MODULE
Module 9/ Trouble-shooting of equipments
1
MODULE
9:
COMMON
EQUIPMENTS
&
TROUBLE
SHOOTING
The module is designed to complement in-service education and orientation of nursing personnel involved in the care
of newborns.
LEARNING OBJECTIVES
The participants will learn about:
MODULE CONTENTS
The module includes following elements:
Text material: Easy to read format for quick reproduction and essential reference material for the
participants. Key messages are highlighted in the boxes.
Demonstration: Observing the functioning and upkeep in the hospital setting.
Self-evaluation: At the end of text, self evaluation based on what has been learnt is included. Feel free to
consult your text material, if you need assistance in recapitulating.
Use and upkeep of neonatal equipments : Radian warmer, Incubator,
Phototherapy machine, Weighing machine Electronic, Resuscitation bag ,
Suction machine electric & electronic
Learn trouble shooting ,keeping them sterile and routine maintenance
Module 9/ Trouble-shooting of equipments
2
I.
INCUBATOR
Determine the appropriate temperature for the
incubator based on the babys weight and age
(Table).
Warm the incubator to the desired temperature
before placing the baby inside.
Recommended incubator temperature for Air Mode
Incubator Temperature by Age*
Weight of baby
35
o
C
34
o
C
33
o
C
32
o
C
Less than 1.5 kg
1 to 10 days old
11 days to 3 wks
old
3 to 5 wks old
More than 5 wks
old
1.5 to 2.0 kg
1 to 10 days old
11 days to 4 wks
old
More than 4 wks
old
2.1 to 2.5 kg
1 to days old
3 days to 3 wks old
More than 3 wks
old
More than 2.5 kg
1 to 2 days old
More than 2 wks
old
* If the incubator is single-walled, increase the incubator temperature 1
o
C for every 7
o
C difference in
temperature between the room and the incubator.
Clean the mattress and cover it with a clean sheet.
Ensure that the incubators water reservoir is empty; dangerous bacteria may grow in the water and infect
the baby. Leaving the reservoir dry will not affect the function of the incubator.
Ensure that the babys head is covered and the baby is clothed or covered unless it is necessary for the
baby to be naked or partially undressed for observation or a procedure.
Module 9/ Trouble-shooting of equipments
3
Place only one baby in each incubator. If baby is in supine position place the skin probe on the right
hypochondrium. When in prone position, place the probe on the loin area. .
Close the hood as quickly as possible after placing the baby inside, and keep the portholes of the incubator
closed at all times to keep the incubator warm.
Work in air mode if baby is unstable and skin mode/servo mode if baby is stable. If the incubator is in
skin/servo mode the set temperature should be between 36
o
C to 37
o
C. Smaller the baby, upper is the set
temperature.
Check the temperature of the incubator every hour for the first eight hours, and then every three hours:
-
If the temperature of the incubator does not match the set temperature, the incubator may not be
functioning properly; adjust the temperature setting until the desired temperature is reached inside the
incubator, or use another method to warm the baby.
Measure the babys temperature every hour for the first eight hours, and then every three hours:
-
If the babys temperature is less than 36.5
o
C or more than 37.5
o
C, adjust the temperature of the
incubator accordingly;
-
If the babys temperature remains less than 36.5
o
C or more than 37.5
o
C in spite of the incubator being
kept at the recommended setting, suspect infection.
Move the baby to the mother as soon as the baby no longer requires special care, frequent procedures and
or treatment. For a stable baby, if the heater output is less than 25% on skin/servo mode or in air mode at
28 to 30
o
C, if the baby is maintaining the skin temperature, it is time for shifting the baby to the mother.
Place the incubator in a place where there is no direct sunlight. OR
Place the incubator shielded from direct sunlight. Always position the incubator in such a way that free air
enters the air inlet.
When the equipment is in use, all approachable internal and external surfaces should be cleaned daily with
an antiseptic solution like gluteraldehyde. Spirit or other organic solvents must NOT be used to clean the
incubator hood or panel.
Every seventh day, after shifting the baby to another clean incubator, the used equipment should be
cleaned thoroughly, first by light detergent solution and then by antiseptic solution. All detachable
assemblies, especially from the under deck area, are to be treated similarly. After drying, the parts are
reassembled and sterilized using a vaporizing agent and/or fumigation. Adding 50 ml of formalin to 50 ml of
distilled water in humidity tank and plugging it for 4 hours leads to fumigation of the incubator.
Gluteraldehyde (2%) is a good alternative. After fumigation it should be thoroughly aired. The sleeves of the
access windows must preferably be changed daily and cleaned. Check and dust the air filter every day.
Maintenance checklist
o Date of change of air-filters: - (change every 3 months)
o Date of temperature calibration:
- (every 3 months)
o Date of preventive check:
- (every 6 months)
Module 9/ Trouble-shooting of equipments
4
ALARMS ON THE INCUBATOR:
Whenever alarm is ON try to identify the reason and take corrective action. Silencing the alarm without understanding
may harm the baby.
Alarm
Problem
Response
Power alarm:
This alarms if the mains power fails.
Find alternative means for heating if
power cannot be fixed (KMC).
System alarm:
This alarms if there is an error in the
electrical circuit. There will be Error codes
(EEE) on the displays.
Change incubator as the incubator
needs repair.
Over temperature
alarm:
This alarms signals that the temperature
inside the incubator is too high. The heater
power will be automatically disconnected. It
sounds when the air temperature is > 38
o
C
in manual mode or when the air temperature
is > 39
o
C in servo mode.
Check set temperature settings and
adjust down if set too high. If set
temperature appropriate then change
incubators and the incubator needs
repair.
Air flow alarm:
This alarm sounds if the air circulation in the
incubator fails.
Change the air filter as per the
recommendation or look for the fan is
not moving If problem persists the
incubator should be changed; this is a
maintenance issue.
Sensor alarm:
This alarm sounds if the air sensor is not
connected properly or if it is not functioning
properly.
Try to re-connect the sensor correctly.
If this does not work it requires
changing.
Skin temperature
alarm:
This alarm operates in servo mode only. It
sounds when the patient temperature differs
from the SET temperature by > 1
o
C. in
servo mode and 3 C in Air mode
Change to manual mode and adjust the
temperature to try and normalize the
babys temperature. Check for signs of
infection.
Set temperature
alarm:
This alarm operates in manual mode
only. It alarms if the set temperature is
>1.5
o
C above or < by 3
o
C below the air
temperature once the incubator has had
sufficient time to heat after turning on.
The incubator needs repair.
Module 9/ Trouble-shooting of equipments
5
II.
PHOTOTHERAPY UNIT
Protect the eyes from light using eye patches once the
lights are on
Keep baby naked with a small nappy to cover the
genitalia
Change position supine to prone after each feed 3 hourly
Place the baby as close to the lights as the
manufacturers instructions allow. Use white
curtains or linen as slings so as to reflect back as
much light as possible to the baby, making sure
not to cover top surface of unit which allows air flow for cooling the bulbs.
Encourage frequent breast feeding. No need to supplement breastfeeding with any other type of feed or fluids.
Temporary interruptions for feeding or procedures are allowed. But not for oro-gastric feeding or for IV fluids.
If baby is on IV fluids or expressed breast milk increase the volume by 10 %
Monitor for and ensure urinary frequency 6-8 times/day
Monitor temperature 4 hourly and weight every 24 hours.
Estimate serum bilirubin frequently ~ q12 hourly. Clinical or visual assessment of jaundice under lights
becomes fallacious
Change tube lights every 6 months (or usage time >1000 hrs) whichever is earlier; or if tube ends blacken or if
tubes flicker
Monitor irradiance of the phototherapy machine once every week. Use a flux meter to monitor irradiance.
Change light source if irradiance falls below 6-8 祑/cm
2
/nm
Do not place anything on the p