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Unit IV - Neonatal Equipments

A Neonatal Intensive Care unit, usually shortened NICU and also called a newborn intensive
care unit, Intensive Care Nursery (ICN), and special care baby unit (SCBU) is a unit of a
hospital specializing in the care of ill or premature newborn infants. The NICU is distinct
from a special care nursery (SCN) in providing a high level of intensive care to premature
infants while the SCN provides specialized care for infants with less severe medical
problems. A NICU is typically directed by one or more neonatology’s and staffed by nurses,
nurse practitioners, Nursery Nurses, physician assistants, resident physicians, and respiratory
therapists. Many other ancillary services are necessary for a top-level NICU. Other
physicians, especially those with "organ-defined" specialties often assist in the care of these
infants.
Infant Incubator
“Infant incubator is a Bio Medical Device which provides Warmth, Humidity and Oxygen all in a
controlled environment as required by the New born “An infant incubator provides a controlled
environment for newborns needing special care, such as those born prematurely. In addition to
regulating oxygen, temperature, and humidity levels, incubators protect infants from pollutants and
infection. The infant neatly bundled up, lies on a small mattress supported on springs so delicate that
the whole frame gently oscillates with every movement, even the breathing of the child
Basic Principle:
 The infant incubator is normally in the form of a trolley with a small mattress on the top
covered by a rigid clear plastic cover.
 Incubator chamber provides a clean environment, and helps to protect the baby from noise,
dust, infection, and excess handling.
 A temperature sensor is taped to the baby's skin, and the incubator heater adjusts to maintain
the baby at a constant temperature or, the temperature is controlled by a thermostat in the
heated air stream
 Underneath the baby is an air-blown electric heating system and humidification system which
circulates heated humid air at a desired temperature and humidity through the incubator
chamber.
 Additional oxygen may also be introduced into the chamber.
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Application of Infant Incubators

 NICU

 SCN

 Post 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.

Reasons for incubation

• Are born before 36 weeks of gestation (the normal full-term gestation is 40 weeks).

• Have difficulties with their breathing that require support.

• Are born with problems that require surgical correction.

• Are at risk of feeding problems.

• Have a suspected infection.

• Just require close observation for a short while, sometimes for just a matter of hours.

• Have other medical conditions requiring treatment in hospital.

Use of infant incubator:

The Incubator is set up to deliver a suitable temperature. After a period of equilibrium to allow the
temperature to stabilize the baby can be placed on the mattress tray inside the incubator. This tray can
be moved/ tilted within specified levels to facilitate care of the baby.
Block Diagram:

Atmospheric air
Canopy heater blower
(Incubator)
sensors

230v AC
Control
unit
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Power
Supply

Differences

Transport Incubator NICU Incubator

Battery powered Mains operated

Air (Manual) Mode only Both Air & Patient mode of operation
Resuscitation apparatus attached not attached
Compactable in size Bigger

Disadvantages of Infant Incubator:

1) The disadvantage is that since the baby lies in a closed hood it is difficult to accesses the baby for
medical procedure or care.
2) Noise - Premature babies are fragile. One of their special needs is quiet environment. However, in
the neonatal intensive care unit (NICU), high noise levels and frequent handling leave the babies sleep
deprived and may disrupt their normal growth and development.

Patient Preparation
 Defer bathing until medically stable.
 For Infants still in their Incubators use only sponge baths followed by immediate drying
within their Incubator.
 Warm all surfaces – scales, stethoscopes, bedding, etc., before making contact with the infant
to prevent conductive loss.
 Run the Incubator till it reaches the desired temperature before you place the Infant inside it.
 For Infants in an incubator, always use a skin temperature probe as it is too easy to overheat
infants when using the manual mode as compared to the skin mode.
Safety

Do not leave any patient inside the Incubator unattended for a long time.
Humidifier compartment should be fixed even if it is not used.
Do not place the Infant Incubator in direct sunlight or other source of light as it might overheat
the infant.
If ambient temperature is higher than set value then Incubator will be ineffective.
When oxygen is administered always check the level using an independent oxygen monitor
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Infant Warming Devices

Baby Warmer is a form of warm therapy. Babies are not as adaptable as adults to temperature change.
A baby's body surface is about three times greater than an adult's, compared to the weight of his/her
body. Babies can lose heat rapidly, as much as four times more quickly than adults. Premature and
low birth weight babies usually have little body fat and may be too immature to regulate their own
temperature, even in a warm environment. Even full-term and healthy newborns may not be able to
maintain their body temperature if the environment is too cold.

Ways to keep babies warm:

There are several ways to keep babies warm, including the following:

• Immediate drying and warming after delivery

A baby's wet skin loses heat quickly by evaporation and can lose 2 to 3°F (Immediate drying and
warming can be done with warm blankets and skin-to-skin contact with the mother, or another source
of warmth such as a heat lamp or over-bed warmer.)

• Open bed with radiant warmer

An open bed with radiant warmer is open to the room air and has a radiant warmer above. A
temperature probe on the baby connects to the warmer to regulate the amount of warming. When the
baby is cool, the heat increases. Open beds are often used in the delivery room for rapid warming.
They are also used in the NICU for initial treatment and for sick babies who need constant attention
and care. Babies on radiant warmer beds are usually dressed only in a diaper.

Warming System can also be divided into

General Block Diagram

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Differences between Incubator & Warmer

Incubator Radiant warmer

• Closed care Open care

• Convection principle Radiation Principle
• Humidity Adjustment No Hy.Adjust
• Less disturbances External Disturbances more
• Oxygen control available No O2 control
• Battery powered Mains operated
• Air (Manual) Mode only Both Air & Patient mode of
operation
• Resuscitation apparatus attached Not attached
• Compactable in size Bigger

Modes of Operation
Incubator

 1.Air Mode – Air Temp will be taken as reference for the control.
 2.Skin Mode- Skin Temp taken as reference for control
Note: safety temp sensor present for auto cutoff at higher temp.

Radiant Warmer
 1.Manual mode- constant heater output as per setting
 2.Servo (skin) Mode
 Skin Temp taken as reference for control of heater output

PHOTOTHERAPY
Light is made of photons (the smallest unit in light). Photons travel at the speed of light & its energy
is related to frequency of the radiation. Shorter the wavelengths, greater the energy of the photons
which result in greater acceleration when that energy is transferred to the electrons to de discharged.
Therefore color is frequency within the visible spectrum of light, which composes a very small band
of the Electromagnetic Spectrum, from violet at 400nm (higher energy photon) through red at 780
nm (lower energy photon). Beyond violet in increasingly shorter wavelengths are Ultraviolet Light,
X-rays & Gamma radiations that contain tremendous amounts of energy. Infrared & radio waves are
longer wavelengths outside the red end, with very little energy.
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Lights used in Phototherapy:

 Red = Energies
 Orange = Spirit raising
 Yellow = Stimulates elimination of toxins.
 Green = Cooling, Relaxing. Reduces Inflammation.
 Blue = Peaceful effect
 Violet = Promotes awareness, consciousness. Improves mental ability.
 UV Spectrum = Penetrating effect. High energy to kill diseased areas.
 Infrared Spectrum = Heating ability

The phototherapy light shines the light onto the baby’s skin. The light must be the correct wavelength
(420–500nm Blue light ) & the correct intensity ( brightness). It is used to treat the condition
Hyperbilirubinemia Jaundice.

Effectiveness of the Phototherapy depends:

 Wavelength of the spectrum.
 Intensity of the Light.
 Duration of the therapy.
 Area of skin exposed to the light. More the area, more the effectiveness.

Halogen Spotlights: Initial type of phototherapy units. Seen less often nowadays. Here a white
halogen bulb is used. Delivers 20- 25 µW/cm2/nm. As white light contains blue range spectrum, this is
used to treat the neonate though the treatment time will be more

Fluorescent Lights: Most common type of unit seen nowadays in the NICU. Blue or white tube-
lights are available. Effective types are the blue tube-lights with the spectrum o/p at 450-470nm. Used
alone or in combination with white light. Disadvantage is that they degenerate with time. So any tube-
light delivering less than 8 µW/cm2/nm should be replaced.

Fiber-optic Phototherapy: Most recent & advanced type. A fiber-optic cable containing about
2000-2400 individual acrylic fibers deliver the light from a tungsten halogen lamp to a fiber-optic pad
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or blanket on which the infant lies. Easy to use and as effective as the conventional phototherapy.
Though expensive, the treatment time is less; treatment is precise & controlled on the affected area.

Patient Preparation:

 Keep the infant clean & at a distance of 30- 45cms from the light.

 Try to keep the infant naked, as it will increase the treatment area.

 Clean infant only with water. Do not apply oils and creams in order to prevent skin rashes.

 Eye shielding & genitalia covering should be done to reduce the dangers due to prolonged illumination.

To prevent burns, place the infant on top of saline water bags

Safety Precautions to be followed:

 Do not place the phototherapy in direct sunlight or any other source of light as it may lead to
over-heating.
 The air circulation & ventilation ports should not be obstructed to prevent over- heating.
 If phototherapy is used in conjunction with Infant Incubator, there will be risk of elevated
temperature. Therefore check the temperature periodically.
 If phototherapy is used in conjunction with Infant

Fetal Monitoring Instruments

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“Fetal Monitoring is defined as monitoring the baby’s heart rate for indicators of stress,
usually during labor and birth using Ultrasound and Electrocardiography”
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• The fetal monitor, also known as a Cardio Toco Graph (CTG Machine)
• The machine is particularly vital for premature babies or those who have shown
irregular heart patterns, as well as mothers with high blood pressure, diabetes or heart
condition

Purpose
 To monitor fetal well being
 Provides graphical , Numeric and audible information
 Graphical Representation
 Fetal Heart Rate (FHR)
 Uterus Contraction
 Fetal Activity

Fetal Monitoring
• Antepartum (Before child birth)
• Intrapartum ( During child birth)

Antepartum Monitor
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• Antepartum Monitors used to monitor fetus development, Movement and FHR pattern
• Only External monitoring capabilities such as Ultrasound and external UA
• Number of fetal and uterine monitors of varying capabilities available for the
antepartum (pre-labor) measurement of fetal activity.
• Monitors uterine and fetal activity
• Print out a graph of the activity

Intrapartum Monitor
 Intrapartum Monitors are used in labour room with additional features like
 Internal fetal ECG (Spiral electrode rupturing in to fetus scalp)
 Twin fetal monitor with Toco & U/S
 Fetal SpO2
 NIBP

Application
• For high-risk pregnant women
• Uterine activity and fetal heart rate is monitored externally using a ultrasound and
toco transducer.

Maintenance
• CTG machine should be clean and free of dust and dirt. Use appropriate cleaning solution to
clean the exterior part of machine
• Diluted cleaning solution must be used
General Care
• Remove any adhesive used on transducers, cables and connectors.
• Sponge electrodes, transducers, cables with warm water and soap then dry.
• Do not submerge electrodes/ transducers for prolonged period.
• Clean the recorder regularly with 70%of Isopropyl solution.
• Check paper sensing mechanism for dust free.
• Check each cable for corrosion, cracks and deterioration

DOPPLER EFFECT
 Apparent change in received frequency due to relative motion between a sound source and
sound receiver is called as Doppler Effect.

 Source moving TOWARD receiver = HIGHER frequency, higher the intensity

Source moving AWAY from receiver = LOWER frequency, lower the intensity
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DOPPLER SIGNAL PROCESSING

 Original signal added to the signal reflected from the moving surface, giving “beats”,
then rectified and then passed through a low pass filter. Mat lab simulation:
originalfrequency transmittedfreq+reflectedfreq
1 2

0.5 1

0 0

-0.5 -1

-1 -2
0 500 1000 0 500 1000
rectified filtered
4 3

3
2
2
1
1

0 0
0 500 1000 0 1000 2000

Unit V - INFUSION DEVICES

“Therapeutics devices which are used to administer therapeutics like Analgesics, anti-
microbial substances, blood products, chemotherapy, and nutrients are called Infusion
Devices.”
The most common application of infusion devices is to maintain appropriate fluid levels in
the patient. Fluid therapy is used in the management of patients during and after surgery, for
treatment of burns, and in treating dehydration in pediatric patients usually at a rate
determined by the patient’s fluid balance. Infusion systems are also commonly used to
intravenously supply nutrients to support life and to maintain growth and development in
pediatric patients. Continuous drug infusion is also used for such widely different
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applications as delivering anesthetic during surgery, chemotherapy for cancer, ox toxic agents
for inducing labour and anti-arrhythmic drugs for patients in the coronary care units.

Generally Drug Infusion Systems are of two types:

 In the Open Loop system, the art of delivery is set by the nurse on the basis of past
experience, mathematical computation, or by trial & error. The fluid is delivered at the
set rate until the setting is changed. Examples are the Infusion systems which are
commonly used to intravenously supply nutrients to support life and to maintain growth
and development in pediatric patients. Because no feedback variable is available to
provide control signals, these systems are operated open-loop.

 In Closed Loop system, the effects of drugs are monitored by appropriate transducers, &
the desired delivery rate is computed & set automatically. The pump operates in such a
way as to keep the physiological variable as close as possible to a desired value . An
example of a closed loop system is the use of controlled infusion of the drug sodium
nitro-pruside for the control of blood pressure. A pressure transducer measures the
blood pressure and this information is sent to the control algorithm which determines
the rate at which the drug is infused into the patient . This is obviously a more
effective method of controlling the blood pressure as compared to the manual control
using the same chemical agent.
Components of Drug Infusion System:
The drug infusion systems basically consist of two components:
 A mechanism that delivers the drug.
 Means of controlling the rate of delivery.

Types of Infusion Delivery:

The User-Interface of pumps usually requests details on the type of infusion from the technician or
nurse that sets them up:

• Continuous infusion usually consists of small pulses of infusion, usually between 500
nanoliters and 10000 micro liters, depending on the pump's design, with the rate of these
pulses depending on the programmed infusion speed.
• Intermittent infusion has a "high" infusion rate, alternating with a low programmable
infusion rate to keep the cannula open. The timings are programmable. This mode is often
used to administer antibiotics, or other drugs that can irritate a blood vessel.
• Patient-controlled is infusion on-demand, usually with a preprogrammed ceiling to avoid
intoxication. The rate is controlled by a pressure pad or button that can be activated by the
patient. It is the method of choice for patient-controlled analgesia (PCA), in which repeated
small doses of opioid analgesics are delivered, with the device coded to stop administration
before a dose that may cause hazardous respiratory depression is reached.
• Total parenteral nutrition usually requires an infusion curve similar to normal mealtimes.
• Some pumps offer modes in which the amounts can be scaled or controlled based on the time
of day. This allows for circadian cycles which may be required for certain types of
medication.

Types of Infusion Devices:

 Large Volume Infusion Pump - Pumps nutrient solutions large enough to feed a patient
 Small Volume Infusion Pump - Pumps infuse hormones, such as insulin, or other
medicines, such as opiates.
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Infusion Pumps
“Infusion pump delivers measured large amounts of fluids or medications into the bloodstream over a
longer period of time.”

Different Infusion Pumps use different techniques for the pumping action. One method is the
peristaltic action where fingers or rollers on a drum squeeze the fluid tubing in a controlled manner to
force the fluid down the tubing.

A second method is obtained by using a cassette (or chamber) that fills with fluid & is then emptied
out by the pumping mechanism in a controlled manner.

The Infusion Pump uses a combination of these two techniques described as quasi-peristaltic. A
three-chambered cassette is employed with the pumping mechanism operating on these three
chambers in turn. The user can set the rate of fluid delivery in milliliters per hour (ml/hr) together
with the volume of fluid that should be delivered in milliliters (ml).

Block Diagram of Infusion Pump:

Control
Power Supply Unit Display Unit
Unit/processing
unit

Alarm Unit

Detector Unit
Motor / Delivering
System

Peristaltic Pumps:
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(a) Principle of peristaltic pump using rotor and flexible tubing. (b) Rotor on eccentric shaft to
squeeze plastic tube. (c) Pump with cam-operated fingers on flexible tubing.

Drop rate counter type infusion pump

Drops per minute from

thumbwheels

Start
switch

LSI
device
Motor drive
Zero rate Alarm latch and motor
detector

Drop and
71.68 K Hz
sensor
Low battery Alarm oscillator
detector
detector
To nurse
call
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Implantable Infusion Pump:

Programmed Controlled Insulin-Dosing Device

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General Cautions:

• Do not use hard instruments for cleaning.

• Do not spray liquids or foam directly on the pump.

• Do not submerge the pump into liquids of any kind.

• Do not clean, disinfect, or sterilize any part of the pump by autoclaving or with the use of
ethylene oxide gas. Doing so may damage the pump and void the warranty. Only external parts of
the pump should be disinfected.

• Do not use the following chemicals on the pump, as they will damage the front panel:
acetaldehyde, acetone, ammonia, benzene, hydroxytoluene, methylene chloride, or ozone.

• Keep food and drinks away from the area around the pump.

General Safety:

The range of safety features varies widely with the age and make of the pump.

• Certified to have no single point of failure. That is, no single cause of failure should cause the pump
to silently fail to operate correctly. It should at least stop pumping and make at least an audible error
indication. This is a minimum requirement on all human-rated infusion pumps of whatever age. It is
not required for veterinary infusion pumps.

• Batteries, so the pump can operate if the power fails or is unplugged.

• Anti-free-flow devices prevent blood from draining from the patient, or infuscate from freely
entering the patient, when the infusion pump is being set-up.

• A "down pressure" sensor will detect when the patient's vein is blocked, or the line to the patient is
linked. This may be configurable for high (subcutaneous and epidural) or low (venous) applications.

Syringe Pump
A syringe driver or syringe pump is a small infusion pump (some include infuse and withdraw
capability), used to gradually administer small amounts of fluid (with or without medication) to a
patient or for use in chemical and biomedical research. It is a positive displacement motor driven
pump and is designed specially for precisely controlled rate to deliver the fluid to patient.
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(a) Conventional method (b) Computer assisted therapy (c) Closed loop control

Block Diagram
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General Features:

• Highly accurate in volume delivery and constant flow for small volumes

• Appropriate for neonatal, infants and critical care application

• It is useful where the small amount of drug to be delivered over an extended period.

• Drug dose calculation function

• Occlusion : Most of syringe pumps detects the excessive back pressure when the motor drive
stalls and some syringe pump have slipping clutch fitted. The maximum back pressure is
inversely proportional to internal diameter of syringe plunger.

• Dispensing accuracy of ± 1% .

General Applications:

• For delivering anesthetic during surgery , chemotherapy for cancer , ox toxic agents for
inducing labour and anti-arrhythmic drugs for patients in the coronary care units.

• The largest group of potential users of infusion pumps are ambulatory diabetics.
Conventional therapy , consisting of one or two daily injections of insulin , allows
substantial fluctuations in blood glucose levels. Continuous insulin therapy has been shown
to improve metabolic control.
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Types of Syringe Pumps

Patient Controlled Analgesia – (PCA) -
• A stepper motor drives the plunger of syringe or with peristaltic pump at precise rate with
additional required doses
• The patient controlled analgesia devices varies according to dose delivery
• Programming Options for PCA pump
Disadvantages of PCA
• Narcotics security
• Requires additional (special) IV tubing (sidearm connection)
• Patients must be assessed for suitability and instructed on PCA use.
• Nurses must be trained on safe PCA use.
• Batteries (and other components) in PCA machines may fail.
• Requires patient to have an IV (generally)
• PCA pumps must be programmed

Anesthesia Pumps –
• It must be used only for anesthesia purpose
• It must be operated by qualified personnel
• This type of syringe pumps are designed especially for anesthesia or sedation purpose.
• It has all functions which can be monitored.- the rate, amount of fluid can be accessed during
infusion.
• These pumps have high rate bolus capacity and higher flow rate range.
Insulin Pumps
• Contains a reservoir filled with insulin, like a syringe
• Utilizes a computer chip that allows the user to control exactly how much insulin is delivered
• Worn 24 hours per day
• Delivers one type of insulin
• Insulin is infused through a set that is changed by the patient every 2-3 days
• Delivery of insulin to the patient occurs in 2 ways: