neonatal routine care · web viewincubator air temperature has been consistently 290c or less over...

CHHS15/058

Canberra Hospital and Health ServicesClinical ProcedureNeonatal Routine Care Contents

Contents...................................................................................................................................1

Purpose.................................................................................................................................... 2

Scope........................................................................................................................................2

Section 1: Assessment each shift (NICU & SCN).......................................................................2

Section 2: Bathing a Baby - Parental Education........................................................................5

Section 3: Observation & Monitoring.......................................................................................6

Section 4: Pain Assessment & Management in Neonates........................................................8

Section 5: Thermoregulation....................................................................................................9

Section 6: Weight/Length/Head Circumference in Neonates................................................12

Implementation......................................................................................................................14

Evaluation...............................................................................................................................14

Related Policies, Procedures, Guidelines and Legislation.......................................................14

References..............................................................................................................................15

Search Terms..........................................................................................................................16

Consultation...........................................................................................................................16

Appendices.............................................................................................................................17

Doc Number Version Issued Review Date Area Responsible PageCHHS15/058 1 24/02/2015 December

2019WY&C - Neonatology

1 of 24

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/058

Purpose

To outline the routine care of neonates being cared for in the Division of Women Youth & Children. This includes: Assessment each shift Bathing a baby - parental education Observation and monitoring Pain assessment and management in neonates Thermoregulation Weight/length and head circumference

Scope

This procedure applies to all staff involved in the care of newborns, including nurses/midwives or medical staff with competency recognised by ACT Health. New nursing/midwifery or medical staff, or students (if within their defined scope of practice) will be required to perform these skills under the direct supervision of a credentialed and competent practitioner.

This document pertains to babies born at or transferred to the Canberra Hospital.

Strict hand hygiene should be adhered to at all times when performing all clinical procedures as per CH&HS Hand Hygiene SOP CED 11-50

Section 1: Assessment each shift (NICU & SCN)

Equipment Observation flow chart

Procedures1. Assess previous documentation of observations, fluid and nutritional status for any

variations2. Identify possible causes for any detected variations e.g. temperature instability,

increasing apnoea, bradycardia etc.3. Position baby:

Check that the environment is warm with no draughts The baby should remain exposed for as short a time as possible Check for any individualised infant positioning plan from the physiotherapist,

speech pathologist, skin care or nursing/medical care plan or as applicable.4. Check baby has ID bands x 2- labelled correctly (as per the Patient Identification Policy

and Procedure).5. Examine the infant, observing for:



2 of 24


CHHS15/058

Head Check fontanelles. Suture lines Bruising, abrasion, laceration and/or cephalo-haematoma /caput succedaneum or

sub-galeal haemorrhageEars Check for skin tags and dimples Check position Check for patency of ear canalsEyes Check if clean Note redness, swelling or exudate Check colour of corneaMouth and chin Check for thrush (white pustules on tongue or inside mouth) Abnormal swellings on checks e.g. salivary gland swelling Check hard and soft palate for clefts Asymmetry with crying – facial nerve paralysis Micrognathia Check for ankyloglossia (tongue-tie) Nose Shape Observe for any nasal discharge or if baby is “snuffly.” Nasal flaringChest Signs of respiratory distress e.g. recession, increase in respiratory effort, nasal

flaring, tachypnoea and/or symmetry of chest wall movement Listen to breath sounds and record if equal air entry and/or crackles and wheezesCirculation Check central and peripheral capillary refill Listen for heart murmurs and document and report findingsAbdomen Observe for swelling, distension and/or, discolouration Listen to bowel sounds Check for output urine and faecesUmbilicus Check for redness, swelling, any ooze, and assess for signs of healing. Check umbilical lines and document position of lines in centimetres, and numbers

of days the line has been insitu Report and document any umbilical flare.

Genitalia Observe for patency of anus, broken skin, rash or pustules Check scrotum for size and colour and penis for hyper/ hypospadias Check vagina for discharge and note colour and type



3 of 24


CHHS15/058

Skin Colour (e.g. jaundice, pale plethoric.) Check areas of flexure/skin folds for signs of chafing, especially around neck and

underarms Observe for rashes, pustules, broken areas, haemangioma on baby’s bodyMusculoskeletal Check number of fingers and toes Check for presence/absence of palsy and ensure symmetrical movements of all

limbs Check for presence/absence of fracturesSpine Check for any disruptions, tufts of hair, haemangioma, dimpling Check for abnormal curvature of spineCheck IV sites For oedema, swelling, redness of the limb and patency of line Check fluids are running at appropriate rate and type as specified on fluid balance

chart Ensure all IV medications are given as ordered and are at appropriate dose before

administration Check long line insertion site for oedema, swelling, and redness of the limb and

patency of line Long line dressing must be intact or replaced and line securedCheck oxygen requirements Check that the oxygen saturations alarm limits are set at 88-95% for infants in

oxygen and 88-100% for infants in air. If there is an increase in oxygen requirement, notify the medical staff

Assess the histogram to ensure oxygen administration is appropriate 6. Dress and settle the baby7. Document the examination findings on the admission sheet and/or in patient notes8. Report any abnormalities to the Nursing Team Leader and the Medical Officer and

record these in the progress notes

Back to Table of Contents



4 of 24


CHHS15/058

Section 2: Bathing a Baby - Parental Education

Equipment Alcohol based hand rub (ABHR) Bath containing warm water approximately 36.7 - 38 degrees Celsius (C) or warm on the

inside of the wrist. Collect necessary linen:

o Clotheso Nappyo Towelo Face washer

Infant liquid soap/baby wash (Department of Neonatology only) Electrodes (Department of Neonatology only)

Procedure1. Demonstrate, explain and support family throughout the procedure2. Do not bath baby until temperature stable 3. Ensure ambient temperature of room is 25-28 degrees Celsius and draft free4. Collect equipment5. Perform base line axilla temperature (Department of Neonatology only)6. The midwife/nurse must remain with parents for the first bath7. Bathe from clean to dirty beginning with the face 8. Undress baby except for nappy and wrap firmly in towel, with head exposed9. Wipe each eye from inner canthus to outer canthus with corners of face washer

dampened in bath water10. Dry each eye with a separate corner of face washer11. Wash and dry face12. The mouth should be clean and dry13. Clean ears with the face washer (not cotton tip swabs) wash behind the ears because

regurgitated milk may accumulate there 14. Wash neck, babies have naturally short necks which can make it difficult to clean neck

folds 15. Wet baby’s head with water and wash the baby’s head using the football hold i.e. one

hand to support head 16. Hold baby’s head over bath and rinse17. Place baby on dry towel and dry head with towel18. Unwrap baby and remove nappy19. Inspect the baby’s cord and wash and dry in bath20. Place baby in bath with body submerged (if equipment/condition allows) supporting the

baby’s head clean all areas paying particular attention to skin folds clean the nappy area last

21. Remove baby from bath ensuring the parent has a firm hold of the baby and that the cot /isolette is close to the bath

22. Place on dry towel and dry well, paying special attention to skin folds



5 of 24


CHHS15/058

23. Dress in nappy first24. Dress and wrap warmly25. Change baby’s bed clothes if necessary26. Dispose of equipment appropriately and clean bath as per Unit Procedure


Section 3: Observation & Monitoring

Equipment Stethoscope Watch/clock with second hand Blood pressure module, lead and recommended size cuff Oxygen saturation module, lead and probe Thermometer and covers

Frequency of Cardio-respiratory and Temperature Observations 1. On admission to Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) all

infants are to have full observations recorded hourly for 4 hours. This includes hourly blood pressures in NICU

2. Infants who are ventilated or on Continuous Positive Airway Pressure (CPAP) are to be monitored continuously and have observations recorded hourly

3. In SCN observations are completed depending on the infants condition, but must be recorded as a minimum, each shift (including infants rooming-in)

4. Infants transferred from an incubator to an open cot require hourly temperature for 4 hours

Normal Ranges for Cardio-respiratory and Temperature ObservationsPrior to commencing observations assess respiratory rate observing the infant’s colour and presence of any rib recession, grunting or nasal flaring: Heart rate: 100-160 beats per minute Respiration rate: 30-60 breaths per minute Temperature: 36.5-37.4 C measured per axilla (PA)(See Section 5- Thermoregulation)

Alarm Settings Heart rate: 100 – 180 beats per minute (Reduce lower limit if baseline bradycardia evident and infant has been reviewed by a

Medical Officer) Respiration rate: 30-60 breaths per minute Apnoea settings to be set at 20 seconds



6 of 24


CHHS15/058

Oxygen Saturation MonitoringAll infants in Oxygen are to have Oxygen saturations and O₂ recorded hourly

Alarm settings - Oxygen saturation levels for all gestations 88-95% if on/in Oxygen 88-100% if on/in Air

Saturation limits to be modified only on direction of the Consultant/Fellow and documented - such as older term infants and infants with persistent pulmonary hypertension of the newborn.

Blood Pressure Monitoring1. Umbilical/peripheral Arterial Line – recorded hourly on infants2. Non-invasive BP in stable infants.

2.1. Infants < 1250gm <1 week old – 6-8 hourly 2.2. Infants < 1250gm >1 week old - BD 2.3. Infants born < 32 weeks gestation <1 week of age – 6-8 hourly2.4. Infants with Chronic Lung Disease (O2 dependant, > 28 days of age) daily or as

directed by the medical officer on service 3. Factors affecting the reliability of readings include

3.1. Three measurements must be taken each time for peripheral BP readings – the first BP is generally higher than the second and third readings.

3.2. Size and fit of cuff - Cuff must be attached snugly and cover 2/3 of the limb. Either the arm or leg may be used

3.3. State of alertness or agitation of the infant – the BP should only be recorded if the baby is awake and settled or sleeping, recordings should not be taken while the baby is feeding.

4. Persistent Blood pressures above the 95th percentile or below the 5th percentile for gestation should be reported to medical officer or team leader (see graphs in Appendix 3)

AlertReport any abnormal findings to the Team Leader and Medical Officer.




7 of 24


CHHS15/058

Section 4: Pain Assessment & Management in Neonates

Equipment Alcohol Based Hand Rub Pain tool- Premature Infant Pain Profile-Revised (PIPP-R) Flow Chart Medication chart IV Order chart

When to use the assessment tool 1. Whenever you suspect an infant may be in pain2. Whenever you are using analgesia (as a baseline)3. To assess the effect of analgesia 4. Post operatively5. To assess sedation if analgesia is being used6. Infants requiring respiratory support (Ventilation and CPAP)7. Babies undergoing painful procedures

While completing tools consider 1. When you suspect an infant may be in pain2. Whenever you are using analgesia (as a baseline)3. To assess the effect of analgesia 4. Post operatively

Use of the tool1. Document score on observation chart2. Discuss score at nursing handover with the nurse from the preceding shift

Pain Score Guidelines 1. Observe infant for 15 seconds at rest and assess vital sign indicators (highest heart rate

(HR) and lowest O2 saturation (O2 SAT) and behavioural state2. Observe infant for 30 seconds after procedure and assess change in vital sign indicators

(maximal HR, lowest O2 SAT and duration of facial actions observed)3. If the infant requires an increase in oxygen at any point before or during the procedure,

they receive a score of 3 for the O2 SAT indicator4. Score for corrected gestational age (GA) and behavioural stat (BS) if the sub-total

score>05. Calculate total score by adding Sub-total Score + BS Score



8 of 24


CHHS15/058

Pain management1. Document management in progress notes2. Discuss the management plan at handover with preceding staff member3. Implement non-pharmacologic comfort measures first if minimal pain score and no

identifiable cause of the pain 3.1. Developmental positioning 3.2. Facilitated tucking3.3. Non-nutritive sucking3.4. Containment strategies3.5. Rocking3.6. Reducing environmental stressors such as noise/ lights

4. Provide pain relief as ordered (see Medication and/or IV fluid charts)5. Seek medical review if no and / or inadequate analgesia prescribed6. Reassess 30 minutes after pain relief and review management if required


Section 5: Thermoregulation

BackgroundNormal Range >36.50 – 37.40C for all infants measured per axilla using digital thermometers and using

skin temperature probes An infant’s core body temperature will generally be higher than the skin temperature,

with a difference of ~0.50C in term infants; the difference may be narrower in very preterm or ill infants

Hypothermia Any axillary temperature below 36.5oC implies that the infant’s ability to produce

sufficient heat has been exceeded and they will demonstrate evidence of cold stress The neonate’s physiological responses to cold stress are

o Peripheral vasoconstriction o Flexion of limbs o Pulmonary vasoconstriction o Metabolic acidosiso Disseminated intravascular coagulopathy o Apnoea

AlertControlled hypothermia may reduce the extent of brain injury following an hypoxic ischaemic challenge see Document- Cooling for HIE



9 of 24


CHHS15/058

Hyperthermia Any axillary temperature of 37.50C or higher Hyperthermia must be assessed for endogenous or exogenous causes Endogenous causes include infection, drugs or other impairment of the hypothalamic

control areas. A useful indicator of an endogenous aetiology is cold extremities as the baby attempts to conserve body heat to meet the new internal set point

If the extremities are also warm this is suggestive of an external source i.e. too many blankets, isolette temperature too high etc.

Physiological responses, especially to exogenous hyperthermia, include: o peripheral vasodilation which maximises radiation of heat from blood o the term infant may sweat, enabling evaporative heat loss o irritability, lethargy, hypotonia, poor feeding, tachypnoea and apnoea

Rather than actively cooling, infants are to be cooled by removing external heat sources and any objects that block heat loss (such as thermal tunnels and humidification).

AlertHyperthermia may worsen the extent of brain injury following hypoxic ischemia

Heating / Cooling Infants are to be warmed /cooled slowly to prevent rapid metabolic changes, vaso-dilation/constriction and shock Raise/lower the infant’s temperature by 0.50C per hour Monitor temperature every 30 – 60 mins during warming and cooling

ProcedureAdmission1. Set the isolette to AIR control2. Pre-warm isolette to:

a) 37o C for babies less than 28 weeks gestation/1000 gramsb) 35o C for babies greater than 28 weeks gestation/1000 grams

3. Add humidity to isolette of babies less than 28 weeks gestation/1000 grams. Commencement may be delayed until Umbilical lines have been inserted.

4. On admission, for ease of visualisation when nursed in an isolette, the baby is nursed in a nappy only for the first 4 hours. For all other babies dress in pre-warmed hat, nappy and clothing

5. Measure and record PA temperature for the first 4 hours following admission6. A temperature probe is placed under the infant until there temperature is stable.

Measure and record the infant’s PA temperature and compare with skin temp probe reading. Once accuracy of skin probe is confirmed, monitor continuously, and record probe temperature hourly.

7. Record PA temperature 4-6 hourly with cares, regardless of whether using a temperature probe



10 of 24


CHHS15/058

AlertWhen commencing or ceasing phototherapy, monitor infants’ temperature regularly as the isolette temperature may need to be adjusted. Make adjustments by 0.50C

8. During procedures that require the isolette door / portholes to remain open for extended periods, activate the heat shield on the Giraffe isolette

9. If overheating occurs while the infant in an isolette, decrease isolette temperature by 0.50C

10. Do not leave portholes open 11. Isolette power should always be on

Transferring from isolette to open cot Criteria for transferring an infant to an open cot

o Infant is gaining weight and weight is not less than 1600gms o Tolerating enteral feeds o No apnoea and bradycardia requiring stimulation o Incubator air temperature has been consistently 290C or less over a minimum of

24hours The process of transition from an isolette to an open cot should begin as soon as the

infant has met the above criteria The infant’s weight is monitored according to unit policy or medical orders following the

transition from isolette to open cot Energy demands for thermal control take precedence over demands for growth,

potentially leading to poor weight gain Infants nursed in isolettes for reasons other than thermal management (such as

phototherapy, observation or isolation) can be moved out of the isolette into an open cot without following these guidelines

BATHING: should not occur until the axilla temperature has been maintained after transition for at least 48hrs.

Equipment Perspex cot Thin mattress Sheet 1 -2 blankets Clothing – hat and booties, singlet, top and cardigan.

Procedure 1. The isolette temperature should be reduced 0.50C whilst maintaining the per axilla

temperature between >36.50 – 370C at intervals of 6-8 hours until 290C. 2. Within 8-24 hrs of maintaining the per axilla temperature in this range and reducing the

isolette temperature to 290C the infant should then be dressed appropriately, wrapped in cuddly and blankets then placed in a Perspex cot away from drafts.



11 of 24


CHHS15/058

3. Continue to measure and record axilla temperature hourly for 4 hours after transfer into an open cot

4. Adding or removing of blankets or clothing may be required once the transition has taken place in order to maintain the per axilla temperature >36.50 – 370C.

5. A Cosy-cot mattress may be used to maintain temperature if the infant meets the above criteria but fails to maintain temperature > 36.5-370C.

6. Measure and record infant’s temperature hourly for 4 hours after placing infant on the Cosy-cot mattress

Criteria for returning infant to isolette1. If the infants per axilla temperature fails to be maintained >36.5 – 370C during any of

the above steps the procedure should be discontinued. 2. Other signs of unsuccessful transition include vomiting, apnoea and bradycardia and

weight loss after transition has occurred. 3. If any of the above signs occur the infant should be unwrapped and undressed and then

returned to an isolette or overhead warmer in order to regain a per axilla temperature within the required parameters.

4. The isolette temperature must be set at the temperature that the infant required prior to the transition to an open cot


Section 6: Weight/Length/Head Circumference in Neonates

Equipment Isolette with inbuilt scales Portable scales Warm cover for scales Length board Disposable tape measure

Procedure Department of Neonatology

1. All neonates are to have weight, length & head circumference attended on admission to the department

2. Plot weight, length and head circumference on Percentile chart3. Continue to plot weight, length and head circumference each week on their full

gestation day4. All neonates are to have weight charted twice per week. Once on the day of their full

gestation and once on gestation + 4 days. Head circumference and length are also to be plotted on the anniversary of their full gestation

5. Weighing of infants <1250gms is to be performed on a daily basis for the first 7 postnatal days or until birth weight has been regained



12 of 24


CHHS15/058

6. Daily weighs may be required in other circumstances not fitting these criteria as prescribed by the neonatologist

7. Document: on cot card (on admission) on the flow chart On percentile chart

AlertFor the safety of the infant two staff members will weigh all infants that are intubated

Maternity8. All babies are to be weighed at birth, on day 3 and discharge (maternity only) or more

frequently if clinically indicated9. All babies should have their length and head circumference measured at birth/on

admission 10. Document:

on delivery summary and cot card (on admission) in Personal Health Record (Blue) Book midwives data sheet and Birthing Outcome System (BOS)

For inbuilt isolette scales11. Remove all obstructions and position mattress flat on the scales12. Undress the infant and remove as many leads as safe13. Follow the directions of the inbuilt scales14. Deduct the weight of any equipment, leads or IV equipment attached to infant

according to chart - see attachment A15. Record weight on weight chart and observation chart

Weighing infants on portable scales16. Follow directions as above 17. Place warmed cover on scales18. Ensure the scale is set to zero19. Weigh the infant and deduct as above 20. Record the weight as above




13 of 24


CHHS15/058

Implementation

This Clinical Procedure will be communicated to staff working in the NICU/SCN during Orientation for new staff. Also those staff undertaking the New Graduate Program, the Transition Program or the Graduate Diploma in NICU/SCN Nursing will be informed of its existence during lectures relating to the topic.

Evaluation

Outcome Measures The outcome measures for the Routine Care Clinical Procedure are to be considered in

terms of improved performance in the domains of safe practice and prevention/reduction of potential complications.

This may include: >95% Compliance against Clinical Procedural guidelines Improved Benchmarking performance against similarly delineated facilities Where possible Parents/Primary caregivers should be encouraged to be engaged in

their babies care while being kept informed of their condition and progress

Method Clinical Audits of compliance against Clinical procedural guidelines as conducted by

Clinical Development Nurses (CDNs) and reported on at Staff Unit and Unit Quality Meetings

The Neonatal Intensive Care and Special Care Nursery participate in collaborative audits and research, contributing data to the Australian and New Zealand Neonatal Network (ANZNN). The data is analysed and compared with data collected from Hospitals both in Australia and New Zealand providing a core data set. The ANZNN publish a report with the intention of improving clinical practice while maintaining national standards of evidence-based care.

Parents/Primary caregivers are involved with their babies care and are kept informed of their treatment.


Related Policies, Procedures, Guidelines and Legislation

PoliciesCooling for HIE




14 of 24


CHHS15/058

References

Anand K.J.S., Garcia-Prats J., &Kim M. (2008) Assessment of Neonatal Pain. Literature Review Up to Date www.utdol.com/online/content/topic.do?topicKey=neonatol/30909&view=print downloaded from World Wide Web 24/06/2008

ANZNN (2007) Best Practice Clinical Guidelines: Assessment and management of neonatal pain Stevens B., Johnstone C., Petryshen P.& Taddio A. (1996) Premature Infant Pain Profile development and initiate validation, Clinical Journal of Pain, 12(1): 13 – 22.

Bryanton, J., Walsh, D., Barrett,M., & Gaudet, D. (2006) Tub Bathing Versus Traditional Sponge Bathing for the Newborn. 33: 6, 704-712.

Deacon, J. (2005) “Parental preparation” Thureen, P., Deacon, J., Hernandez, J. & Hall, D. In Assessment and Care of the Well Newborn, Missouri, Elsevier.

Gibbins S., Stevens B., Yamada J., Dionne K., Campbell-Yeo M., Lee G., Caddell K., Johnston C., & Taddio A. (2013) Validation of the Premature Infant Pain Profile-Revised (PIPP-R), Early Human Development. 90. 181-193.

Kent, A., Kecskes, Z., Shadbolt, B. & Falk, M. (2007) Normative blood pressure data in the early neonatal period, Pediatric Nephrology, 22:9, 1335-1341.

Kent, A., Meskell, S., Falk, M. & Shadbolt, B. (2009) Normative blood pressure data in non-ventilated premature neonates from 28-36 weeks gestation. Pediatric Nephrology, 24, 141-149.

Stevens B.J., Gibbins, S.,Yamada J., Dionne K., Lee G., Johnston C., & Taddio. (2014) The Premature Infant Pain Profile-Revised (PIPP-R) Initial Validation and Feasibility, Clinical Journal of Pain, 30(6), 238-243.

Thureen, P., Deacon, J., Hernandez, J. and Hall, D. (2005) Assessment and care of the well newborn. 2nd Ed, Elsevier, St LouisChollopetz da Cunha, M & Procianoy, R MD, (2005) Effect of bathing on skin Flora of preterm newborns, Journal of Perinatology 25, 375–379.




15 of 24


CHHS15/058

Search Terms

Neonatal Intensive Care Maternity Infant, newborn Neonate Oximetry Pulse Oximetry Weight

Length Head circumference Observations Assessment Bathing Parent Education


Consultation

Name/position/Division of person(s) consulted

Feedback ReceivedYes/No

Feedback incorporatedYes/No

Comment

A/g CSN NICU/SCNWomen, Youth and Children

Yes Yes Changes made to observations and assessment each shift

Clinical Director Department of Neonatology,Women, Youth and Children

Yes Yes Changes made to weight/length /head circumference

Staff Specialist Department of Neonatology,Women, Youth and Children

Yes Yes Changes made as suggested




16 of 24


CHHS15/058

Appendices

Appendix A: Equipment WeightsAppendix B: Premature Infant Pain Profile-Revised (PIPP-R)Appendix C: Blood Pressure

Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved By17 August 2014 Section 1 ED/CHHSPC Chair



17 of 24


CHHS15/058

Appendix A: Equipment WeightsWeights of equipment, leads and attachments to be deducted when weighing babiesEquipment WeightsVygon ETT 4 gramsBlue line ETT 3 gramsNeobar 2 gramsPneumotac 14 gramsCPAP Large Velcro + 2 small Velcro straps 10 gramsCPAP 2xside strips + 1 x toggle 10 gramsCPAP chin strap & 2 small Velcro straps 2 gramsCPAP snorkel size 18 gramsCPAP snorkel size 20 gramsCPAP snorkel size 23 gramsCPAP hat small 28 gramsCPAP hat medium 36 gramsCPAP hat large 49 gramsTrache care 26 gramsTrache care Y connector 4 gramsChest tube Fr 10 2 gramsChest tube Fr 12 3 gramsChest tube connector 4 gramsReplogle tube 32 gramsHigh flow nasal cannula 14 gramsNasal cannula neonate 49 gramsLow flow nasal prongs 65 gramsOptiflow nasal cannula - purple 12 gramsOptiflow nasal cannula – orange 8 gramsOptiflow nasal cannula - Red 6 gramsChest leads (3m red dots) x3 6 gramsMasimo sats probe 5 gramsTCM Rings 1 gramsFeeding tube size 5 2 gramsFeeding tube size 6.5 3 gramsFeeding tube size 8 4 gramsBrainz leads x 5 35 gramsBrainz Needles x 4 20 gramsEar muffs x 1 2 gramsBrainz wrap hat 16 gramsFitted name tag 2 gramsIlliostomy bag 2 gramsUrine bag 2 gramsHollister colostomy pouch 4 gramsStoma bag with clip lock 10 grams



18 of 24


CHHS15/058

UVC double lumen 2 gramsUAC 2 grams2 way chooks foot extension 6 gramsIV canulla nil3 way tap 4 gramsPall IV filter 4 gramsLipid filter 5 gramsArm board large 9 gramsArm board small 6 gramsExtension line 6 gramsLong line BD 5 grams3 way chooks foot extension 12 grams



19 of 24


CHHS15/058

Appendix B: Premature Infant Pain Profile-Revised (PIPP-R)

Premature Infant Pain Profile-Revised (PIPP-R). *Subtotal for physiological and facial indicators. If subtotal score > 0, add GAand BS indicator scores. **Total score: subtotal score +GA score + BS score. BS indicates behavioural state; GA, gestational age.



20 of 24


CHHS15/058

Appendix C: Blood Pressure



21 of 24


CHHS15/058



22 of 24


CHHS15/058



23 of 24


CHHS15/058



24 of 24


neonatal routine care · web viewincubator air temperature has been consistently 290c or less over...

Documents