© Lifebox 2014. All rights reserved
Using the Lifebox oximeter in neonates
Tutorial 2 – advanced
© Lifebox 2014. All rights reserved
The Lifebox Pulse Oximeter
In this tutorial you will learn about:
• Using an oximeter correctly
• What can interfere with an oximeter
• Maintaining a pulse oximeter
• What to do when the oxygen saturation falls
© Lifebox 2014. All rights reserved
The Lifebox oximeter probe
• The Lifebox oximeter can be supplied with two types of probe: • Universal probe • Wrap around probe
• Probes contain an LED that shines
light through the finger. Transmitted light is detected by the photo detector on the other side of the finger
• The probe needs to be put on the
patient correctly!
• Probes are fragile!
© Lifebox 2014. All rights reserved
What do you think of these two probes?
© Lifebox 2014. All rights reserved
This probe is well positioned on the finger.
• Fits well
• Not too tight – Does not constrict the
circulation
• Not too loose – Will not fall off or let other
light in.
© Lifebox 2014. All rights reserved
• This probe is too small for the toe
• Forcing the probe on to a large digit in this way will damage it
• The probe will not pick up the light
© Lifebox 2014. All rights reserved
Paediatric probes
• Paediatric probes are made for small children (less than a year old).
• Alternatively a universal probe can be tried on the fingers, thumb or big toe.
• If a good signal is obtained the oximeter is working
© Lifebox 2014. All rights reserved
What can prevent a pulse oximeter reading accurately?
Can you think of 3 things that might stop a pulse oximeter reading accurately?
© Lifebox 2014. All rights reserved
Answers
• Bright light on the probe
• Patient movement
• Poor perfusion
© Lifebox 2014. All rights reserved
Bright light
• Bright light such as the operating light may interfere with the light detector
• Avoid shining bright light directly on the probe!
© Lifebox 2014. All rights reserved
Movement
Here is an oximeter attached to a neonate. The SpO2 is 97% and pulse 124bpm. The trace shows a good waveform with a regular pulse. What is the difference between the two traces on the next slide?
© Lifebox 2014. All rights reserved
© Lifebox 2014. All rights reserved
The pulse waveform is erratic and not being well detected
This baby may be moving...hold the hand or foot steady to obtain a reading
Moving is a common reason why it is difficult to pick up the oxygen saturation. Check the baby carefully before deciding the oximeter is not correct!
© Lifebox 2014. All rights reserved
How can you check if an oximeter is working?
If you are concerned whether an oximeter is working correctly - how could you check it?
© Lifebox 2014. All rights reserved
Is the probe working?
Put the probe on your own finger to check!
© Lifebox 2014. All rights reserved
Perfusion
• Oximeters need a flow of blood through the finger to function. Some oximeters give an indication of the blood flow detected.
• In this oximeter there is a scale which is an indication of the blood flow. Sometimes these have numbers on them.
• Why might this scale be important?
Why might this scale be important?
© Lifebox 2014. All rights reserved
Low perfusion..
Peripheral vasoconstriction will result in low perfusion
This is commonly due to:
• Cold
• Hypovolaemia or shock
Note the fast pulse rate and low perfusion alarm in the second image – this baby is shocked due to sepsis
© Lifebox 2014. All rights reserved
Lifebox power supply
• Mains power
or
• Rechargeable battery
or
• Normal (AA) alkaline battery – do not try to recharge these batteries
© Lifebox 2014. All rights reserved
Making the Lifebox rechargeable battery last longer
• Optimise your battery when you first receive it – Place the rechargeable battery
in the oximeter – Charge fully (4 hours) – Use until fully discharged – Recharge fully (4 hours)
• Thereafter use/recharge as required
• The oximeter should run for 12-16 hours between charges
• NOTE: readings may be inaccurate when the battery is very low
© Lifebox 2014. All rights reserved
Caring for your oximeter
Keep the battery charged in case of power failure!
© Lifebox 2014. All rights reserved
Caring for your oximeter
Clean the probe gently between patients with a damp cloth or alcohol swab
© Lifebox 2014. All rights reserved
Caring for your oximeter
• Position safely to avoid dropping or damage from spillages.
• Consider connecting to a pole or trolley using the clip supplied with the Lifebox oximeter.
© Lifebox 2014. All rights reserved
Caring for your oximeter
• When connecting the oximeter probe or lead, always insert the plug correctly. Check carefully to avoid damage.
• Note that the lead only ever inserts one way – check the shape before inserting
© Lifebox 2014. All rights reserved
Caring for your oximeter
• When disconnecting and connecting a probe, grip the plug firmly and not the cable.
• If the cable is pulled, small wires inside will break
© Lifebox 2014. All rights reserved
Caring for your oximeter
When not in use, always coil the lead and position the probe where it cannot be damaged. Too tight a coil will damage the lead. Leaving the lead dangling will result in damage.
© Lifebox 2014. All rights reserved
What to do when the oxygen saturation falls
© Lifebox 2014. All rights reserved
What is the normal oxygen saturation in a term neonate?
1. 85 - 89%
2. 90 - 94%
3. 95 - 99%
4. 100%
• Select one answer
© Lifebox 2014. All rights reserved
Normal oxygen saturation in a term neonate
1.85 - 89%
2. 90 - 94%
3. 95 - 99%
4. 100%
• Select one answer
The normal SpO2 is 95% or above. This means we need to be concerned with SpO2 readings below 95%
© Lifebox 2014. All rights reserved
Oxygen toxicity in pre-term neonates
• Too much oxygen may lead to eye damage in pre-term neonates (retinopathy of prematurity).
• Oxygen saturation should be kept between 85%-95% in babies <32 weeks gestation.
• Always monitor SpO2 and only give oxygen if needed
© Lifebox 2014. All rights reserved
When should oxygen be given to neonates?
© Lifebox 2014. All rights reserved
At birth?
• Oxygen is not usually required
• Bag and mask ventilation with air is successful in most situations – The lungs are full of fluid at
birth – The problem is failure to start
breathing or for the baby to take deep breaths to clear the lung fluid
– Babies with on-going respiratory problems (e.g. due to aspiration) may require oxygen.
© Lifebox 2014. All rights reserved
Which babies do require oxygen?
• SpO2 <90% term neonate
• SpO2 <85% in pre-term neonate
• If danger signs are present: – Central cyanosis
– Drowsy or unconscious
– Convulsions
– Breathing fast (>60 bpm) or breathing slow (<20 bpm or apnoeic episodes)
– Head nodding or grunting
– Severe chest in-drawing
– Unable to breastfeed
© Lifebox 2014. All rights reserved
Giving oxygen to neonates
• Oxygen is a limited resource and should be used carefully
– Oxygen should always be given continuously, not intermittently
– Oxygen therapy should be monitored using an oximeter
– Avoid giving too much oxygen to pre-term neonates – maintain SpO2 85% - 95%
© Lifebox 2014. All rights reserved
What should we do if the baby becomes hypoxic?
The hypoxia action plan describes steps to deal with hypoxia
By using the plan, a logical approach to hypoxia is followed.
Study the hypoxia action plan for a few minutes
© Lifebox 2014. All rights reserved
© Lifebox 2014. All rights reserved
Healthcare workers should start to investigate why the SpO2 falls to 94% in any neonate. When the SpO2 falls below 90%, the baby is becoming seriously hypoxic and the Lifebox pulse oximeter will alarm.
Urgent action is needed!
© Lifebox 2014. All rights reserved
If the SpO2<90% and danger signs are present - URGENT ACTION!!
• Give oxygen
• Give bag and mask ventilation if respiratory rate is slow (<20)
• Monitor the baby continuously
© Lifebox 2014. All rights reserved
If the SpO2<90% and heart rate is <100 – EMERGENCY INTERVENTION!!
• The heart is starved of oxygen
• Check: Airway, Breathing, Circulation
• Start Basic Life Support: – Clear the airway
– Bag and mask ventilation
– If the heart rate remains slow (<60); check ventilation is effective and add chest compressions
© Lifebox 2014. All rights reserved
Action plan for SpO2 < 94%
The next few slides will look at each part of the plan in turn and describe how to use it
© Lifebox 2014. All rights reserved
Immediate checks
Immediately the SpO2 falls below 95% - CHECK THE BABY
TAKE ACTION: • Give oxygen* • Consider bag mask ventilation to make sure the lungs are filling with
oxygen
THEN TRY TO SOLVE THE PROBLEM: • Check the probe is on correctly • Is the problem with the patient or the equipment? • Call for help if needed
• Check ABCDE
*In pre-term, only if SpO2 < 85%
© Lifebox 2014. All rights reserved
Immediate checks – call for help
Always call for help early. Hypoxia may develop rapidly. It needs emergency treatment. It is better to call someone unnecessarily than to have no help to manage a deteriorating child.
HELP!!
© Lifebox 2014. All rights reserved
• The next set of actions -
• CHECK ABCDE
• Using the plan will remind you to check everything and manage the patient logically.
• The treatment will depend on whether the problem is in the patient or the equipment. This is a crucial decision to make.
Action plan for SpO2 < 94%
© Lifebox 2014. All rights reserved
• Look for danger signs
• Check and take necessary action:
– Airway
– Breathing
– Circulation
– Drugs
• Start basic life support if required
© Lifebox 2014. All rights reserved
Drugs
• Analgesic drugs (morphine) and sedatives may cause respiratory depression
• In a newborn baby, don’t forget drugs given to the mother during labour or delivery
© Lifebox 2014. All rights reserved
Can you think of problems with the equipment that might cause hypoxia?
© Lifebox 2014. All rights reserved
Equipment
Check the oxygen supply:
• Check the pipeline is working
• Check the oxygen cylinder is not empty
• Check the oxygen concentrator is working
• Check the oxygen tubing is not obstructed or disconnected
• Always have a back-up self inflating bag and mask
© Lifebox 2014. All rights reserved
Now try to draw the whole plan for treating hypoxia from memory!
© Lifebox 2014. All rights reserved
Did you get it correct?
© Lifebox 2014. All rights reserved
Summary – in this tutorial you have learnt:
• Oximeters are essential for safe neonatal care
• Oximeters and probes need looking after carefully
• Certain factors can interfere with oximeters
• When the SpO2 starts to fall – take action!
• Use oxygen carefully and avoid too much oxygen in premature neonates
• Use the plan to help you!
Immediate checks
Airway Breathing Circulation Drugs Equipment