Nitric Oxide
Monitoring

 

 Authorised by:
Charge Nurse - Newborn
June 2007
Clinical Guidelines Back Newborn Services Home Page
Printer NOx Emptying water trap for Printer NOx Monitoring and Documentation NOx Air Monitor

Printer NOx

Printer NOx

Process

Step

Action

1

 When not in use and for long term monitoring, keep printer NOx plugged into mains power.

Printer NOx has batteries with a life of 3 hours.

2

 Connect the water trap and sampling line (single patient use) into machine (see diagram).

3

 Switch on Printer NOx (switch is at rear of machine). An introduction screen and printing occurs at this point.

4

 Calibration status then shows on screen. Calibration will be performed monthly by Anaesthetics. If calibration is due to be performed and machine is in use it can be overridden by pressing enter and sampling will continue. Send Printer NOx for calibration when free.

5

 Press enter.

This displays the ‘select option’ menu. To acquire:

  • Measurement - press 1
  • Set alarms – press 3
  • To return to menu – press 4

6

 To set alarms:

Press enter to bring up menu.

  • Press 3 to bring up alarm options.
    • Set NO alarm at 5 above and 3 below prescribed amount of NO.
    • Set NO2 at 1.
  • Press 4 to return to previous select option menu.

NB: The Printer NOx will default to measuring after 45 seconds.

Emptying Water Trap for Printer NOx

Empty the water trap

Step

Action

1

 Take extreme care with water trap. Empty when near full or when instructed by the machine ‘empty water trap.

2

 Unscrew the two retaining screws and remove the water trap from the Printer NOx.

3

 Disconnect the NO sampling line from surfactant connector and occlude the hole with a luer plug.

4

 Connect syringe adapter to water trap (filter end).

5

 Connect 20ml syringe to adapter.

6

 Use specimen pot to collect water from sampling line.

7

 Flush with air through the water trap and NO sampling line to empty water trap.
8 Reconnect water trap to the Printer NOx and secure with the two retaining screws.
9 Reconnect NO sampling line to surfactant connector.
10 Press 1 for measuring to continue.

Monitoring and Documentation

Process
  • Follow the steps below while administering Nitric Oxide to ensure appropriate monitoring is in place to maintain safety for the baby and documentation is complete.

Step

Action

1

 Concentration of Nitric Oxide is adjusted and documented by Doctor/NS-ANP on ventilator chart in ppm.
2 Nursing staff:
  • An experienced Level 3 Nurse or Level 4 Nurse who has attended a NO/HFV study session, cares for baby
3 Ensure at the beginning of each shift the concentration of NO prescribed on ventilation chart is consistent with the level showing on the Printer NOx and signed as correct by the nurse.
4 NO and NO2 levels are monitored continuously and checked and documented on the ventilation chart, in ppm hourly. Upper safety level of NO determined by Medical Staff for each individual baby.
5 If NO readout levels rise, check that there is not a leak or loose fitting in ventilator circuit. If  ventilator alarms indicating no gas flow from ventilator, bag baby attaching the NO sampling line to the Nitric adapter delivery line of anaesthetic bag (otherwise baby receives 800ppm NO).
6 If NO2 levels >1ppm notify Doctor/NS-ANP. NO2 levels should not exceed 3 ppm.
7 Methaemoglobin levels should not exceed 3% (measured with each blood gas).
8 Observe water trap in Printer NOx sampling line and empty PRN. If this over fills, water will run back to baby.
9 Monitor Blood Pressure continuously and document hourly.
10 Circuits are not changed routinely without discussion with Doctor/NS-ANP as baby may deteriorate rapidly if NO is discontinued (due to very short half life of NO).
11 During a circuit change hand bag baby until NO and NO2 monitoring is stable (Doctor/NS-ANP present).
12 When baby is reintubated or hand bagged cap ventilator end. DO NOT TURN VENTILATOR OFF AS THE NO AND NO2 LEVELS RISE IN THE TUBING.
13 Observe and monitor baby closely for signs of deterioration during any trial off NO. (Consultant orders this to determine need for continuing NO administration)
14 Replace cylinder if less than 300 pounds per sq inch (psi). (If baby is on i.e. 20ppm of NO and a ventilator flow of 10, the cylinder only drops one little line over 24 hour period.).  CCN to order new cylinder.

NOx Air Monitor

Step

Action
1 NOx air monitor. Hangs on ventilator when in use.
2 Turn NOx air on (tests). Will tell you state of batteries. If level under 100 need to replace batteries. (4 pen light batteries). Needs Allen key to open. After hours phone Shift Engineer. Day hours phone Electronics.
3 Turn the dial to gas to start monitoring. Has green light that flashes every 3 seconds.
4 Alarms (pre set). Will alarm if level goes over 3. If over 3 consider the possibility of a NO leak.
5 Calibrate every 6 months (date on monitor when due). Monitor goes to Anaesthetics (same as NOx box) or Medical Electronics for a battery change.


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