NICU Monitors and Equipment

Your baby will be closely monitored throughout her stay in the NICU or SCN. This means wires, tubes, patches, probes, and machines — which can all be scary. It can be difficult to watch your little one being poked and prodded and hooked up to machines. Knowing that it’s all for her own good, and understanding a little bit about what you’re seeing and hearing may help to ease some of the fear.

Phototherapy lights (often called bililights) are used to treat a condition called jaundice. Jaundice is a condition where too much bilirubin in the blood turns your baby’s skin and the whites of his eyes yellow.

If your baby’s bilirubin level rises too high, he’ll be placed under phototherapy lights. These are specially designed lights that help break down the bilirubin so it’s easier for your baby’s body to get rid of it. The lights can be applied in different ways including beds, cases, or blankets.

Your baby’s eyes will be covered to protect them from the lights. Your baby will be undressed to allow as much of the skin as possible to absorb the light rays. The lights won’t burn or harm the skin. If your baby is undergoing phototherapy, you should limit the time you hold him to allow maximum exposure to the lights.

A variety of devices can help your baby breathe better or give your baby additional oxygen. These may include the following:

• Nasal cannula [KAN-yuh-luh]. This is a flexible, hollow tube with two small prongs that fit just below the baby’s nose to deliver a steady stream of oxygen.
• Nasal prongs. A tube with two prongs attached to it, these are placed inside your baby’s nostrils to provide a steady stream of oxygen. If the oxygen is delivered under pressure, it is known as CPAP (continuous positive airway pressure).
• Suction catheter. This small tube is used to remove mucus from your baby’s nose, throat, or windpipe. It helps keep the baby’s breathing tubes clear.
• Ventilator. A ventilator (sometimes called a respirator) is a machine that provides additional breaths and oxygen to your baby as needed. A ventilator is attached to your baby by a small, plastic tube leading from the baby’s mouth to the windpipe. This tube is called an endotracheal [en-doh-TREY-kee-uhl], or ET, tube. The ventilator sends air through this tube into your baby’s lungs. Since the tube passes through your baby’s vocal cords, no sound will come out when your baby cries. There are several types of ventilators. Some make it look as if your baby is vibrating slightly.

Unlike peripheral lines — which are inserted into a surface vein in the arm, hand, leg, foot, or scalp — a central line is placed in the blood vessel that leads directly to the heart. A central line must be placed by a doctor or a specially trained nurse. The baby may be given pain medicine before the catheter is placed to make the baby more comfortable.

A common type of central line is a PICC line. PICC stands for peripherally inserted central catheter — meaning a central catheter that is inserted through the skin and into a vein. It is then guided into a larger vein. An x-ray is taken to ensure that the catheter is in the correct position.

Complications that may occur with insertion of a PICC line include infection, an irregular heartbeat, bleeding, and breaking or plugging of the catheter. The line may need to be removed if any of these occur.

A PICC line has advantages over a peripheral line:

• It allows higher concentrations of nutrients and medicines to be given with less irritation to the veins.
• When IV therapy is needed for a long time, the PICC line eliminates the need for multiple attempts to place IVs for nutrition, fluids, or medicines.

Your baby may need one or more chest tubes, especially if he has chest surgery, has a pneumothorax (air or gas in the membranes surrounding the lungs), or has fluid accumulation in the membranes surrounding the lungs. A chest tube is a tube inserted in the space between the ribs and the lungs. Its purpose is to drain excess air or fluid out of the chest to allow your baby’s lungs to expand, which will help him breathe easier.

The IV catheter may be hooked up to an IV pump. An IV pump is a machine that allows caregivers to program the exact amount of nutrients or other fluids delivered to your baby. An alarm on the IV pump may be set to go off at regular intervals to remind your baby’s nurse to check that everything is working correctly.

Babies who are premature, have breathing problems, or are too sick or stressed to receive medicine and nutrients by mouth will have intravenous [in-truh-VEE-nuhs], or IV, therapy. Intravenous means “within a vein.”

IV therapy involves putting a small, flexible tube (called a catheter) into your baby’s vein to deliver fluids, nutrients, medicines, or blood. Your baby may also have an arterial [ahr-TEER-ee-uhl] line. An arterial line is similar to an IV line, except it goes into an artery instead of a vein. This line can be used to measure blood pressure or draw blood.

Your baby will be attached to one or more monitors that record and show her vital signs — heart rate, breathing rate, blood pressure, and the amount of oxygen in her blood — such as:

• Small monitoring pads, called electrodes [ih-LEK-trohds], which detect chest movement as your baby breathes. They also pick up the impulses of her heartbeat. Wires attached to the electrodes send the information to the monitor by your baby’s bed.
• A blood pressure monitor that checks periodically via a small cuff placed around your baby’s arm or leg. Blood pressure may also be monitored continuously through a small catheter in your baby’s artery.
• A pulse oximeter [awk-SIM-i-ter], which is also known as an oxygen saturation monitor. This device measures the amount of oxygen in her tissues. The oximeter shines a small red light through your baby’s hand or foot to register the amount of oxygen in the blood. This number is recorded on one of the monitors by your baby’s bed.
• Electrodes placed on his head to monitor his brain. This type of monitoring is called amplitude-integrated electroencephalography [ih-lek-troh-en-SEF-uh-lah-graf-ee] or aEEG.
• A transcutaneous [trans-kyoo-TEY-nee-uh s] monitor or TCM, which can measure oxygen and carbon dioxide through the skin. A small circular piece attaches to the skin with adhesive. This piece heats up a tiny area of skin and can measure the oxygen and carbon dioxide levels. A tiny cord travels from the circular piece to a machine that displays the information. The oxygen measurement from this piece is different from that measured by the pulse oximeter and is usually lower. Because the skin is heated, the circular piece may leave a red spot. The location of the piece is changed regularly. The red spots will fade over time.
• Other monitors in the NICU or SCN that are not listed here. If you have questions about any equipment used to care for your baby, ask your baby’s caregivers.

If any of your baby’s vital signs become abnormal, an alarm will sound to alert the NICU or SCN staff. Sometimes a monitor may alarm for a nonemergency reason, such as a loose electrode, an extra heart beat, hiccups, or increased muscle activity when your baby moves. The NICU and SCN nurses are trained to know which alarm sounds require immediate response.

When your baby is transferred to the NICU or SCN, he may be placed in an open warmer, an incubator [IN-kyuh-bey-ter], or a combination bed that can function as both an open warmer and an incubator (the Giraffe OmniBed). An open warmer is an open table that allows easy access to the baby and equipment. The heat comes from a lamp heater above the baby’s mattress.

An incubator is an enclosed clear-plastic, box-like bed with an internal heat source. (An incubator is also called an isolette [ahy-suh-LET].) These pieces of equipment give your baby a controlled environment in which to grow and get better. A coated wire, called a temperature probe, is placed on your baby’s skin and is covered with an adhesive patch. The wire measures the baby’s temperature. This information is used to help regulate the amount of heat from the overhead warmer or incubator.

A peripheral [puh-RIF-er-uhl] line is an IV placed into the arm, hand, leg, foot, or scalp. To place a peripheral line, a small needle is inserted into a vein that is close to the skin’s surface. Once in place, the needle is removed, and a catheter (small hollow tube) remains in place. The catheter will be secured so that the baby can’t pull it out.

If the IV is placed in the arm or leg, it may be secured with an armboard — a small splint that helps prevent the IV from being accidentally pulled out. The site of a peripheral line needs to be changed frequently.

An umbilical catheter is inserted through the end of the baby’s umbilical cord into either an artery — an umbilical [uhm-BIL-i-kuhl] artery catheter or UAC — or a vein (an umbilical vein catheter or UVC). The umbilical catheter is secured to the baby’s tummy with tape.

You may also notice a small stitch at the base of the line. This stitch secures the line to the edge of the umbilical cord. The stitch won’t hurt your baby because there are no pain receptors or nerves in the umbilical cord. The umbilical catheter has some advantages:

• Blood samples can be painlessly drawn directly from either type of umbilical catheter for lab tests. This eliminates the need for your baby to be stuck with a needle each time he needs to provide a blood sample.
• With a UAC, the doctors and nurses can constantly monitor your baby’s blood pressure from within his body.