimsTo provide basic understanding on the use of Infant

Incubator

To perform and understand the basic user’s troubleshooting steps


Objectives - as a result of completing this module, the user should be able to:

describe what an Infant Incubator is including its applications

Perform basic user maintenance

perform and identify basic problems, errors and basic troubleshooting solutions.


Introduction: What is infant incubator?An infant incubator provides a closed, controlled

environment that warms an infant by circulating heated air over the skin. The heat is then absorbed into the body by tissue conduction and blood convection.

Ideally, both the skin and core temperatures should be maintained with only minor variations.


Basic ConstructionIncubators are enclosed bassinets that are used

to keep environmental conditions ideal for newborns.

FunctionsIncubators are available in all neonatal

intensive care units (NICUs). The incubator controls temperature, humidity and oxygenation of the air. It can increase oxygenation by nasal tubes, or by mechanical control of oxygen levels


ProtectionBy creating a closed and controlled environment, the

incubator protects the newborn from infection, air drafts and handling by nurses and others who may carry bacteria or viruses on their bodies or in their clothing.

NourishmentThe incubator also allows feeding of the newborn through

intravenous tubes, as well as the intravenous administration of any necessary medication

TransportIncubators can also be constructed as carriers, to be used

when premature or ill newborns are moved from one facility to another. These transport incubators have self-enclosed feeding and monitoring equipment and a portable oxygen supply.


History1891 First modern Incubator invented

by Dr.Alexandre Lyon

1898 First American Incubator Hospital set up at the Trans Mississippi Exposition in Omaha , Nebraska.

1901 The World famous Pan American Exposition was held in Buffalo, New York. For 10 cent admission fee people can go in and see


History1907 Pierre Constant Budin released

study of the Influence of Body temperature on Infant Mortality.

1932 Julius Hess in his patents for incubators proposed a mechanism for the addition of supplemental oxygen in the Incubator.

1933 Blackfan and Yaglaw released report on the Improved survival for New Born infants nurtured in Humidity enriched environment.



Early infant incubators

1952 Japan first modern infant incubator

Atom Infant Incubator N-52h

1955 Atom Infant Incubator V-55


The modern incubators

1975 Atom Infant Incubator Model V-75



1998 Atom Infant Incubator V-2100G


ATOM INFANT INCUBATOR V-2200


ATOM V-2100ATOM V-2100G



Anatomy and Physiology

SKIN FUNCTIONSkin Skin is often considered

the largest organ system of the human body.

The average adult male has 18 square feet of skin weighing over 6 pounds.

Skin is comprised of three layers, the Epidermis, Dermis and Subcutaneous tissue.


EpidermisEpidermisOuter Layer of the Skin Outer Layer of the Skin

Contains up to 5 layers Contains up to 5 layers

Thinnest in eyelids and thickest in solesThinnest in eyelids and thickest in soles

Continuously regenerates itselfContinuously regenerates itself


DermisDermisMiddle Layer of the SkinMiddle Layer of the Skin

They contain blood vessels, hair They contain blood vessels, hair follicles , oil and gland and nerve follicles , oil and gland and nerve endingsendings

They transmit sensation of pain, itch They transmit sensation of pain, itch and and

temperature temperature


Subcutaneous TissueSubcutaneous TissueMade up of fat and connective Made up of fat and connective tissuetissue

Houses larger blood vessels and Houses larger blood vessels and nervesnerves

Regulates body temperatureRegulates body temperature24 July 2014 Armando Darino Ngojo 22

Skin - FunctionProvides a physical barrier to the

outside environment.

Assists in the development of the immune system

Conserves body fluid by preventing evaporative loss.

Maintains body temperature.


Skin - FunctionExcretes water and oils.

Produces vitamin D in the presence of sunlight.

Provides sensations of temperature and touch.

Stores water, fat, and vitamin D.


Principle: Important Parameters

Temperature

Humidity


Body TemperatureNormal core body temperature can range

between 36.1°C (97°F) to 37.2°C (99°F).

Cells, tissues and organs operate efficiently only within this narrow temperature limits.

If the temperature rises 2°F above the normal of 98.6°F (37 °C), we become ill (38.11 °C). If it rises 7°F, we become critically ill (40.89 °C).

If our temperature decreases 2°F, we feel cold (35.89 °C). A 7°F decrease puts our life in jeopardy (33.11 °C)


Conversion factors for temperature

oF = (oC)(9/5) + 32 (ex: 35°C to °F) = (35°C)(9/5) + 32 = 95 °F

oC = (oF - 32)(5/9) (ex: 97°F to °C) = (97°F-32)(5/9) = 36.11 °C


Quick Facts: temperatureThe NHS (England) says that a normal

temperature is around 37C (98.6F), although it depends on:

The personTheir ageWhat they've been doingThe time of dayWhich part of the body you take the

temperature from24 July 2014 Armando Darino Ngojo 28

Normal body temperature also depends on where the temperature reading is taken. For instance, a reading from the armpit will be about 0.5°C lower than the body's core temperature.

Research from Winthrop University in the US published in 2006 found that older people have lower temperatures and that, even when ill, their bodies may never reach temperatures that would be regarded as fever.


Cont…. Quick facts

Body TemperatureHypothermia- means Low body temperature

Hyperthermia- means High body temperature


HypothermiaIt occurs when core body temperature

drops To 95°F or lower

Happens when heat loss exceeds heat gain

New born with temperature below 36.0-36.4°C (96.8-97.5°F) is in moderate Hypothermia


HypothermiaRemedy

Skin-to-skin contact with the mother

Use a heated water-filled mattress

Use radiant heater

Use Incubator


HyperthermiaHyperthermia can be defined as a core

temperature greater than 98.6° F (37.0° C)

In adults it may lead to Fever, Heat syndromes like collapse, cramps, stroke etc.


HyperthermiaIn neonates hyperthermia rarely does occur

but for an external source like:

Overzealous re-warming Poorly serviced equipment Misuse of warming lamps Incubator too close to a sunny window Temperature probe not in good contact with the skin


HyperthermiaHyperthermia in Neonates can lead to Increased oxygen requirements Apnea Dehydration Metabolic acidosis Heat stroke, brain damage, shock and even death.


ThermoregulationThermo regulation is the ability of the body to balance the heat produced in the body with the heat lost by the body thereby maintaining the body temperature in the normal range.


ThermoregulationThe temperature of the body is

regulated by hypothalamus

Sweating begins almost precisely at a skin temperature of 37°C

If the skin temperature drops below 37°C a variety of responses are initiated to conserve the heat in the body and to increase heat production


HypothalamusThe hypothalamus links the nervous system and is located below the thalamus, just above the brain stem


Neonatal RiskHave limited thermoregulatory ability

Transition from the Poikilothermic to Homeothermic state is delayed.

Rely on external heat to maintain their core temperature.

Thermal instability can last for several days or even weeks!


Poikilothermy Poikilothermy - This refers to

creatures whose internal temperatures vary, often matching the ambient temperature of the immediate environment. (In medicine, loss of normal thermoregulation in humans is referred to as poikilothermia.)


Homeothermy Homeothermy is

thermoregulation that maintains a stable internal body temperature regardless of external influence. This temperature is often higher than the immediate environment. The opposite is poikilothermy.


Thermoregulation—Humidity Maintaining fluid and heat balance is of vital

importance to the newborn infant. At birth, the infant is exposed to a cold and dry environment, putting preterm neonates, in particular, at risk of dehydration and hypothermia.

Preterm neonates have a high rate of water and heat loss mainly because of their immature skin. The care environment influences the magnitude of water and heat exchange, and needs to be individually tailored on the basis of the infant’s:

Clinical statusMaturity at birthPostnatal age


Causes of heat loss:At birth, an infant’s core and skin temperatures

tend to drop significantly because of heat loss from:

Conduction Convection radiationwater evaporation


Heat Loss

Conduction

Heat loss to cooler solid objects which are in direct physical contact.

24 July 2014 44Armando Darino Ngojo

Heat Loss

Convection

Heat loss to cooler

surrounding air.


Heat LossRadiation

Heat loss to cooler solid objects which are not in direct physical contact.


Heat Loss

Evaporation

Heat loss that happens when water evaporates from skin and respiratory tracts


Incubators are used in hospital neonatal units to care for newborn babies who may be premature or suffering from illness, breathing difficulties or other birth complications. The incubator has evolved into a complex machine capable of many different functions essential to the recovery of newborns in distress.


Application

Applicable departments:NICUSCNPost natal care wards Transport Incubators can be found in Labour

ward to transport the new born to Post natal wards or NICU.

Hospitals that don’t have a dedicated NICU will have a transport incubator so that critical new born can be shifted via ambulance or helicopters to the nearest hospital having an NICU facility.


Principles of operation

The neonate lies on a mattress in the infant compartment, which is enclosed by a clear plastic hood. Most incubators have hand access ports with doors that permit the infant to be handled while limiting the introduction of cool room air.

The clinician can raise or remove the plastic hood or open a panel to gain greater access to the infant. Some units feature an air curtain that causes warm air to sweep past the opening.


The neonate lies on a mattress in the infant compartment, which is enclosed by a clear plastic hood.


Cont… Principles of operation

Most incubators warm the infant by a forced or natural flow of heated air. At least one unit supplements air convection by actively warming the incubator walls to reduce radiant heat loss. Another unit uses a mattress of warm water, rather than a convective airflow, to warm the infant.

Heating and humidification systems are located beneath the infant compartment.

A fan or natural flow circulates air past the heater and the temperature measuring device, over a water reservoir used to humidify the air (if desired), and up into the infant compartment.



Most incubators are equipped with proportional heating controls that provide electrical power to the heating coil in response to the difference between the actual temperature and the desired temperature.

Most units have two modes of operation: air-temperature control and skin-temperature control. With the air-temperature (manual) control, the operator sets the temperature of the air in the incubator; changes in infant body temperature are usually measured periodically with a thermometer, and adjustments in air temperature are made accordingly.



In the skin temperature control mode, also called the servo (automatic) mode, a sensor is taped to the infant’s skin, and the heater responds to changes in the sensor to keep the skin temperature at the preset level.

Most units allow the user to vary relative humidity from either a built-in reservoir or an outside source (e.g., a humidifier that attaches to one of the inlet ports). Although increasing the relative humidity in an incubator can reduce evaporative heat loss, many clinicians avoid supplemental humidification because of concern that infectious organisms may proliferate in the water reservoir.

Many incubators have one or two oxygen inlet ports and can be equipped with optional oxygen controllers. These incubators can also provide support and protection for oxygen cylinders when oxygen must be delivered to the infant in the incubator.



Pre-warmed to a temperature appropriate to the infant’s age, size and condition.

Use in Air mode and must always be switched on with the motor running if in use for a baby.

Check and record the incubator temperature hourly.Position away from draughts or direct sunlight.Do not routinely use on the humidity function while in use for

babies in Starship hospital– this function is generally required for premature infants only.

Note: Ensure alarms self-test has been completed (automatic). If the unit fails the self test, the alarm sounds, and one or more messages are displayed in the trend/alarm window.


- Maintain axilla temperature between 36.5°C and 37.2°C - Access baby by using the portholes, limit opening of large door as this interferes with air temperature. - Ensure baby is nursed naked apart from a nappy. - Position baby utilizing rolled towels/cloth nappies to provide boundaries that support ‘nesting’ and flexion of limbs but keeping face clear


- Ensure they are familiar with how to access baby as it is optimal for parents to continue to touch and provide comfort.- Maintain a quiet environment - There is no tapping on the canopy.- No equipment is placed on top of the canopy.- Careful opening and closing of doors.


-Default incubator temperature in NICU is 35 °C -Adjust the incubator temperature by no more or less than 0.5 of a degree at a time.

- Re-check the temperature within half an hour of making any adjustment.


- Axilla temperature is taken on admission into the incubator and rechecked in the first hour.

- Temperature is documented 4-6 hourly as condition dictates.


- It is utilized for incubator care of preterm babies only – NOT required for babies >32weeks.

Remember: - A stressed baby is less able to maintain thermoneutrality- Surgical babies are prone to stress both before, during and after surgery.

Infant IncubatorAdvantages It provides the closest environment to that

of the mother’s uterus Temperature at a uniform airflow and the

Humidity can be controlled to the desired level

It protects the baby from all the disturbances and infection in the NICU


Infant IncubatorDisadvantages The disadvantage is

that since the baby lies in a closed hood it is difficult to access the baby for medical procedure or care.



-Only properly trained personnel should use the incubator as directed by an appropriately attending qualified physician aware of currently known hazards. Incubator misuse may result in harm to an infant and user.

-Do not use the incubator if it fails to function properly. Refer service to qualified personnel

- If the access panel is left open, the hood temperature may rise above normal preset level. Therefore do not leave the access panel longer than essential. For infant safety, do not leave the infant unattended when the access panel is open.


Electrical precautions:

-Shock hazard: - To ensure grounding reliability, plug the AC power cord onlyInto a properly grounded three-wire hospital-grade outlet.

-Do not use extension cords.-An electric shock hazard exists within the controller when thecover is removed. Only qualified personnel should service it.

-Make sure the building power source is compatible with the Electrical specifications of the unit.


Warning:-Do not use in the presence of flammable anesthetics. Personal injury or equipment damage could occur

-Small quantities of flammable agents such as ethyls and alcohol, left in the incubator may cause fire line connection with oxygen


-Improper use of supplemental oxygen may be associated with the serious side effects including blindness, brain damage, and death. The method, the concentration and the duration of oxygen administration should be prescribed by the attending physician

-As oxygen use increases the danger of fire, do not place auxiliary equipment that produces sparks in an incubator. Personal injury or equipment damage could occur

Reported Problem1. Deaths and injuries to neonates in incubators have

been linked to thermostat failure that caused incubator overheating and infant hyperthermia.

2. If a surface temperature sensor does not make adequate thermal contact with the infant’s skin, incorrect low temperature readings may result and the incubator could overheat the infant in response to the false readings. However, using a strongly adherent tape to fasten the sensor can produce skin irritation or damage. Periodic checks of sensor placement are strongly recommended


Reported Problem

3. Inadequate control over the amount of oxygen delivered in an incubator can cause hyperoxia or hypoxia (excessive or inadequate oxygen respectively, in body tissues). Excessively high concentration of oxygen can contribute to retrolental fibroplasia (I.e. formation of fibrous tissue behind the lens leading to detachment of retina and arrest growth of the eye) in premature infants.


Reported Problem4. Incubators can produce excessive internal

noise levels that might adversely affect infant hearing. Slamming a porthole, using a nebulizer, activating an alarm and tapping on the incubator hood further increase The noise level to the infant: levels as high as 90 to 100dBs have been reported. The 1991 Association for Advancement of Medical Instrumentation (AAMI) standard for incubator specifies that the max. noise level inside the infant compartment should not exceed 60dBs during normal use.


Basic Trouble ShootingSymptom - Over temperature alarm falsely activated

when incubator air temperature below 38*C is indicated.

Possible Cause : 1. Faulty setting of over temperature alarm 2. Either thermistor or thermostat sensor not properly

positioned. 3. Dirty micro-air filter 4. Clogged air intake pipe. 5. Motor not working. 6. Over temperature alarm thermostat sensor faulty.


Basic Trouble Shooting

Symptom - Safety device operating below 38*C or above 39*C.(Device is normally set to operate between 38 and 39*C)

Possible Cause:

1. Thermostat (for over temperature control) not properly set.


Basic Trouble Shooting Symptom - Sharp temperature drop inside

incubator

Possible Cause

1. Motor not running.2. Broken heater or its wiring.


Basic Trouble ShootingSymptom - Heater not heating up

Possible Cause :

1. Defective incubator temperature thermistor sensor.2. Heater element faulty.3. Defective circuit board.


Questions!!!


THANK YOU

9524 July 2014 Armando Darino Ngojo

24 July 2014Armando Darino Ngojo1 HOSPITAL SUPPORT SERVICES INFANT INCUBATOR TRAINING By: Armando...

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