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Neonatal Intensive Care Monitoring. Overview Neonatal Blood Gases Pulse Oximeters Neonatal Hemodynamic Equipment Transcutaneous Monitors. Neonatal Blood Gases - Sampling Possibilities. Arterial Gases Venous Gases Capillary. Arterial Gases. Radial, Brachial, Temporal Punctures

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Presentation Transcript
neonatal intensive care monitoring
Neonatal Intensive Care Monitoring
  • Overview
    • Neonatal Blood Gases
    • Pulse Oximeters
    • Neonatal Hemodynamic Equipment
    • Transcutaneous Monitors
neonatal blood gases sampling possibilities
Neonatal Blood Gases - Sampling Possibilities
  • Arterial Gases
  • Venous Gases
  • Capillary
arterial gases
Arterial Gases
  • Radial, Brachial, Temporal Punctures
  • Radial Artery Line
  • Umbilical Artery Gases
  • Umbilical Artery Catheter (UAC)
  • Preductal placement vs postductal placement
venous gases
Venous Gases
  • Drawn from Umbilical Venous Catheter (UVC)
  • Not desirable but......
capillary gases
Capillary Gases
  • Drawn from heel
  • Procedure:
    • heel warmed to ‘arterialize’ blood
    • lancet puncture
    • blood flows, trapped in capillary tube

Preferred Sites

variability in cap gases
Variability in Cap Gases
  • Warming time
  • Amount of contact with air
  • Squeezing blood
  • As a result, not desired but .......
comparative
Comparative
    • pH pCO2 HCO3 PO2
  • Arterial 7.4 40 24 60-80
  • (term)
  • Arterial 7.4 40 24 50-70
  • (preterm)
  • Capillary 7.4 40 24 40-50
  • Venous 7.35 45 24 35-45
pulse oximeters
Pulse Oximeters
  • Sites of attachment

(foot and hand)

  • Preductal placement in first twelve hours

(right hand)

pulse oximeters9
Pulse Oximeters
  • Reads high
    • Methemoglobin
    • Caboxyhemoglobin
    • Jaundice
  • Reads low
    • Medical dyes
  • Other causes of inaccuracy
    • Motion
    • Hypothermia/vasoconstriction
    • Hypotension
    • Excessive ambient light on sensor probe
hemodynamic monitoring
Hemodynamic Monitoring
  • Umbilical Artery Catheter (UAC) preferred
uac insertion procedure
UAC Insertion Procedure
  • Insertional position 1/3 length heel to crown
  • Procedure
    • sterile field and drape
    • purse string suture around umbilicus
    • cut cord and snug
    • tease umbilical artery open
    • insert catheter
    • fix position
    • follow with CXR
monitoring uac post insertion
Monitoring UAC Post Insertion
  • Position of catheter tip

(aortic arch is preductal and not preferred) Normal position above diaphragm

(low position is L3-L4)

  • Monitor leg color of infant

(blanching indicates obstruction of flow)

indwelling uac gases
Indwelling UAC Gases
  • Orange Medical Company
  • PO2 electrode at tip of catheter
  • Provides continuous reading

Cathode

Anode

transcutaneous gas monitors
Transcutaneous Gas Monitors
  • Useful as ‘trend’ monitor
  • Can detect hypoxemia, hyperoxemia
  • Can detect hypocarbia, hypercarbia
  • Also responds to changes in blood flow
types of transcutaneous monitors
Types of Transcutaneous Monitors
  • Single Electrode Models
  • PO2 most common
types of transcutaneous monitors16
Types of Transcutaneous Monitors
  • Dual element electrodes
  • PO2 and PCO2
  • Called TcPO2 and TcPCO2
principle of operation tc monitors
Principle of Operation Tc Monitors
  • Heated electrode placed on skin
  • Temperature 43 to 45 C
  • ‘Arterializes’ sample
  • Gas diffuses through skin
calibration of transcutaneous monitors
Calibration of Transcutaneous Monitors
  • Requires high and low calibration
  • TcPO2
    • Can be done with chemical zero and room air
    • Most commonly done with cylinders

Calibration value = Concentration of gas in cylinder x Pb

Using a cylinder that contains 10% O2, what would be the calibration value of a TcPO2 device if the barometric pressure was 760?

Calibration value = .1 x 760 = 76 mm Hg

calibration of tcpco2 devices

Calibration value = .1 x 760 = 76 = 47.5

1 .6

1 .6

Calibration of TcPCO2 Devices
  • Similar to TcPO2 except.......
  • 1.6 is the factor that accounts for heating increasing CO2 production

Calibration value = Concentration of CO2 x Pb

1 .6

normal transcutaneous gases
Normal Transcutaneous Gases
  • TcPCO2 is 35 to 45 torr
  • TcPO2 is 50 to 70 torr
advantages of transcutaneous monitors
Advantages of Transcutaneous Monitors
  • Decreased number of ‘sticks’
    • cost reduction
    • lower infant risk (less invasive)
  • Trend tool
    • blood sample provides ‘view’ at one moment
    • gases values wander (+ 7 torr)
    • infant reaction to sample varies
problems with transcutaneous monitors
Problems with Transcutaneous Monitors
  • Labor Intensive
    • Change site every 4 to 6 hours or more
    • Limited choices for attachment
    • (site must have perfusion)
    • Air leak around electrode
  • Burns
    • called ‘hookies’ after Huch
interpretation of tc results
Interpretation of Tc Results
  • Air leak under electrode
    • TcPCO2 reading near zero
    • TcPO2 reading near PbO2
  • Decreased perfusion under electrode
    • TcPCO2 will increase
    • TcPO2 will decrease