Equipment used in the NICU
The Neonatal Intensive Care Unit has equipment for stabilizing and monitoring severely ill newborns. Some equipment is used by almost every baby in the NICU and some is used on an as-needed basis. This is an overview of the most commonly used equipment. It can be overwhelming to see your baby surrounded by wires and monitors, but understanding why the equipment is needed and it's function may help you look beyond the machines and see your newborn.
Radiant warmer/isolette/giraffe bed:
This allows medical staff to observe and stabilize the baby and maintain his or her temperature. Medical procedures require most babies to be placed in an open radiant warmer. These beds have an overhead heat source that provides constant temperature regulation. The baby's temperature is monitored using a probe attached to the skin with an adhesive patch. The heat turns on and off according to the baby's temperature. Infants need to be kept warm because complications like breathing problems and low blood sugar are associated with lower-than-normal temperature.
This machine looks like a small flat screen TV and sounds an alarm if certain body functions fall outside an acceptable range. It has the following functions:
- Cardiac monitoring: This monitors heart rate and rhythm. Adhesive patches with wires attached to the baby's chest, abdomen and/or leg monitor heart rate and rhythm. NICU nurses listen to the heart for the rate and heart sounds. The nurse records the heart rate frequently to determine your baby's normal range. Most infants have faster heart rates than adults. The average rate for infants is 120-160 beats per minute. Knowing when your baby's heart rate is faster or slower than normal helps doctors and nurses detect problems like infections or breathing problems.
- Respiratory monitoring: This monitors breathing rate and pattern. Nurses frequently monitor and record your baby's breathing rate and pattern. While the nurse counts the breathing rate, he or she also listens to make sure the lungs sound clear. Excess fluid in the lungs can make breathing sound different than normal. Another respiratory complication is a collapsed lung, indicated by unequal sounds on each side. The normal breathing rate for an infant is faster than for an adult. The average rate is 30-60 breaths per minute. Changes in rate can indicate breathing problems.
- Pulse oximetry: This monitors oxygen saturation, or the amount of oxygen in the hemoglobin. Hemoglobin is a substance in the blood that carries oxygen to organs and body tissues. A light sensor attached to the hand or foot measures the saturation level. Ask your baby's nurse about the normal range for your baby.
- Arterial pressure: Many babies in the NICU will have an umbilical artery catheter placed in an artery in the umbilical cord stump that is left after the cord is cut in the delivery room. A transducer attached to the catheter monitors blood pressure. The blood pressure is displayed on the screen. Fluids and medications can be given through the catheter, and blood can be removed for testing.
- Central venous pressure: A central line catheter is threaded into the heart's top right chamber, allowing central venous pressure to be measured. CVP indicates fluid balance. Central lines can be placed by several ways. Some babies will have an umbilical venous catheter placed into the vein located in the umbilical cord stump that is left after the cord is cut in the delivery room. Other ways to place a central line include:
1. Into a major vein through an incision in the chest wall.
2. Through a "cut down," or small surgical incision made at the site of a major vein.
3. Through a vein not in the chest or abdomen (often times in the arm). This is a called a peripherally inserted central catheter.
CVP is not a common measurement used in the NICU. It is used more frequently in the Pediatric Intensive Care Unit (PICU) for post-operative cardiac procedures.
Blood pressure cuff and monitor:
If your baby does not have an umbilical artery catheter to monitor blood pressure, nurses check blood pressure with a cuff that is inflated and deflated to get the pressure reading. If frequent readings are needed, the baby may be attached to a blood pressure machine that inflates the cuff and checks pressure at frequent intervals.
Nasal gastric/oral gastric tube:
Many infants in the NICU will have one of these tubes in place. While infants are being stabilized and evaluated, they usually are not allowed to eat anything by mouth. To keep the stomach deflated or empty of air and gastric content, a tube is passed through the nose or mouth into the stomach. The tube is left open so anything in the stomach can drain out. When the baby is ready to eat, breast milk or formula can be given through an NG or OG tube if needed.
Peripheral intravenous and intravenous pumps:
These lines are common among babies in the NICU and can be placed in the hand, arm, foot, lower leg or scalp. Babies can receive fluid and medication through these lines with an intravenous pump. Pumps allow the amount given to be monitored closely. Some medications are given over a specified time period, and pumps can ensure the entire dose is given in that time frame. Babies who do not eat by mouth can receive all their nutritional requirements through IV lines. This is called total parenteral nutrition (TPN). Pumps dispense the fluid at a steady rate so blood sugar levels remain constant. In TPN, two types of IV solution are used:
- Hyperalimentation: This yellow solution contains all the proteins, sugar, vitamins, minerals, electrolytes and calories the baby will need to grow. The content or amount of each component is partly determined by doing blood work to evaluate electrolyte levels in the baby's blood.
- Lipids: This solution contains fats the baby needs to grow. The solution is white and looks like milk.
Urinary catheter and drainage bag:
Intake and output are monitored on most infants in the NICU. Intake is anything that is taken in, including IV fluids, blood products and formula or breast milk. Output is anything removed or eliminated from the baby. Output can include urine, stool, NG/OG drainage or chest tube drainage. A baby's diaper can be weighed before it is put on and after it is soiled and removed. This provides a rough measurement of urine and stool output. Urine is sometimes collected in a bag attached to the baby's vaginal area or around the penis. The urine can be removed from the bag and measured without taking the bag off. This is more accurate. The most accurate measurement of urine output is done by inserting a catheter through the urethral opening (area in the genitalia where urine passes out of the body) into the bladder. Urine flows through the tube into a drainage bag for measurement. The urine may be tested to evaluate the baby's well-being.
If your baby has a collapsed lung, a chest tube may be placed in the area the lung should occupy. Some surgeries require a chest tube. The chest tube is connected to a pleurovac or waterseal drainage system. This creates a suction that allows the collapsed lung to re-expand into the space and heal. Drainage is removed by the chest tube and collects in the drainage system.
Phototherapy or bililights:
Hyperbilirubinemia is an increased level of bilirubin in the blood. Bilirubin is a byproduct of red blood cells breaking down. The liver removes this waste. Bilirubin can build up in the blood when too much is produced or if the liver is not mature enough to keep up with the amount being made. Bilirubin is sensitive to light waves, which break it down so it can be excreted in the urine and stool. While a baby is under phototherapy, his or her eyes are covered. The eye cover can be removed periodically for eye contact with your baby.
This small, black attachment looks like a visor and is placed on the baby's forehead. Small disks under the visor measure blood flow to the brain. The disks are moved daily to prevent skin irritation.
Oxygen can be delivered to an infant several ways. Room air is 21 percent oxygen, but percentages of oxygen up to 100 percent can be delivered.
- Oxygen can be delivered through a clear plastic hood placed around the baby's head if he or she is breathing well alone. The baby can be removed from the hood to be held. Tubes delivering oxygen to the hood can be held near the baby's face while he or she is out of the hood.
- Oxygen can be delivered through nasal cannulas. This is the same type of system you may have seen on an adult. Soft plastic tubing with prongs in each nostril is attached around the head. Babies can eat and be held while getting oxygen this way.
- Continuous positive airway pressure is a method of assisted breathing. Constant pressure is supplied so the tiny air sacs in the lungs stay open when the baby exhales. This allows the baby to breathe with less effort. The positive pressure also can be used to deliver oxygen. CPAP can be delivered two ways.
1. Pressure and oxygen are delivered through prongs that completely cover the nostrils.
2. The baby is intubated, meaning a special tube called an endotracheal tube is passed through the vocal cords into the windpipe. This prevents the baby from making noise.
- Mechanical ventilation is a way of breathing for the baby. This machine is also called a respirator. The baby is intubated, and the ventilator delivers oxygen, positive pressure and breaths at a specified rate. In some cases, the ventilator does all the breathing, and in others, the baby can do some of his or her own breathing. The endotracheal tube will be suctioned to remove discharge from the baby's windpipe. There are different types of ventilators, and the differences will be explained if your baby needs one.
Weighing a baby daily helps medical staff assess his or her well-being. It is a delicate balance to provide sick newborns with the right amount of fluids and nutrition. Accurate intake and output records help doctors and nurses see how well the kidneys are keeping up with the fluids given. Daily weights are another way to assess fluid levels. If the kidneys are not functioning normally, a baby may gain weight faster than normal because he or she is retaining fluid. Fluid retention also can indicate decreased cardiac function.
Another type of scale found at the bedside is used to weigh diapers. The diaper is weighed before it is put on the baby and again after it has been soiled and removed. The difference between the weights is the amount of output. This is not the most accurate way to determine output, but it provides information used to assess your baby's kidney and bowel function.
Suction equipment is located at each NICU bedside. Many babies need discharge suctioned frequently, especially babies with ETTs or on ventilators. The suction machine is used for deep suctioning. It is used with a catheter that can be passed into the throat or tubes, like the ETT. Another type of suction is the bulb syringe, which is used to suction the nose and mouth only.
Oxygen with bag and mask: This is another piece of equipment that is at every NICU bedside. It is provided for emergency use. It may be used if a baby not on oxygen suddenly needs supplemental or increased oxygen. It also may be used for a baby who is not breathing well enough to provide enough oxygen for his or her body. Some babies have apnea (long pauses in breathing) or bradycardia (slower-than-normal heart rate) that can become serious enough to require breathing assistance to increase the heart rate. An oxygen bag and mask also may be used if a tube is accidentally removed until the baby is re-intubated.