Administration and Monitoring of Phototherapy

 

Reviewed by Cherry Olsen

April 2010
Clinical Guidelines Back Newborn Services Home Page
Purpose Medela Phototherapy Lamp Ohmeda Biliblanket Phototherapy Lite Meter

Purpose

The following policy/recommended best practice outlines the use of phototherapy lights and the Ohmeda Biliblanket to ensure the best outcomes for babies in the Newborn Service.

Scope

Applies to all Nurses who work in Newborn Services

Associated Documents

Operating manuals for:

  • Medela Phototherapy Lamp (Instructions for Use)
  • Minolta/Airshields Fluoro-Lite Meter (Model 451)
  • Biliblanket Plus Phototherapy System (Operation, Maintenance and Service Manual)

Medela Phototherapy Lamp

Step Action
1 Position phototherapy unit 25-30cm from baby in a cot or 5cm above the top of the incubator.
2 Baby is nursed naked.
3 If the infant is in an incubator, the light rays should be perpendicular to the surface of the incubator in order to minimize loss of efficacy due to reflectance.
4 Use appropriate eye shields (size and type) to protect the eyes.
  • Baby shades (small)
  • Baby shades (large) - used hydragel adhesive to position on baby
  • Eye Max (term infants)
5 Eye pads should be removed 4 hourly and eye cares attended with normal saline.
6 Feeding /IV Fluids:
  • Term Babies: Complementary feeds in the form of intragastric or bottle feeds with EBM/formula may be required if oral intake is insufficient and there are concerns that the infant is dehydrated.
  • Preterm Babies: Preterm infants have about a 20% increase in transepidermal water loss when they receive phototherapy despite being nursed in humidity and a double walled incubator.
  • The daily fluid rate may need to be increased by 10ml-15ml/kg/day to prevent dehydration.
  • When increasing the daily fluid rate the gestational and postnatal age, fluid input and output, serum sodium levels need to be reviewed and the fluid rate must be individualised for each infant
   
7 Use the phototherapy lite meter to check the unit’s light output each duty. Output should be over 10mcw/nm/cm2 on all body surfaces.
8 To avoid the possibility of burns do not use baby lotions or creams on baby’s skin.
9 Phototherapy lamps act as a source of radiant heat.  Monitor the baby's temperature closely when commencing phototherapy and adjust incubator temperature as required to avoid overheating.

Ohmeda Biliblanket

Step Action
1 Insert the fibreoptic pad into, disposable cover.
Secure the cover around the protruding cable with the self-adhesive tabs.
Do not use without disposable cover.
2 Set the brightness selector switch to high.
3 Place covered pad directly under baby with the white illuminating side facing up.
4 Use appropriate sized eye shields to protect eyes.
5 Ensure the air circulation vents on the top and bottom of the illuminator are unobstructed at all times and that the blocked air circulation indicator is not on

Minolta/Airshields Fluoro-Lite Meter 451

Step Action
1 Place cap firmly over the receptor head dome.
2 Set the on/off switch to on. The letters ‘Cal’ should appear in the display window.
3 The ‘Cal’ display will be followed by a zero level display. This indicates that the meter is calibrated.
If the display window is blank, or three decimal points (…) appear, this indicates a weak battery.
4 Hold receptor level with the upper surface of baby. Read the digits displayed. If <10mcw/nm/cm2 remove the phototherapy unit and send to electronics for evaluation
5 If no measurement is recording, press the hold/run measuring switch. This will allow the measurement to be displayed
 

References

1 Mills, J.F. & Tudehope, D. (Updated October 31, 2009). Fibreoptic phototherapy for neonatal jaundice. [Cochrane Review]. In Cochrane Database of Systematic Reviews, 2009 (1). Retrieved October 12, 2010 from The Cochrane Library, Wiley Interscience.
2 Neonatal Jaundice Guideline. (n.d.) Retrieved October 12, 2010, from http://www.sswahs.nsw.gov.au/rpa/neonatal/html/newprot/jaund2.html


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