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Organization of nicu

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The document outlines the organization and components of a neonatal intensive care unit (NICU). It discusses the history of NICUs, physical facility requirements including adequate space, equipment, and staffing. Key aspects that are emphasized include maintaining appropriate environmental conditions, developing different levels of care (I, II, III), and facilitating family involvement to create a gentle environment that supports recovery and development of infants. The overall aim is to reduce mortality and morbidity of at-risk newborns through specialized intensive care.

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ORGANIZATION OF NEONATAL INTENSIVE CARE UNIT
DEFINITION: •Newborn or neonatal intensive care unit, an intensive care unit designed for premature and ill newborn babies. Andria Santiago
NEONATAL CARE The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate pediatric intensive care unit.
Organization of nicu
HISTORY: •1961: Vanderbilt university by professor Mildred Stahiman •Mid 19th century: Dr. Stephane Starnier, father of incubator (isolette). •Dr. Budin: father of perinatology
AIMS OF ORGANIZING OF NICU : • Reducing the neonatal mortality and improving the quality of life among the survivors
OBJECTIVES: • To save the life of the sick new born • To prevent damage in infants with problems at birth and also reduce morbidity in later life. • To monitor high risk newborns so as to reduce mortality and morbidity in these babies
BASIC FACILITIES: • Adequate space • Availability of running water • Centralized oxygen and suction facilities • Maintenance of thermo- neutral environment • Availability of plenty of linen and disposables • Facilities for availability to treat common neonatal problems
MAIN COMPONENTS TO BE CONSIDER WHILE ORGANIZING A NICU: • PHYSICAL FACILITIES • PERSONNEL • EQUIPMENTS • LABORATORY FACILITIES • PROCEDURE MANUAL • TRANSPORT OF SICK INFANTS • COOPERATION BETWEEN THE OBSTETRICIAN AND NEONATOLOGIST
1.PHYSICAL FACILITIES: •Location •Space •Floor plan •Lighting •Environmental temperature and humidity
• Handling and social contacts • Communication system • Acoustic characteristics • Ventilation • Electrical outlets
LOCATION: • Located as close as to labour room and obstetric care unit • Adequate sunlight for illumination • Fair degree of ventilation for fresh air
SPACE: • serve as a referral unit for the infants born outside the hospital • Each infant should be provided with a minimum area of 100 sq. ft. or 10sq. meter • Space for promotion of breast feeding
 500-600 Gross square feet per bed. Space includes patient care area, storage area, space for doctors, nurses, other staff, office area, seminar room area, laboratory area and space for families 6 Feet gap between two incubators for adequate circulation and keeping the essential lifesaving equipment
FLOOR PLAN Open encumbered space The walls should be made of washable glazed tiles and windows should have two layers of glass panes. Wash basins with elbow or floor operated taps facility having constant round-the clock water supply should be provided. The doors should be provided with automatic door closers. Isolation room
VENTILATION: Effective air ventilation Central air conditioning
LIGHTING The whole unit must be well illuminated and painted white The lighting arrangement should provided uniform shadow-free, illumination of 100 foot candles at the baby’s level
ENVIRONMANTAL TEMPERATURE AND HUMIDITY • The temperature inside the unit should be maintained at 28’ +_2’C, while the humidity must be above 50%. • Portable radiant heater, infra red lamp can be used
ACOUSTIC CHARACTERISTICS • The ventilation system, incubators, air compressors, suction pumps and many other devices used in the nursery produce noise. • Sound intensity in the unit should be exceed 75 decibels. • Telephone rings and equipment alarms should be replaced by blinking lights.
COMMUNICATION SYSTEM: • The unit should also have an intercom & a direct outside telephone line
ELECTRICAL OUTLETS • Each patient station should have 12 to 16 central voltage – stabilized electrical outlets sufficient to handle all pieces of equipment • An additional power plug point • There should be round-the-clock power back up including provision of UPS system
STAFF • A direct who is a full time neonatologist • One neonatal physician is required for every 6-10 patients  One resident doctor should be present in the unit round-the-clock. • Anesthetist - pediatric surgeon and pediatric pathologist are essential persons in establishment of a good quality NICU
Organization of nicu
NURSES  A nurse : patient ratio of 1:1 maintained thought out day and night is absolutely essential for babies on multi system support including ventilatory therapy.  For special care neonatal unit and intermediate care, nurse to patient ratio of 1:3 is ideal but 1:5 per shift is manageable. • Head nurse is the overall in-charge  In addition to basic nursing training for level-II care, tertiary care requires, staff nurse need to be trained in handling equipment, use of ventilators and initiation of life-support like use of bag and mask resuscitation, endotracheal intubations, arterial sampling and so-on.  The staff must have a minimum of 3 years work experience in special care neonatal unit in addition to having 3 months hand- on-training in an intensive care neonatal unit.
OTHER STAFF • Respiratory therapist • Laboratory technician • Public health nurse or social worker • Biomedical engineer • Clark
DISPOSABLE ARTICLES REQUIRED FOR THE NICU •IV Catheters •IV sets •Micro burette sets •Bacterial filters •Feeding tubes •Endotracheal tubes •Suction catheters •Three-way stopcocks •Extension tubing •Umbilical arterial and venous catheters •Syringes, needles
Organization of nicu
Organization of nicu
Organization of nicu
BABY CARE AREA • Areas and rooms for inborn or intramural babies • Examination area • Mother’s area for breast feeding and expression of breast milk • Nurses station and charting area.
HAND-WASHING AND GOWNING ROOM: Should be located at the entrance. self closing doors.
PERSONNEL: • Skilled nurses • Neonatologists • Lab technician • Biomedical technician • Respiratory therapists • Pathologists
Equipment's :
RADIANT WARMER:
Organization of nicu
Organization of nicu
Organization of nicu
Organization of nicu
Organization of nicu
Laboratory facilities •5.Transport of sick infants •6.Procedure manual
7.Cooperation between the obstetrician and neonatologist •Antenatal care and fetal diagnosis •Perinatal hypoxia •Promotion of feeding with human milk •Supervised care of low birth
MANAGEMENT OF NURSING CARE 1. Assessment 2. Monitoring physiological data 3. Safety measures 4. Respiratory support 5. Thermoregulation 6. Protection from infection 7. Hydration 8. Nutrition 9. Feeding resistance 10. Skin care
11. Administration of medication 12. Developmental outcome 13. Facilitating parent-infant relationship 14. Discharge planning and home care 15. Neonatal loss
LEVELS OR GRADES OF NEONATAL CARE •Level I •Level II •Level III
LEVELS OF NEONATAL CARE LEVEL I CARE •The minimal care •Provided by the mother under the supervision of basic health professionals. • Neonates weighting more than 2000 gm or having gestational age maturity of 37 weeks or more belong to this care. •This care can be includes care of delivery, provision of the warmth, maintenance of asepsis, and promotion of breast feeding.
LEVELS OF NEONATAL CARE LEVEL II CARE •This care includes requirement for resuscitation, maintenance of thermo-neutral temperature, intravenous infusion, gavage feeding phototherapy and exchange transfusion. •10-15 percent of the newborn require this care • This care s is anticipated for the infants weighing in between 1500 & 1800 gm or having gestational age maturity of 32 to 36 weeks.
LEVELS OF NEONATAL CARE LEVEL III CARE •This care includes life saving support system like ventilator and best suited special intensive neonatal care. •Three to five percent of newborn require care of this level. •This level of care is for critically ill babies, for those weighing less than 1500 gm or having gestational age maturity of less than 32 weeks.
TOWARDS A GENTLE AND FRIENDLY NICU ENVIRONMENT •It has been realized that physical and social environment of nursery affect the recovery and long term morbidity of the neonate. •Attempts should be made to reduce unnecessary noise and light. •Avoid excess of light •Handling should be gentle •Neonates including pre terms feel pain and painful stimuli can cause deleterious physiological responses. Analgesia should be provided during all procedure including ventilation. •Parent should be allowed unrestricted entry to the nursery, •They should be explained about various tubing and attachments to the baby and should be involved in care of their baby.
QUERRIES ???????
EVALVUATION………
MCQS 1. Level 1 Care includes A. Basic care following delivery B. Special newborn care C.Ventilator care D. Intensive care
Each infant should be provided with a minimum area of …………. sq. ft A. 50 B. 100 C. 150 D. 200

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Organization of nicu

  • 2. DEFINITION: •Newborn or neonatal intensive care unit, an intensive care unit designed for premature and ill newborn babies. Andria Santiago
  • 3. NEONATAL CARE The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate pediatric intensive care unit.
  • 5. HISTORY: •1961: Vanderbilt university by professor Mildred Stahiman •Mid 19th century: Dr. Stephane Starnier, father of incubator (isolette). •Dr. Budin: father of perinatology
  • 6. AIMS OF ORGANIZING OF NICU : • Reducing the neonatal mortality and improving the quality of life among the survivors
  • 7. OBJECTIVES: • To save the life of the sick new born • To prevent damage in infants with problems at birth and also reduce morbidity in later life. • To monitor high risk newborns so as to reduce mortality and morbidity in these babies
  • 8. BASIC FACILITIES: • Adequate space • Availability of running water • Centralized oxygen and suction facilities • Maintenance of thermo- neutral environment • Availability of plenty of linen and disposables • Facilities for availability to treat common neonatal problems
  • 9. MAIN COMPONENTS TO BE CONSIDER WHILE ORGANIZING A NICU: • PHYSICAL FACILITIES • PERSONNEL • EQUIPMENTS • LABORATORY FACILITIES • PROCEDURE MANUAL • TRANSPORT OF SICK INFANTS • COOPERATION BETWEEN THE OBSTETRICIAN AND NEONATOLOGIST
  • 11. • Handling and social contacts • Communication system • Acoustic characteristics • Ventilation • Electrical outlets
  • 12. LOCATION: • Located as close as to labour room and obstetric care unit • Adequate sunlight for illumination • Fair degree of ventilation for fresh air
  • 13. SPACE: • serve as a referral unit for the infants born outside the hospital • Each infant should be provided with a minimum area of 100 sq. ft. or 10sq. meter • Space for promotion of breast feeding
  • 14.  500-600 Gross square feet per bed. Space includes patient care area, storage area, space for doctors, nurses, other staff, office area, seminar room area, laboratory area and space for families 6 Feet gap between two incubators for adequate circulation and keeping the essential lifesaving equipment
  • 15. FLOOR PLAN Open encumbered space The walls should be made of washable glazed tiles and windows should have two layers of glass panes. Wash basins with elbow or floor operated taps facility having constant round-the clock water supply should be provided. The doors should be provided with automatic door closers. Isolation room
  • 17. LIGHTING The whole unit must be well illuminated and painted white The lighting arrangement should provided uniform shadow-free, illumination of 100 foot candles at the baby’s level
  • 18. ENVIRONMANTAL TEMPERATURE AND HUMIDITY • The temperature inside the unit should be maintained at 28’ +_2’C, while the humidity must be above 50%. • Portable radiant heater, infra red lamp can be used
  • 19. ACOUSTIC CHARACTERISTICS • The ventilation system, incubators, air compressors, suction pumps and many other devices used in the nursery produce noise. • Sound intensity in the unit should be exceed 75 decibels. • Telephone rings and equipment alarms should be replaced by blinking lights.
  • 20. COMMUNICATION SYSTEM: • The unit should also have an intercom & a direct outside telephone line
  • 21. ELECTRICAL OUTLETS • Each patient station should have 12 to 16 central voltage – stabilized electrical outlets sufficient to handle all pieces of equipment • An additional power plug point • There should be round-the-clock power back up including provision of UPS system
  • 22. STAFF • A direct who is a full time neonatologist • One neonatal physician is required for every 6-10 patients  One resident doctor should be present in the unit round-the-clock. • Anesthetist - pediatric surgeon and pediatric pathologist are essential persons in establishment of a good quality NICU
  • 24. NURSES  A nurse : patient ratio of 1:1 maintained thought out day and night is absolutely essential for babies on multi system support including ventilatory therapy.  For special care neonatal unit and intermediate care, nurse to patient ratio of 1:3 is ideal but 1:5 per shift is manageable. • Head nurse is the overall in-charge  In addition to basic nursing training for level-II care, tertiary care requires, staff nurse need to be trained in handling equipment, use of ventilators and initiation of life-support like use of bag and mask resuscitation, endotracheal intubations, arterial sampling and so-on.  The staff must have a minimum of 3 years work experience in special care neonatal unit in addition to having 3 months hand- on-training in an intensive care neonatal unit.
  • 25. OTHER STAFF • Respiratory therapist • Laboratory technician • Public health nurse or social worker • Biomedical engineer • Clark
  • 26. DISPOSABLE ARTICLES REQUIRED FOR THE NICU •IV Catheters •IV sets •Micro burette sets •Bacterial filters •Feeding tubes •Endotracheal tubes •Suction catheters •Three-way stopcocks •Extension tubing •Umbilical arterial and venous catheters •Syringes, needles
  • 30. BABY CARE AREA • Areas and rooms for inborn or intramural babies • Examination area • Mother’s area for breast feeding and expression of breast milk • Nurses station and charting area.
  • 31. HAND-WASHING AND GOWNING ROOM: Should be located at the entrance. self closing doors.
  • 32. PERSONNEL: • Skilled nurses • Neonatologists • Lab technician • Biomedical technician • Respiratory therapists • Pathologists
  • 40. Laboratory facilities •5.Transport of sick infants •6.Procedure manual
  • 41. 7.Cooperation between the obstetrician and neonatologist •Antenatal care and fetal diagnosis •Perinatal hypoxia •Promotion of feeding with human milk •Supervised care of low birth
  • 42. MANAGEMENT OF NURSING CARE 1. Assessment 2. Monitoring physiological data 3. Safety measures 4. Respiratory support 5. Thermoregulation 6. Protection from infection 7. Hydration 8. Nutrition 9. Feeding resistance 10. Skin care
  • 43. 11. Administration of medication 12. Developmental outcome 13. Facilitating parent-infant relationship 14. Discharge planning and home care 15. Neonatal loss
  • 44. LEVELS OR GRADES OF NEONATAL CARE •Level I •Level II •Level III
  • 45. LEVELS OF NEONATAL CARE LEVEL I CARE •The minimal care •Provided by the mother under the supervision of basic health professionals. • Neonates weighting more than 2000 gm or having gestational age maturity of 37 weeks or more belong to this care. •This care can be includes care of delivery, provision of the warmth, maintenance of asepsis, and promotion of breast feeding.
  • 46. LEVELS OF NEONATAL CARE LEVEL II CARE •This care includes requirement for resuscitation, maintenance of thermo-neutral temperature, intravenous infusion, gavage feeding phototherapy and exchange transfusion. •10-15 percent of the newborn require this care • This care s is anticipated for the infants weighing in between 1500 & 1800 gm or having gestational age maturity of 32 to 36 weeks.
  • 47. LEVELS OF NEONATAL CARE LEVEL III CARE •This care includes life saving support system like ventilator and best suited special intensive neonatal care. •Three to five percent of newborn require care of this level. •This level of care is for critically ill babies, for those weighing less than 1500 gm or having gestational age maturity of less than 32 weeks.
  • 48. TOWARDS A GENTLE AND FRIENDLY NICU ENVIRONMENT •It has been realized that physical and social environment of nursery affect the recovery and long term morbidity of the neonate. •Attempts should be made to reduce unnecessary noise and light. •Avoid excess of light •Handling should be gentle •Neonates including pre terms feel pain and painful stimuli can cause deleterious physiological responses. Analgesia should be provided during all procedure including ventilation. •Parent should be allowed unrestricted entry to the nursery, •They should be explained about various tubing and attachments to the baby and should be involved in care of their baby.
  • 51. MCQS 1. Level 1 Care includes A. Basic care following delivery B. Special newborn care C.Ventilator care D. Intensive care
  • 52. Each infant should be provided with a minimum area of …………. sq. ft A. 50 B. 100 C. 150 D. 200