ORGANIZATION OF NEONATAL UNIT.pptx

Neonatal intensive care unit:
New born or neonatal intensive care unit, an intensive care unit designed or premature and ill new born babies.
NEONATAL CARE:
The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate paediatric intensive care unit.
INDICATIONS :
Babies less then 30 weeks
Very low birth weight babies of less then 1500 gm
Cardiopulmonary monitoring.
Surfactant therapy.
Convulsion
Sever birth asphyxia
Assisted ventilation
Total parenteral therapy
Major surgeries
aims:
Reducing the neonatal mortality and improving the quality of life among the survivors
basic facilities:
Adequate space
Availability of running water
Centralized oxygen and suction facilities
Maintenance of thermo- neutral environment
Availability of plenty of linen and disposables
Facilities for availability to treat common neonatal problems
EMPHASIS SHOULD BE LAID ON THEFOLLOWING:
 Asepsis
 Warmth and thermo neutral environment
 Adequate nutrition with human milk
 Non stimulating noise free ward
 Safety from all biological, physical and chemical hazards.

NEONATAL CARE SERVICES

 LEVEL - l NORMAL NEONATALCARE

 LEVEL – II SPECIAL CARE NURSARY

 LEVEL – III INTENSIVE NEONATALCARE UNIT

LEVEL - I
 The minimal care
 Provided by the mother under the supervision of basic health professionals.
 Neonates weighting more than 2000 gm or having gestational age maturity of 37 weeks or more belong to this care.
 This care can be includes care of delivery, provision of the warmth, maintenance of asepsis, and promotion of breastfeeding.
LEVEL - II
 This care includes requirement for resuscitation, maintenance of thermo-neutral temperature, intravenous infusion, gavage feeding phototherapy and exchange transfusion.
 10-15 percent of the newborn require this care
 This care s is anticipated for the infants weighing in between1500 & 1800 gm or having gestational age maturity of 32 to 36weeks.
LEVEL - III
 This care includes life saving support system like ventilator and best suited special intensive neonatal care.
 Three to five percent of newborn require care of this level.
 This level of care is for critically ill babies, for those weighing less than 1500 gm or having gestational age maturity of less than 32 weeks




TRANSPORT:

DEFINITION
Newborn transport is used to move premature and other sick infants from hospitals without specialist, intensive care facilities require for optimal care of the baby to hospitals with neonatal intensive care and other specialist services
Out born newborns:
A significant number of neonates require emergent transfer to a tertiary care center, often because of medical, surgical, or rapidly emerging postpartum problems. These are termed “out born” neonates, because they have been born somewhere besides the facility to which they’ve been transferred.

1. ORGANIZATION OF NEONATAL UNIT PRESENTED BY, MISS.C.KEERTHANA M.SC(N)., NURSING TUTOR SRMTCON.

2. INTRODUCTION Neonatal intensive care unit: New born  or neonatal intensive care unit, an intensive care unit designed or premature and ill new born babies. NEONATAL CARE: The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate paediatric intensive care unit. Date Your Footer Here 2

3. INDICATION FOR THE ADMISSION TO NICU Babies less then 30 weeks Very low birth weight babies of less then 1500 gm Cardiopulmonary monitoring. Surfactant therapy Convulsion Sever birth asphyxia Assisted ventilation Total parenteral therapy Major surgeries Date Your Footer Here 3

4. AIMS OF ORGANIZING OF NICU Reducing the neonatal mortality and improving the quality of life among the survivors OBJECTIVES: To prevent damage in infants with problems at birth and also reduce morbidity in later life. To monitor high risk new-born's  so as to reduce mortality and morbidity in these babies To save the life of sick new born. Date Your Footer Here 4

5. BASIC FACILITIES: Date Your Footer Here 5 Adequate space Availability of running water Centralized oxygen and suction facilities Maintenance of thermo- neutral environment Availability of plenty of linen and disposables Facilities for availability to treat common neonatal  problems

6. Cont.. Equipment and articles of general and special use like iv stands, various procedure trays, stethoscope, torch, syringes, bowels, kidney trey, feeding cup, jugs, basin etc. Machines like incubator, phototherapy unit, ventilator, monitors etc. Stationary as per need. Toilets and bathrooms Date Your Footer Here 6

7. EMPHASIS SHOULD BE LAID ON THEFOLLOWING: Asepsis Warmth and thermo neutral environment Adequate nutrition with human milk   Non stimulating noise free ward Safety from all biological, physical and chemical hazards. Date Your Footer Here 7

8. NEONATAL CARE SERVICES LEVEL - l  NORMAL NEONATALCARE LEVEL – II SPECIAL CARE NURSARY LEVEL – III INTENSIVE NEONATALCARE UNIT   Date Your Footer Here 8

9. LEVEL - I The minimal care Provided by the mother under the supervision of basic health professionals.  Neonates weighting more than 2000 gm or having gestational age maturity of 37 weeks or more belong to this care. This care can be includes care of delivery, provision of the warmth, maintenance of asepsis, and promotion of breastfeeding. Date Your Footer Here 9

10. LEVEL - II This care includes requirement for resuscitation, maintenance of thermo-neutral temperature, intravenous infusion, gavage feeding phototherapy and exchange transfusion. 10-15 percent of the newborn require this care This care s is anticipated for the infants weighing in between1500 & 1800 gm or having gestational age maturity of 32 to 36weeks. Date Your Footer Here 10

11. LEVEL - III This care includes life saving support system like ventilator and best suited special intensive neonatal care. Three to five percent of newborn require care of this level. This level of care is for critically ill babies, for those weighing less than 1500 gm or having gestational age maturity of less than 32 weeks Date Your Footer Here 11

12. DEFINITION   Newborn transport is used to move premature and other sick infants from hospitals without specialist, intensive care facilities require for optimal care of the baby to hospitals with neonatal intensive care and other specialist services Date Your Footer Here 12

13. Out born newborn : A significant number of neonates require emergent transfer to a tertiary care center , often because of medical, surgical, or rapidly emerging postpartum problems. These are termed “out born” neonates, because they have been born somewhere besides the facility to which they’ve been transferred.   Date Your Footer Here 13

14. TRANSFER  Transfer can be within the hospital; to ICU■Transfer can be to other hospital NEONATAL TRANSFER TYPES Emergency: unplanned Elective : planned and informed Date Your Footer Here 14

15. How can we transfer? The short distance transport within the hospital can be accomplished in a transport incubator. The use of plastic basket with perforated sides coupled with careful placing of hot water bottles is recommended for use in the rural setting. The baby can be wrapped in tin foil or covered with several layers of cotton. Themocole (polystyrene) box is an effective insulator and can be used in community. Skin to skin contact with mother or a care taker is a useful modality of transport in rural areas or resource poor settings. Date Your Footer Here 15

16. INDICATIONS OF NEONATAL TRANSPORT Preterm infant with a birth weight <1500g or gestation <32 weeks Respiratory distress requiring CPAP or assisted ventilation Severe hypoxic-ischemic encephalopathy Life threatening sepsis Intractable seizures Bleeding neonate Congenital anomalies or surgical neonate  Inborn errors of metabolism Severe jaundice Procedures or diagnostic facilities unavailable at parent hospital. Date Your Footer Here 16

17. TRANSPORT EQUIPMENTS Transport incubator with multi-channel vital signs monitor for recording temperature, heart rate, NIBP, oxygen saturation CPAP facility with nasal prongs and portable ventilator Airway equipment: suction devices, oral airways, bag and mask, laryngoscopes (size 00,0 and 1 blades) Infusion facilities: infusates , infusion pumps, glucometer  Date Your Footer Here 17

18. Cont.. Oxygen, compressed air cylinder, oxygen mask, hood, heat and light, sources of electric powers and adapters. Disposables: catheters (5, 6, 7,8,10,12Fr), syringes, needles, feeding tubes (8 & 10Fr), alcohol, betadine swabs, micropore tape, gloves etc. Instrument tray for ET intubation, vascular access, insertion of chest tubes, NG tube etc. Life saving drugs Date Your Footer Here 18

19. TRANSPORT TEAM  The neonate needing special or intensive care should be transported by a skilled transport team. Teams include at least,1.One senior resident2.One specially trained neonatal nurse Date Your Footer Here 19

20. STABLE Sugar Temperature Airway Blood pressure Lab work Emotional support SAFER  Sugar Arterial circulatory support Family support Environment Respiratory support Date Your Footer Here 20

21. TOPS Temperature Oxygenation (airway and breathing) Perfusion Sugar Date Your Footer Here 21

22. Protocols Maintain airway, oxygenation, thermal stability and tissue perfusion Stop oral feeding and start parenteral feeding with 10% of dextrose. Ensure umbilical or peripheral venous access Insert an NG tube and decompress the stomach Maintain adequate blood glucose level Obtain culture samples and administer first dose of antibiotics. Date Your Footer Here 22

23. Cont.. Obtain a recent chest skiagram as a base line and to check the position of catheters and tubes. Take the family member or parents along with the baby whenever feasible. When required transport team should undertake life saving procedures (like ET tube insertion, chest tube insertion etc )  Date Your Footer Here 23

24. Administer life saving drugs like surfactant and prostaglandins The referring hospital should prepare a detailed transport note including copies of obstetric and neonatal charts for the transport team. Monitor the baby’s color and temperature. Date Your Footer Here 24

25. Arrival at the receiving NICU The transport team should remain in constant touch with the referral NICU during the course of journey. The team should brief the NICU care givers regarding the status of the baby and immediate clinical concerns. Hand over all the documents The referring hospital and parents should be informed about the safe arrival and latest condition of the baby. The inventory of transport equipment should be checked, medications and essential supplies should be restocked for the next transport service. Date Your Footer Here 25

26. ORGANIZATION OF NEONATAL INTENSIVE CARE UNIT Date Your Footer Here 26

27. MAIN COMPONENTS TO BECONSIDER WHILE ORGANIZING A NICU Physical facilities Personnel Equipment Laboratory facilities Procedure manual Transport of sick infants Cooperation between the obstetrician and neonatologist Date Your Footer Here 27

28. I.PHYSICAL FACILITIES Location Space Floor plan Lighting Environmental temperature and humidity Handling and social contact Communication system Acoustic characteristics Ventilation Electrical outlets Date Your Footer Here 28

29. Date Your Footer Here 29

30. A) LOCATION Located as close as to labor room and obstetric care unit Adequate sunlight for illumination Fair degree of ventilation for fresh air  Date Your Footer Here 30

31. B) SPACE Serve as a referral unit for the infants born outside the hospital, allowance should be made for additional physical facilities and space. Each infant should be provided with a minimum area of 100 sq. ft. or10sq . Meter. However , additional space would be needed to provide for additional facilities Space for promotion of breast feeding, expression of breast milk and its storage. 500-600 Gross square feet per bed. Space includes patient care area, storage area, space for doctors, nurses, other staff, office area, seminar room area, laboratory area and space for families 6 Feet gap between two incubators for adequate circulation and keeping the essential lifesaving equipment. Date Your Footer Here 31

32. C) FLOOR PLAN Ward should preferably be in square shape so that abundant open space is available. The walls should be made of washable glazed tiles and windows should have two layers of glass planes to ensure the protection from heat and sound insulation. Wash basins with elbow or floor operated taps facility having constant round-the clock water supply should be provided. The doors should be provided with automatic door closers. solation room There should be nursing station, doctor’s room, store room, a procedure room, pantry, toilet and bathroom, milk storage room and cleaning area. The ward should have the clean area, infected area, separately located where infants can be segregated Date Your Footer Here 32

33. VENTILATION Effective air ventilation is necessary to reduce nosocomial infection. The most satisfactory ventilation is achieved with laminar flow system which is bit expensive. A simple method for achieving satisfactory ventilation consist of provision for exhaust fans in reverse direction near ceiling for input of fresh uncontaminated air. Central air conditioning Date Your Footer Here 33

34. LIGHTING The whole unit must be well illuminated and painted white or slightly off white to permit prompt detection of jaundice and cyanosis. The lighting arrangement should provided uniform shadow-free, illumination of 100 foot candles at the infant’s level. The number and exact location of fixation of lights depends upon size of ward, height of ceiling and availability of natural light. Spot illumination for various procedure can be provided by portable angle poise lamp having two, 15 watt florescent bulbs . In place where electric failure is frequent, the ward must be attached with generator. Date Your Footer Here 34

35. ENVIRONMANTAL TEMPERATURE AND HUMIDITY The temperature inside the unit should be maintained at 28’ +_2’C, while the humidity must be above50%. Portable radiant heater, infra-red lamp can be used. ACOUSTIC  CHARACTERISTICS The ventilation system, incubators, air compressors, suction pumps and many other devices used in the nursery produce noise. Sound intensity in the unit should be exceed 75 decibels. Telephone rings and equipment alarms should be replaced by blinking lights. Date Your Footer Here 35

36. COMMUNICATION SYSTEM The unit should also have an intercom so that the ward is well connected with other units of the hospital, & a direct outside telephone line so that the parents have easy access to enquire about the well-being about their child. ELECTRICAL OUTLETS Each patient station should have 12 to16 central voltage – stabilized electrical outlets sufficient to handle all pieces of equipment An additional power plug point There should be round-the-clock power back up including provision of UPS system Date Your Footer Here 36

37. One neonatal physician is required for every 6-10 patients A direct who is a full time  neonatologist One resident doctor should be present in the unit round-the-clock. Anaesthetist - paediatric surgeon and paediatric pathologist are essential persons in establishment of a good quality NICU PERSONNEL Date Your Footer Here 37

38. NURSES A nurse : patient ratio of 1:1 maintained thought out day and night is absolutely essential for babies on multi system support including ventilator therapy. For special care neonatal unit and intermediate care, nurse to patient ratio of 1:3 is ideal but 1:5 per shift is manageable. Head nurse is the overall in-charge In addition to basic nursing training for level-II care, tertiary care requires, staff nurse need to be trained in handling equipment, use of ventilators and initiation of life-support like use of bag and mask resuscitation, endotracheal intubations, arterial sampling and so-on. The staff must have a minimum of 3 years work experience in special care neonatal unit in addition to having 3 months hand on-training in an intensive care neonatal unit. Date Your Footer Here 38

39. OTHER STAFF Respiratory therapist ■ Laboratory technician ■  Public health nurse or social worker ■ Biomedical engineer ■ Clark  Date Your Footer Here 39

40. EQUIPMENT During past few years, a large number of sophisticated devices for diagnostic and therapeutic purpose have been developed. Acquisition of new equipment does not necessarily mean better services and outcome. The maintenance of existing equipment in proper working condition is more important then acquiring new and sophisticated gadgets. Date Your Footer Here 40

41. DISPOSABLE ARTICLES REQUIRED FOR THE NICU: IV Catheters IV sets Micro burette sets Bacterial filters Feeding tubes Endotracheal tubes Suction catheters Three-way stopcocks Extension tubing Umbilical arterial and venous catheters Syringes, needles Date Your Footer Here 41

42. MEDICAL EQUIPMENT IN THE NICU Beds Your baby will be admitted to a radiant warmer or giraffe bed, then changed into an isolette or open cribde pending on age and medical condition. Monitor  Three sticky leads are placed on your baby’s skin to monitor heart rate and breathing. A saturation probe is placed on your baby’s hand or foot to read the oxygen level. A temperature probe may be placed on the skin, under the baby’s arm to measure the body temperature. A blood pressure cuff will be placed on your baby’s legor arm to measure blood pressure. Date Your Footer Here 42

43. Oxygen Saturation   (blue line and number) is a measurement of how much oxygen the blood cells are carrying and is described as a percentage of 100%, normal = 80 to 93 for pre-term infants, 85 to 100 for term infants Heart rate-  (green line and number) varies depending on infant Temperature - (orange number)normal is 36.2 to 37.6 Celsius or 97.2 to 99.7 Fahrenheit) Respirations -(white line and number)are your baby’s breaths, normal rate is 40 to 60 Blood pressure - (purple number)varies depending on infant Blood pressure cuff -(left leg) reads the baby’s blood pressure Leads -(purple hearts) read the baby’s heart rate and respirations Saturation probe -(right foot) reads the oxygen level the baby is receiving Date Your Footer Here 43

44. RESPIRATORY EQUIPMENT VENTILATOR : It is a machine that provides breathing support while the baby is unable to breathe on his or her own. Date Your Footer Here 44

45. ET Tube-  is a tube that is placed in the windpipe (trachea) and goes to the lungs to help the ventilator provide breathing support for the baby CPAP---  is a machine that helps the baby breathe. CPAP prongs/mask  will be placed in/on the baby’s nose. The prongs/mask allow the CPAP machine to provide breathing support to the baby. Date Your Footer Here 45

46. Nasal Cannula are small tubes that go just inside your baby's nose to give oxygen for breathing support. Humidified Air  for the nasal cannula helps keep your baby's nose from being dried out.   Date Your Footer Here 46

47. The bag and mask  set-up is at every bedside. This emergency equipment is used only temporarily until the ventilator or CPAP machine is brought to your baby. Date Your Footer Here 47

48. A suction set-up  is at every bedside. Suction is used to clear collected secretions/materials from airways to allow babies to breathe easier. Suction is also used to pull contents from the stomach or the lungs. Babies with certain conditions or breathing equipment may require routine suctioning of their airway with their care. Suction is readily available to use in emergencies or with procedures your baby may have done at the bedside . IV Therapy Infusion  and  IV pump  are machines to provide intravenous nutrition, IV  fluidsand /or medications. PIV or PICC are catheters that deliver medications and IV fluid from the medfusion and IV pump to the baby. Date Your Footer Here 48

49. Phototherapy  Some babies have an elevated bilirubin level which is referred to as“jaundice ”. Jaundice is a yellow-tinge in the baby’s skin or eyes. The bili -light helps to reduce the bilirubin level in the baby’s body and will prevent side effects associated with severe jaundice. The baby will have an eye mask to protect his or her eyes from the bright lights of the bili -light. Date Your Footer Here 49

50. TOWARDS A GENTLE  AND FRIENDLY NICU ENVIRONMENT: Attempts should be made to reduce unnecessary noise and light. Avoid excess of light Handling should be gentle Neonates including pre terms feel pain and painful stimuli can cause deleterious physiological responses. Analgesia should be provided during all procedure including ventilation. Parent should  be allowed unrestricted entry to the nursery They should be explained about various tubing and attachments to the baby and should be involved in care of their baby. Date Your Footer Here 50

51. MANAGEMENT OF NURSING CARE Assessment Monitoring physiological data Safety measures Respiratory support Thermoregulation Protection from infection Hydration Nutrition Feeding resistance Skin care Administration of medication Developmental outcome Facilitating parent-infant relationship Discharge planning and home care Neonatal loss Date Your Footer Here 51

52. TRANSPORT OF SICK NEONATES: The goal of every transport is to bring a sick neonate to specialized neonatal center in a stable condition. To avoid complications during transport, the infant should be as stable as possible before leaving the referring hospital and warm chain should be maintained.  The transport service gives high — risk patients timely access to the appropriate services without interrupting their care Date Your Footer Here 52

53. TRANSFER PATTERNS IN REGIONAL SYSTEM: Level I [Basic Care] — Relatively minor problems Level II [Speciality Care] — Low birth weight babies (1500 to 2500 gm, 32 to 36 weeks of gestation) Level III [ Subspeciality Care] — Maternal and Neonatal those at high risk (less than 1500 gm birth weight or less than 32 weeks gestation) Level I to Level II: Complicated cases not requiring intensive care. Level II to Level III: Complicated cases requiring intensive care. Labor less than 34 weeks gestation Date Your Footer Here 53

54. REFERENCE R Dorothy Textbook of Pediatric Nursing6th 19881316 Piyush Gupta Essential Pediatric Nursing M Singh Care of the Newborn 640 D L Hartl E W Jones Genetics: Analysis of Genes and Genomes, Sixth EditionNeuro oncol200572204510.1215/S1152851704200059 Gardner Principles of Genetics8th 2012 Ati Ati Maternal Newborn Nursing, RN Edition, Review2006468 Services & Treatments2018 https://www.floyd.org/medical-services/.../NICU/Pages/Levels-of-Neonatal- Care.aspx.CITED ON 1-05-18 The Neonatal Intensive Care Unit (NICU)2019105 https://www.stanfordchildrens.org/en/topic/default?id=the-neonatal-intensive-care-unit-nicu-90-P02389 https://www.scribd.com/presentation/485489884/5-Organization-of-neonatal-care-services-pptx Date Your Footer Here 54

55. JOURNAL REFERENCE: Organization and management of nursing services in NICU, levels of transport   Javaid Ahmad Mir[ 1 ] Designation: Faculty   Bushra Mushtaq [ 2 ] Designation: Faculty Onaisa Aalia Mushtaq [ 3 ]Email:  [email protected] Designation: P G Nursing Scholar  Dept. of Nursing, Govt. Nursing College Baramulla, Jammu and Kashmir India Dept. of Nursing , Islamic University of Science & Technology Awantipora , Jammu & Kashmir India Dept. of Nursing Education, Sher E Kashmir Institute of Medical Sciences Srinagar, Jammu and Kashmir India Date Your Footer Here 55

56. Thank You! Your Footer Here 56 C.KEERTHANA M.SC (N)., SRMTCON