Brief Introduction of Critical Neonatal Transfusion Equipment

Author: Release time:2016-09-13 Browse13736Second

With the establishment of the newborn transfer system in various medical institutions, there must be a corresponding instrument, equipment and drug configuration, configuration of equipment is expensive, the following describes some of the equipment is essential, such as transfer incubator, oxygen saturation meter , Some equipment can be gradually configured according to the funding situation, experience shows that, as long as the establishment of appropriate transport network, pay attention to the stability of the vital signs before proceeding to avoid transshipment sudden change in condition and caught by surprise, it is not necessary to all instruments Only to start transhipment work.

1, transport with warm box (transport incubator) [1]

Mainly used for transport during the maintenance of high-risk children's body temperature constant, to ensure oxygen supply and prevent bacterial infection in the box, a good transfer with the warm box, in addition to the neonatal compartment in the warm box with the general characteristics, still require small size, Can be fixed on the ambulance, especially in the following performance: ① the best double-layer transparent thermostat cover, children can avoid radiating heat and avoid external temperature on the impact of temperature inside; ② have built-in battery, rechargeable The use of more than 2h, can also access car 12 volt battery or external 12-24 volt battery, which can be used continuously for 2-4h; ③ have enough light inside the box to facilitate observation or treatment during transit children; Maintain a certain temperature of the box temperature, transfer temperature range of domestic warming box set to 25-37 ℃, import warm box is 33-39 ℃, which will alarm more than 38 ℃ and automatically cut off the power to prevent children with hyperthermia; (21-60%), when the oxygen supply, the outside air can be mixed with oxygen through the bacteria filter into a mixture of gas (1), the oxygen concentration of oxygen, , And then by the humidification tank so that the mixture humidity of about 60%, and then by the nozzle, so as to maintain a certain humidity inside the box, carbon dioxide through the lower part of the stomatal outflow of the box; ⑦ box with a seat belt to children, ⑨ light weight, usually about 25kg (including the two subsidiary of the small oxygen cylinder); ⑩ me (including the small oxygen tank); ⑨ box, Body can be placed in the lift car, easy access to the ambulance or walk on the ground.

2, transport with ventilator (transport ventllator) [2]

For neonatal ventilators used for transvaginal breathing support, a constant-speed airflow, time (or volume-time) switching and a pressure-limited portable ventilator are used. (2) breathing patterns, including intermittent positive airway pressure (IP-PV), intermittent mandatory ventilation (IMV) and sustained (1) for the use of intermittent positive pressure ventilation Positive airway pressure (CPAP); ③ suction / expiratory time, respiratory rate, inspiratory flow, inspiratory peak pressure, positive end expiratory pressure, oxygen concentration adjustable; ④ a lack of power, air flow, ⑥ have a fixed pressure safety device can limit the airway pressure is not higher than 6.86kPa or not less than 0.25kPa. ⑥ can be connected to the 12 volt power supply; ⑥ have an internal battery to facilitate the use of recharge; The difference lies in the size, weight, which is the size of the internal battery and whether the other auxiliary functions. Large, heavy weight (10.5-12kg) ventilator, if the internal battery, continuous use after charging 10h; if the battery is small, can only be used after charging 40min, but the machine with an air compressor without external compressed air Bottles, with oxygen concentration measuring device and heating and humidification device; or a breathing mode such as auxiliary / control ventilation, synchronous command ventilation, on-demand air flow and pipeline obstruction alarm. The small size, light weight (2-4kg) is no additional devices or breathing mode, or with an external air-oxygen mixer, the internal battery charge available after 6-8h. The overall requirements of the ventilator for transport is small, light weight, easy to operate and easy to observe parameters, less oxygen consumption, can be fixed in the warm box or lathe, seismic and anti-tilt performance.

3, hand-held pulse oximetry (protable pulse oxymeter) [3]

Pulse oximetry for continuous monitoring of children with oxygen saturation and pulse rate, the instrument in two parts, the central part of a microcomputer, the surrounding part of the sensor, which consists of light-emitting diodes and photodiode composition. According to the difference of absorption of red light by infrared light and reduced hemoglobin by oxygenated hemoglobin when the light source passes through the tissue, the wavelength of the light source diode reaches 660nm (red light) and 940nm (infrared light) Calculated by the micro-computer oxygen saturation, because the absorption rate varies according to the pulse rate, it can also be measured pulse rate.

Hand-held transfer pulse oximetry, small size, light weight (0.2-0.5g) easy to carry, a visual alarm signal to monitor the situation in children, the use of 6-9 alkaline batteries, can be used continuously 12- 100h. The center part can set the calendar, time, and saturation upper and lower limits, pulse rate on the lower limit and power shortage, improper connection alarm. The sensors used are repetitive or single-use. General use of repetitive sensors: including the folder in the thumb, for the 2-20kg baby activity sensor. For accurate measurement, make neonatal activity sensor ≤ 2kg. For accurate measurement, the sensor position should be the same level with the heart position, the tape not tied too tight, so as not to impede blood flow.

Blood oxygen saturation (SaO2) in a certain range and blood oxygen partial pressure (PaO2), but not a linear relationship. Hypoxia changes more sensitive than PaO2, high oxygen PaO2 is high, but very little change in SaO2, so the instrument can be used to monitor hypoxemia, but can not monitor hyperoxemia. When using the instrument should pay attention to two points: ① should be selected for neonatal instruments, such equipment when the oxygen saturation of 75-95%, the accuracy of ± 3%; ② children with blood pressure, heart rate, blood carbon dioxide Partial pressure, blood pH, body temperature, hematocrit, serum bilirubin, etc., have an impact on the SaO2.

4, injection pump (syring pump) [4]

Common injection infusion pump for antibiotics, drugs and intravenous infusion of high nutrient solution, in addition to special purpose injection pump such as for physiological research, heparin anticoagulant therapy, diabetes, insulin injection, careful not to use.

② mechanical devices: usually with a push pulley to guide the screw or directly from the motor through the tape to drive the syringe to promote; ③ electric device: the motor, the motor is equipped with a syringe, Can be connected with the lead screw or wheel; ④ electronic control device, used to set the infusion parameters and alarm.

Different products, its appearance, volume, micro-control level are different. Infusion for the newborn infusion pump requirements are the following conditions: ① injection speed: 0.1-99.9ml / h adjustable; ② infusion accuracy of ± 1%; ③ wide range of syringes: most manufacturers of 10-15ml syringe Can be applied; ④ fast key to clean the pipeline; ⑤ alarm device: including improper selection syringes, placement error, the infusion time remaining 3min, injection is completed, empty syringe, the pressure is too high (blocked) Battery failure, internal failure; ⑥ built-in battery can be used continuously after charging 8-15h. Good injection pump still has: ① self-prompted set, connected to the power, the instrument will prompt the electronic signal for each step in order to not familiar with the equipment used by the staff; ② automatically calculate the injection speed or injection time: Volume, and time (or speed) required, the pump automatically determines the injection speed (or time) for easier use.

Compared with the capacity of infusion pump, infusion pump small size, light weight, portable and easy to use, uniform injection speed, injection accuracy, it is more suitable for neonatal transport applications. But the following problems: ① no air guide alarm device; ② repeated replacement of syringes and use the same catheter, the higher the risk of infection; ③ pump placed too oblique or due to obstruction pressure is too high, can cause the liquid from the rear of the syringe overflow, Use caution.

5, trace blood glucose meter (portable blood glucose monitor) [5]

Mainly used for monitoring the blood sugar during transit, there are a variety of brands, characterized by light weight (80-100g), detection speed (20-45 seconds), easy to use (6-9 V alkaline battery can detect 800- 1000 times), according to its detection principle is divided into light-sensing type (including light reflection intensity detection and light absorption intensity detection) and biological sensor type (electrochemical detection), but the detection method are capillary blood drops on the test paper , And then into the host to detect.

Not all micro blood glucose meter can be applied to newborns for neonatal good trace glucose meter requirements: ① detection range: neonatal normal blood sugar below the adult, <2.2mmol / L is a newborn hypoglycemia, it is suitable for Neonatal blood glucose meter, the detection limit should be 1.1 or 0.55mmol / L (10mg / dL), the upper limit of blood glucose meter in more than 22.2-33.3mmol / L (400-600mg / dL) between; ② detection of blood: The newborn is not easy to obtain a larger drop of blood capillary blood, so the blood glucose meter should be minimized. Blood volume should be in the range of 3.5-5ul, should pay attention to blood volume can lead to blood glucose was significantly lower; ③ accuracy: and the hospital biochemical chamber detection of venous plasma glucose (VPG) compared to trace glucose meter is the detection of capillary whole Blood glucose (CBG), when VPG <4.44mmol / L (80mg / dl), the intracellular glucose concentration was no significant difference between plasma and whole blood glucose equal, but slightly higher than the arterial blood glucose Blood glucose, so CBG slightly higher than the VPG, but the error is only 0-2.9% for neonatal glucose meter, should achieve this accuracy. When the VPG> 4.44mmol / L, the extracellular sugar into the cells due to a certain degree of obstacles, extracellular sugar began to gradually higher than the intracellular sugar (plasma glucose began to be higher than whole blood sugar), then CBG low In the VPG, the error of 7.7-8.4%; ④ have repeatability or stability: the same batch of test strips repeated testing, the error should be <5%; ⑤ anti-interference: the common endogenous substances in the newborns , Bilirubin, lactic acid, creatinine, exogenous substances such as dopamine, vitamin C, sodium citrate, etc., can lead to high blood sugar. Some biosensor microgammeters can detect potentially interfering substances and reduce their effects so that blood glucose levels are undisturbed.

Although the use of neonatal blood glucose meter, should pay attention to different products, when the hematocrit <20-40%, the blood sugar will be high;> 60-76%, the blood sugar will be low. In severe dehydration, shock, blood glucose will be low and the error is large. When found to have hypoglycemia, it is best to make a correction after the determination of time to exclude human error (such as test strips expired, lack of blood).

6, transit apnea monitor (transport apnea monitor) [6]

Apnea monitoring, monitoring and monitoring of children with respiratory conditions, the detection methods are mainly two types: Indirect measurement method: breathing through the pressure pad, abdominal sensor or airway breathing monitor, conduction signal to the respiratory impedance meter or Lt; / RTI & gt; volume sensor. Direct measurement: the use of proximal body pressure sensor and carbon dioxide sensor to measure the lungs out of the air flow and the signal sent to the thermistor and be perceived. When the breathing stops for a period of time, the instrument can send an alarm.

Apnea monitor more types, different functions, there are separate for the monitoring of respiratory conditions, there are also for ECG monitor, which is similar to respiratory ECG monitor, there may be for oxygen saturation and noninvasive blood pressure monitoring By.

Preterm infants, low birth weight infants or high-risk children prone to apnea, due to transit during the car vibration, breathing weak children, their breathing is not easy to observe with the naked eye, the use of apnea monitor, set some monitoring parameters, Apnea time exceeds the set value can be alarm, is conducive to the treatment of children.

A good neonatal transhipment apnea monitor, requirements: ① single function: the newborn unless there is a heart disease, generally during transit for ECG monitoring is not meaningful, because during the transfer of cardiac electrode placement is often inaccurate, then display The heart rate and the actual waveform has a certain gap without analysis of the value of only monitoring the heart rate with pulse oximetry has reached the purpose; ② small size, light weight, easy to carry: weight selection 0.3-0.6kg; ③ sensitivity Respiratory rate display and visual, audible alarm; ⑤ with 1-4 alkaline batteries, working time for the 400-2000h, the use of anti- Some with button batteries, the individual can still be an external AC power; ⑥ sensor with abdominal sensor or pressure pad.