2 Introduction Neonatal monitoring is to set up an intensive care unit to treat the most critical newborns, such as children with respiratory failure, circulatory failure, severe infection, weight less than 1500g, and complicated surgery. Each sickbed has a set of commonly used monitoring and treatment equipment, including radiation heater, cardiopulmonary monitor, artificial respirator, oxygen concentration meter, percutaneous oxygen detector, infusion pump, etc. In addition, there are first-aid items, such as tracheal intubation equipment, aspirator, oxygen and various first-aid drugs. Each ward should have three shifts of nurses every day, and the ratio of patients to nurses in each shift is 1: 1. In addition to pediatricians, it is best to have the assistance of anesthesiologists, and other relevant departments such as surgery and neurology should also participate in the rescue when necessary. Nurses working in the intensive care unit need some professional training before they can skillfully use all kinds of monitoring and treatment equipment, understand the causes and preliminary treatment that may lead to changes in their condition, cooperate with doctors in various operations, and make detailed records of their condition. The use and maintenance of main monitoring and treatment equipment are as follows:
Radiant heaters that are too cold or too hot will increase the oxygen consumption of newborns, especially premature infants. Providing a neutral ambient temperature (minimizing oxygen consumption) is an important measure. Radiation incubator, also known as open incubator, is an ideal equipment. Radiant heat radiates from the top, and the child has a thermistor connected to the heat source. When the body temperature reaches the required height, the radiant heat source is automatically cut off. The advantage of this heater is that the baby is naked, which is convenient for medical staff to observe the changes of the condition and do various operations. The disadvantage is that the skin moisture evaporates more.
3. 1 Precautions for use ① Warm up before use. As soon as the baby is put in, connect the thermistor, put the resistor on the abdomen and fix it. Adjust the temperature to 36.5℃ (full-term infants) or 37℃ (premature infants), and it is best to stick a piece of tin foil on the resistor to reduce the influence of environmental temperature. ② The body temperature should be measured when using the radiation heater. Starting from every hour 1 time. If the resistor falls off, it will cause overheating. Therefore, it is necessary to check whether the thermistor is stuck when shifting gears. (3) Children who use radiation heaters should appropriately increase their liquid intake every day, with a weight of 20 ~ 30ml per kilogram.
4 The heart-lung monitor can be used to monitor the heart rate, respiration and blood pressure of infants rescued in the intensive care unit, and the ECG can be used to display waveforms, so as to find the changes of vital signs as soon as possible and deal with them in time. Cardiopulmonary monitor has an alarm device, which can display ECG waveform and respiratory waveform on the screen. Some monitors are equipped with special buttons. When the nurse finds that the waveform is abnormal, she can press this button to keep the graph on the screen for the doctor to see. In order to make the figure clear and correct, the local skin should be cleaned and coated with appropriate conductive paste before placing the electrode. If the figure is not satisfied and the figure is not accurate, check the reason and try to adjust it, such as ① check whether the ground wire is connected properly; (2) Whether the electrode is in close contact with the skin, and if necessary, clean the skin again or replace it with a new electrode; ③ Lead tracing with clear graphics can be selected by turning the lead knob; ④ If the machine is overheated, it should be stopped.
When using the monitor, you should closely observe the change of the condition, turn the alarm to the "on" position, connect the ground wire, and always pay attention to the skin condition under the electrode. If skin damage is found, the electrode position should be changed. When the instrument gives an alarm, the nurse should do the following work: ① take good care of the child and turn off the alarm; (2) If the child has apnea, pay attention to whether he vomits and suck out the vomit. If there is no vomiting, the child will breathe; (3) If there is still no response after * * * and cyanosis occurs, sputum should be sucked, oxygen should be given with a mask and the doctor should be informed, and oxygen should be given by intubation if necessary; (4) After the situation is stable, analyze the reasons with the doctor and take preventive measures; ⑤ Turn the alarm to the "ON" position again and make records.
5 Tracheal intubation and artificial respiration machine Children who use tracheal intubation and artificial respiration machine must be closely observed and carefully cared for. Instruments used for tracheal intubation include direct laryngoscope and various types of intubation (weight
In the process of using ventilator, if the condition suddenly worsens, we should consider: ① pneumothorax; (2) The tracheal intubation falls off or strays into the esophagus, or the connector is misplaced; ③ Secretion blocks the lumen; It should be handled in time and reported to the doctor. If the tracheal intubation is improperly fixed, the doctor should be informed to fix it again. Fasting for 4 hours before extubation, complete sputum aspiration, pressurized oxygen supply, and preparation of intubation equipment. After extubation, closely observe the breathing situation and re-intubate if necessary.
Oxygen therapy is to improve the hypoxia of premature infants. If too little oxygen is given, it will cause hypoxemia, severe hypoxia and death or sequelae; Excessive oxygen concentration can lead to eye injury (posterior lens fibrosis) and lung injury. Nurses must master and use oxygen: measure oxygen concentration with oxygen analyzer or adjust it with knob on ventilator; Do blood gas analysis on time; Keep the blood oxygen at 50 ~ 80 mmHg. If the blood oxygen is too low, the oxygen concentration should be increased. If the blood oxygen is too high, it should be reduced by 5 ~ 10%. Be careful not to cut too much suddenly, so as not to cause shunt from right to left.
Percutaneous oxygen analyzer is an instrument that can continuously measure blood oxygen tension without taking blood. There is a heating ring on the skin probe, which heats the skin temperature to 42 ~ 44℃, the subcutaneous arterioles dilate, the blood oxygen enters the probe through the skin, and the oxygen tension is accurately measured through the oxygen electrode. Proofreading before use; Pay attention to the skin under the electrode when using.
8 infusion pump infusion pump can ensure constant-speed infusion of liquid, which is used for: ① continuous constant-speed intravenous infusion of short-half-life drugs, such as dopamine and phenobarbital sodium; (2) quantitative constant-speed liquid infusion, such as intravenous hypernutrition; ③ Intravenous heparin should be given at a constant speed and slowly to keep the arterial intubation unblocked. There are two main types of infusion pumps, one is the rolling type, which is suitable for inputting more liquids such as glucose and physiological saline, and the other is the syringe type, which is suitable for inputting liquids within 50ml. The latter is more accurate and can be adjusted below 1ml per hour. The infusion pump should have an alarm device, especially the rolling infusion pump, which may be in danger of air entering. Attention when using: record the liquid input amount every hour; Check the injection site frequently to see if there is liquid extravasation; Check whether the speed of infusion pump is correct.
9 Common operating techniques Commonly used operating techniques in neonatal intensive care unit include arterial puncture, radial artery or umbilical artery intubation, venous catheter, thoracic drainage, central venous catheter, etc. Nurses should understand the purpose, precautions and complications of each operation, make preparations and assist doctors to complete it smoothly. The following mainly introduces radial artery or umbilical artery intubation and thoracic drainage:
9. 1 radial artery or umbilical artery intubation is mainly used for blood collection and blood pressure measurement, and umbilical artery intubation can also be used for infusion. Arterial catheter should be connected to infusion pump and tee. Children with arterial intubation should be cared by special personnel, observe the peripheral blood circulation, ensure the joint connection is tight, and there can be no tube detachment and leakage. Rinse the test tube slowly after blood collection, and strictly observe the aseptic technical regulations during operation.
9.2 Thoracic Drainage Neonates suffer from lung diseases such as meconium aspiration syndrome or pneumothorax caused by ventilator, and their clinical manifestations are sudden deterioration. Thoracic drainage should be carried out in time. Nurses should prepare disinfection equipment in advance for emergency use, and pay attention to whether there are bubbles overflowing or liquid level moving up and down after catheter insertion to keep the wound sterile.
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