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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 neonates
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 REMEMBER:
Warmer should be used with servo control

only. Manual control is not recommended.


Ensure O2 Air is delivered at same
temperature normally 36 - 36.5C .
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 panels. 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 infants 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 patients 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 panels are
locked in position when a patient
occupies the bed.
Do not leave the patient unattended
when the side panels 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

babys skin, displays skin


temperature
Control panel 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 panel - Select either set
temperature or skin temperature.
Temperature selection knobs - Select a desired
set temperature.
Temperature display -Display temperature as
selected, either of the babys 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 36.5C..

STEPS CONT
6. Place the baby on the bassinet.
7. Connect skin probe to the babys

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 babys
axillary temperature at 30 minutes
and then 2 hourly.
10. Respond to alarm immediately.
Identify the fault and rectify it

APPLICATION OF SKIN PROBE:


Dos
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 contact 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 panels or display panel. 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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