Antepartum, Maternal And Newborn – Newborn: Home Phototherapy SECTION: 19.18
Strength of Evidence Level: 3 __RN__LPN/LVN__HHA
PURPOSE:
To provide treatment of physiologic jaundice found in the infant who is otherwise healthy through the use of phototherapy units designed for home use.
CONSIDERATIONS:
1. The infant and caregiver must meet criteria for acceptance.
2. The serum bilirubin should be monitored at least once a day while the newborn is receiving the treatment.
3. The infant must be examined daily by either the nurse or doctor while receiving the treatment.
4. Treatment period usually lasts approximately 3 days.
5. A physician may discontinue therapy if:
a. Significant decrease in hemoglobin or hematocrit.
b. Total bilirubin continues to increase with home phototherapy.
c. Axillary temperature below 97.4 or above 99.6 degrees Fahrenheit.
d. Significant weight loss greater than 10% of birth weight in the first 2 to 3 days of life and greater than 2-3 ounces thereafter.
e. Respiratory distress.
f. Dehydration.
g. Evidence of improper use of equipment.
h. Unsafe home environment.
i. Bilirubin level falls within acceptable range.
6. It is imperative that the caregiver be fully instructed. Involve him/her during each step of the procedure.
7. A bank of lights or fiberoptic blanket may be utilized per physician order.
8. If bank of lights are utilized, eyes need to be covered with patches. Infant should be placed under the light without clothing or diaper. Retinal damage can occur if patches are not applied correctly. If fiberoptic blanket is used, infant can be fully dressed including diaper with a blanket directly on infant skin. No eye patches are required.
9. Skin color is not a valid indication of effectiveness of treatment.
10. The temperature under most overhead phototherapy lights is 5-8 degrees higher than room temperature. Instruct the parent(s) or caregiver(s) as to where to place the lights in the home.
11. Skin usually becomes dry and peels. Avoid use of ointment, creams, oils, as they act as light barriers.
12. Blood work drawn will need to be run STAT by laboratory with results reported to physician within 4 hours or per agency policy. Blood should not be exposed to sunlight or artificial light.
13. An infant under overhead phototherapy lights has an increased risk of dehydration and increased temperature. If is important that the newborn stay hydrated and fed frequently (usually every 2 to 3 hours).
CRITERIA FOR ACCEPTANCE OF PATIENT:
1. Otherwise healthy, term infant with clinically significant icterus.
a. Term, appropriate-for-gestational-age, defined as greater than 37 weeks of gestational age by obstetrical dating and weight of 2,500-4,000 grams at birth.
b. Five-minute Apgar score of 7 or greater.
c. Normal findings on physical examination.
d. Actively feeding infant.
e. Stooling and voiding by 24 hours of age.
f. Greater than 48 hours of age but less than 7 days at the initiation of therapy.
g. Bilirubin levels will vary at the start of therapy. Physician needs to determine if levels are appropriate for home phototherapy.
2. Competent caregiver who is willing and able to care for the infant at home.
3. Residence less than one-half hour from emergency care, or as determined by agency policy.
4. Wiring in home to allow for adapter or 3-pronged plug.
5. Ability to adequately regulate environmental temperature.
6. Telephone must be easily accessible.
7. Blood work will be done while infant is receiving therapy per physician order, usually daily.
EQUIPMENT:
Portable home phototherapy light, fiberoptic blanket, or phototherapy bed (type of unit will be ordered by physician)
Bank light phototherapy kit (bilimask, thermometer, white sheet/pillowcase)
Patient record to be kept by caregiver
Disposable cover for blanket (only needed with fiberoptic blanket)
PROCEDURE:
1. Adhere to Standard Precautions.
2. Identify infant and explain to caregiver that you will be instructing them in all aspects of the procedure.
3. Undress and perform physical assessment of infant.
4. Assess and instruct for dehydration.
5. Check axillary temperature, instruct caregiver. (See Temperature Taking, Axillary or Oral.)
6. Draw any ordered blood work, usually per heelstick.
7. Assemble phototherapy unit as per manufacturer's instructions (may be bank of lights or fiberoptic blanket).
8. Place white sheet on floor/table under the unit.
9. Check calibration of unit per manufacturer's guidelines.
10. Place eye patches on infant's eyes, if bank of lights is used. Instruct caregiver on importance of proper placement of eye patches.
11. Place infant under light. If fiberoptic blanket is used, apply blanket per manufacturer's instructions. Cloth covering should be placed over blanket to protect from soiling. Infant may have clothing placed over the fiberoptic blanket. A cloth blanket may then be wrapped around the infant.
12. If infant is placed on a phototherapy bed no eye patches are needed. Place the infant on his/her back, into the cover provided with a diaper on. Check the infant’s temperature after 30 minutes regardless of the type of unit used to lower the bilirubin (normal axillary temperature should be between 97.4 and 99.0 degrees Fahrenheit). If the infant’s temperature is less than 97.4 degrees Fahrenheit (Ax), have the parents place the unit in a warmer area of the house and recheck again in 30 minutes. If the infant’s temperature is too warm, have the parents place the unit in a cooler area of the house and recheck in 30 minutes. If the infant’s temperature has not then stabilized, notify physician.
13. With bank of lights, shield male infant's gonads with proper placement of diaper and instruct caregiver.
14. If fiberoptic blanket is used, infant may wear a diaper.
15. A medical equipment company may set up phototherapy equipment.
AFTER CARE:
1. Start patient record. Instruct caregiver in use.
2. Instruct caregivers in patient care including: temperature taking, eye patches, turning of infant as per instructions at least every 2 hours.
3. Review signs and symptoms of illness for infant.
4. Plan visit for next day for newborn assessment and to do blood work.
5. Review indications of terminating treatment and notification of doctor or nurse. (See Step 5 in Considerations).
6. Call physician with abnormal findings and time treatment started.
7. Document in patient's record:
a. Findings on examination of infant.
b. Plan of care that has been coordinated with physician.
c. Caregiver’s response to procedure.
d. All instructions given to caregiver and written materials left in home.
e. Meter reading on phototherapy, if available, to document time equipment was on since last nursing visit.