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Newborn - Transcutaneous Bilirubin Assessment

This document provides guidelines for using transcutaneous bilirubinometry (TCB) to screen for jaundice in healthy term newborns at Launceston General Hospital. TCB can avoid the need for blood sampling but any readings in the phototherapy range require confirmation with a serum bilirubin test. The guidelines describe how to use the BiliChek device for TCB measurements, when to inform doctors of elevated readings, documentation requirements, and precautions for accurate measurements. It is intended to standardize TCB screening by midwives on the postnatal ward to assess jaundice in newborns in a noninvasive manner.

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342 views

Newborn - Transcutaneous Bilirubin Assessment

This document provides guidelines for using transcutaneous bilirubinometry (TCB) to screen for jaundice in healthy term newborns at Launceston General Hospital. TCB can avoid the need for blood sampling but any readings in the phototherapy range require confirmation with a serum bilirubin test. The guidelines describe how to use the BiliChek device for TCB measurements, when to inform doctors of elevated readings, documentation requirements, and precautions for accurate measurements. It is intended to standardize TCB screening by midwives on the postnatal ward to assess jaundice in newborns in a noninvasive manner.

Uploaded by

Ywagar Ywagar
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Launceston General Hospital Clinical Guidelines 4.

13-07WACS Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Newborn - Transcutaneous Bilirubin Assessment New Guideline Use of the transcutaneous bilirubinometry on well term babies on the postnatal ward Midwives and medical officers, QVMU Jaundice, bilirubin Care of the Well Newborn WACSClinProc4.3

Purpose: In healthy term newborn babies transcutaneous bilirubin assessment can be safely used as a screening test for jaundice avoiding the need for a newborn capillary blood sample. Definitions: The BiliChek can be used in healthy term (at or above 37 weeks) newborn infants of diverse races and ethnicities to assess neonatal jaundice. The BiliChek works by directing white light into the skin of the newborn and measuring the intensity of the specific wavelengths, which are returned. The assessment of jaundice using the BiliChek can be initiated by midwives on the postnatal unit and extended midwifery service. Results: Where the transcutaneous bilirubinometer (TCB) estimation is within phototherapy range, the level should be confirmed by capillary blood sample (SBR) and pathology contacted to request cord blood be processed for Coombs status. The capillary serum bilirubin (SBR) assessment should be ordered by the resident medical officer. If the SBR is within phototherapy range then the paediatric registrar or consultant must be informed. Documentation: The variance should be noted on the newborns neonatal pathway. BiliChek (TCB) estimation should be documented in the newborns medical record and plotted on the Hyperbilirubinaemia chart. Documentation of bilirubin estimation must indicate whether the reading is a transcutaneous estimation (TCB) or serum bilirubin (SBR), the date and time the reading was obtained. Precautions: Do not point at eyes while taking a measurement Avoid using measurement sites with bruising, birthmarks, haematomas or excessive hairiness as they can produce erroneous results The BiliCal individual calibration tip should not be exposed to light for extended periods of time. Keep the BiliCal in its package prior to use.
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Attachments
Attachment 1 Attachment 2

Instructions for Using the BiliChek References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: _________________________

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ATTACHMENT 1 Procedure: Apply a new BiliCal individual calibration tip to the unit. Firmly press the BiliCal tip onto the Bilichek to ensure proper seating of the tip Press and release either F1 (teal) button or F2 (grey) button to turn unit on The unit will automatically perform a self-test Press and release the Trigger button to start calibration Three dashes (---) will flash in the display window and the measurement status indicator (MSI) will be amber if a BiliCal tip is in place. If the BiliCal tip is not in place the MSI will be red. Attach a BiliCal tip before continuing. Press and release the Trigger button. The dashed lines will stop flashing indicating that the system is calibrating. When calibration is complete the MSI will be amber, you will hear a beep and the display window will read 005 After performing the calibration, pull on the BiliCal tab and peel away the protecting covering and calibration material from the tip and dispose. Press and release the trigger button. The unit is now activated and ready to take a measurement. Gently press the BiliCal tip against the babys forehead. The babys head may need to be supported to prevent movement. The skin should be pressed flat all around the clear ring. The measurement status indicator (MSI) will change from amber to green when proper pressure is applied. Do not continue to increase pressure as this will result in an E04 error message. The display will read 005 and will stop blinking when proper pressure has been applied. The measurement should take less than 2 seconds. At the end of the measurement, a beep will sound (if audio on) and the display will change to 004. Lift the BiliCal tip off the centre of the infants forehead between each measurement. Press and release the trigger button before reapplying the Bili Cal tip on the infants forehead for each measurement. The current measurement being taken will be indicated on the display (005.003.001) and the unit will beep one time for each measurement successfully completed. Upon completion of the five measurements, a beep sound and the test results are displayed with the current time and date. Remove and dispose of the BiliCal tip. The BiliChek does not have an off switch. It will automatically turn off if it is idle for a specified period of time. A single tone indicates a successful reading. A double tone indicates that the reading was not successful and an error code will be displayed. If an error code is displayed, press and release F1 (teal) and F2 (grey) buttons at the same time to return to the previous measurement. Reapply the tip to the babys forehead and take another measurement. It is critical to calibrate the unit and apply a new BiliCal tip immediately prior to performing a test.

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ATTACHMENT 2 REFERENCES Bhutani, V, Gourley, G, Adler, S, Kreamer, B, Dalin C & Johnson, H 2000, Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia, Paediatrics, vol. 106, no. 2. Grohmann, K, Roser, M, Rolinski, B, Kadow, I, Muller, C, Goerlach-Graw, A, Nauck, M & Kuster, H 2006, Bilirubin measurement for neonates: Comparison of 9 frequently used methods, Paediatrics, vol. 117, no. 4, pp. 1174-1183. Robertson, A, Kazmierczak, S & Vos, P 2002, Improved transcutaneous bilirubinometry: Comparison of SpectRx, BiliCheck and Minolta Jaundice Meter JM-102 for estimating total serum bilirubin in a normal newborn population, Journal of Perinatalogy, vol.22, pp.12-14. Thayyil, S & Marriott, L 2005, Can transcutaneous bilirubinometry reduce the need for serum bilirubin estimations in term and near term infants?, Archives of Disease in Childhood, vol. 90, pp. 1311-1312. Yap, S, Mohammad, I & Ryan, C 2004, Avoiding painful blood sampling in neonates by transcutaneous bilirubinometry, Irish Journal of Medical Science, vol. 171, no. 4, pp. 188190.

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