Guidelines on the care of a baby under Radiant Warmer
Checklist for hourly monitoring of ‘the baby in an Incubator / under the Radiant Warmer) Ensure that the temperature of the room used for the therapy is 22 oC.
Clean the mattress and platform, and cover the mattress with a clean linen sheet.
Prior to receiving the baby in the radiant warmer, turn the unit on at least 15 minutes before in order to pre-warm the linen and mattress so that the baby does not lie on a cold surface initially.
After receiving the baby in the radiant warmer connect the skin probe as below:
a) If the baby is in supine position place the skin probe on the right hypochondriac region
b) When the baby is in the prone position, place the probe on the loin area.
Note: Skin injury can be prevented as follows:
How to apply Warmer to patient
Place a gentle transparent adhesive dressing to fix the probe and assess the site frequently.
When changing the transparent dressing, support the skin underneath with one hand and gently peeling away the dressing from the skin with the other hand.
Adhesive dressing removal can be facilitated using- baby oil or petroleum jelly.
Do not apply skin probe over bruised skin & also ensure that the area where the probe applied.
If the temperature is lower than desired, keep warmer in manual mode and continue manual mode till the temperature reaches 36.5 oC under continuous supervision.
When using manual mode (under continuous supervision) the following adjustments could be done: Under Continuous Supervision -adjust the heater output to:
High (75-100% output) : If baby temperature is below 36 oC
Medium (25-75% output): If baby temperature is between 36 oC -36.5 oC
Low (25%): If the baby temperature is between 36.5 oC -37.5 oC or switch on the servo mode/skin mode with a set temperature of 36.5 oC.
Note: The ideal body temperature of the baby between 36.5 oC to 37.5 oC.
While using skin mode (servo mode) check the baby’s temperature intermittently (once every two to three hours) using an alternate method to correlate with the displayed skin temperature
Eg. Axillary temperature (manually) or Peripheral skin temperature (on the monitor).
If equipment giving an alarm, respond, and rectify it immediately.
Check skin probe hourly – if it loosened, detached from the skin, or disconnected from the monitor.
If the skin probe is detached accidentally, it increases heater output resulting in the baby getting heated up in a short time leading to an adverse event, if not noticed immediately. So always make sure the skin probe attached to the baby’s skin during the process of thermoregulation.
Note: Record the heater output in each shift (once every 6 hours). Any sudden increase in heater output (even with the probe secured well on the skin and working appropriately) is an early indication of the ill health of the baby and should be immediately notified to the doctor.
Document the details of monitoring and care as and where appropriate.
General points to note:
Use cling wrap across the panels to prevent insensible water loss, whenever needed.
Ensure that the baby’s head covered with a cap and feet secured in socks and keep the diaper on. Keep the baby dry, change soiled or wet napkins or diapers and baby sheets as needed.
Turn the baby frequently while under the warmer, if possible.
General Instructions for different modes:
- Servo Mode: The set temperature at 36.5 C, the heater output will adjust automatically to keep the baby at the set temperature.
If the baby’s temperature is below the set temperature, the heater output will increase, if the baby is at a set temperature or higher the heater output will become zero.
Look for probe displacement when the baby is in servo mode. Check for and ensure proper probe placement every hour.
For low birth weight or sick neonate adjust heater output depending on baby’s temperature (servo mode).
Manual Mode:
Use this mode only for pre-warming, during resuscitation, initial and need-based stabilization.
Once connected to the mains, the heater output regulated by a knob on the front panel. The output displayed as % or bars or bulbs.
Temperature regulation:
Use maximum (100% output) for rapid warming of bassinet (the area to place the baby) of the warmer. Reduce output to 25-75% after 10 minutes depending on the ambient temperature.
If left on with heater output >80%, the alarm is activated within 15 or 20 minutes, and thereafter the heater output goes to 40%.
Silenced the heater on maximum for another 15 to 20 minutes as per the manufacturer’s recommendation.
Never use full (100%) heater output unsupervised.
For disinfection of the warmer:
When the warmer in use, clean all internal and external surfaces every shift with soap and water. cleaned with the disinfectant (as per the institutional policy), thoroughly dried, and aired.