Basic Guidelines for Working in the Neonatal Unit

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

Prepared by 

To maintain and enhance the quality of care provided, this guide has been prepared to develop the informational, technical, and human skills of the nursing staff working in the neonatal department.

Devices in the Neonatal Intensive Care Unit (NICU):

• Fixed Incubator
• Transport Incubator
• Radiant Warmer (Servo-Controlled Heater)
• Infusion Pump
• Syringe Pump
• Weighing Scale
• Non-Invasive Blood Pressure Monitor
• Pulse Oximeter
• Cardiorespiratory Monitor (Monitor)
• Electric Suction Device
• Phototherapy Unit
• Transcutaneous Bilirubin Meter
• Self-Inflating Resuscitation Bag (Ambu Bag)
• Feeding Preparation Equipment (Electric Kettle, Electric Cooler)
• Blood Glucose Meter

A. Fixed Incubator

Operation

Before switching on the incubator:

• Plug the incubator into the power source and keep it connected to avoid battery damage.
• Position the incubator perpendicular to the wall, ensuring at least 1 square meter of free space around it.
• Lock the wheels.
• Adjust the mattress tilt as needed.

After switching on the incubator:

• Turn on the incubator 10-15 minutes before use.
• Fill the humidifier with distilled water after disinfecting it.
• If using the servo-controlled temperature mode, place the metal side of the temperature probe on the newborn’s abdominal skin, above the liver.
• Adjust the temperature using the control buttons.
• Verify that the heating indicator light is on.
• Check the records for filter replacement and incubator cleaning dates daily.

Response to Incubator Alarms

• Temperature Control Alarm: Activates when air temperature exceeds the set value by 1.5°C or drops below it by 3°C.
• High Air Temperature Alarm: If the air temperature rises excessively, the heater shuts off automatically and does not restart until manually reset.
• Air Circulation Alarm: Activates if airflow inside the incubator stops or becomes insufficient, causing the heater to shut off.
• Probe Disconnection Alarm: Indicates a disconnected air temperature or newborn temperature probe.
• Device Failure Alarm: Indicates a malfunction in the incubator motor.
• Power Failure Alarm: Indicates power disconnection or unplugging of the incubator.

Disinfection and Sterilization

• The assigned nurse must clean the incubators daily following infection control guidelines using the recommended disinfectant.
• Any blood or bodily fluid spills inside or outside the incubator must be disinfected immediately using a cloth moistened with ethanol-based disinfectant or diluted chlorine after thorough cleaning.
• The incubator must be disinfected for each new newborn. It should be changed every 7 days for full-term infants and every 5 days for infants weighing less than 1 kg, or immediately if contaminated.
• To decontaminate between infants or after the specified period, all detachable parts must be cleaned thoroughly with a disinfectant solution. The incubator should be carefully washed, dried with disposable paper towels, then wiped with a disinfectant solution (such as 70% ethanol or 500 ppm diluted chlorine solution). The incubator must be aired before reuse.
• Manufacturer guidelines should be followed for cleaning instructions.

Preventive Maintenance

• Replace the air filter every 3 months or after use by an infected newborn.
• Store the temperature probe cable safely to prevent twisting.
• Inspect the incubator doors, hinges, and side openings to ensure they do not open accidentally.
• Do not use incubator cabinets for storage.
• Report any malfunctions to maintenance personnel.
• Complete the required maintenance documentation.

B. Transport Incubator

Operation and Maintenance

• Check the oxygen cylinder to ensure it is full.
• Keep the power plug connected to maintain battery charge.
• The transport incubator should only be used for transportation, not as a stationary incubator.

Disinfection

• Disinfect using diluted chlorine after each use.

C. Radiant Warmer

Operation

• Position the warmer vertically against the wall.
• Lock the wheels.
• Connect the power cable.
• Switch on the warmer.
• Select either servo-controlled temperature mode or manual control if servo mode is unavailable.
• Ensure the oxygen supply line is connected and the oxygen cylinder is open.
• Check that the suction unit is functioning properly.
• Test the heater by placing a hand near it to confirm warmth.
• Monitor the infant’s temperature regularly when using manual mode.

Disinfection

• Wipe with 70% ethanol or diluted chlorine solution before and after each use, following infection control guidelines.
• Disinfect the temperature probe with ethanol before and after each use.

Preventive Maintenance

• Store the temperature probe cable safely to prevent twisting.
• Report any malfunctions to maintenance personnel.
• Complete the required maintenance documentation.

D. Infusion Pump

Operation

• Plug the infusion pump into the power source.
• Prepare the IV fluid bag and ensure the tubing is free of air bubbles.
• Open the pump door, insert the tubing correctly, then close the door securely.
• Turn on the pump.
• Set the infusion rate (mL/hour) as per the doctor’s instructions.
• Press the "Start" button.
• Test the alarm functionality.

Disinfection

• Wipe with 5% diluted chlorine solution after each use.
• Immediately clean any fluid or blood spills with diluted chlorine.

Preventive Maintenance

• Keep the power plug connected to avoid battery damage.
• Store the infusion pump safely on the incubator shelf.
• Ensure all operational functions are working correctly.
• Report any malfunctions to maintenance personnel.
• Complete the required maintenance documentation.

E. Syringe Pump

Operation

• Plug the syringe pump into the power source.
• Turn on the device.
• Ensure the syringe size matches the display setting.
• Connect the IV tubing.
• Set the infusion rate (mL/hour) as per the doctor’s instructions.
• Press the "Start" button.

Disinfection

• Wipe with 5% diluted chlorine solution after each use.
• Clean any fluid or blood spills immediately with diluted chlorine.

Preventive Maintenance

• Keep the power plug connected to maintain battery charge.
• Store the syringe pump safely on the incubator shelf.
• Ensure all functions are operational.
• Report any malfunctions to maintenance personnel.
• Complete the required maintenance documentation.