[JenTheRN]

Do any of you use the bilichek transcutaneous bilirubin device in any of your newborn nurseries? We use it, and we keep getting readings that are pretty consistently 2mg higher than the serum bilirubin is. I've followed all the recommendations and still get this high reading. Do you have any recommendations or tips? I know the device callibrates every time you turn it on. Do we need to send ours in?

Thanks for your feedback!

You guys always help me with all of my problems/questions!!

[Elvish]

We use Bilichek also and have had good results. However, if we get a result >15 we have standing orders to draw a serum total and direct bili. I think Bilicheck is a great screening tool but IMO it is just that, a screen for potential problems.

What are your screening criteria?? We Bilichek anyone who looks jaundiced, babies of first time BF moms on day of life #2 (since they will most likely be going home that day if they are a vag del), or anyone who will be <48 hrs old at time of discharge.

[JenTheRN]

We bilichek anyone that looks jaundiced. If greater than 10-12 we get a serum level.

I would like to start checking all babes before they are discharged, but not if the machine can't be relied on.

[babyktchr]

I will have to check our policy, but I think we have to send our bilicheck machine in if we get a greater than 3 mg difference between serum and the bilicheck meter.

The thing about these meters. They are for screening purposes, but you have to use them right. You have to have the baby in a well lit area to test, and the baby should be greater than 20 hours old to test. Serum testing should be done, depending on what the bilicheck was and the hours of age the baby was at the time. We have bilirubin charts in all of the baby charts so we can easily calculate a low/med/high risk number. A bili of 8 may not be high in a newborn that is 48 hours old, as opposed to a newborn that is 24 hours old.

All of our babies must have a bili done before they go home.

We send our bili meter out kind of freqently if you ask me. There are times that we are right on the money (+/or - 1.5).

The one thing I know we really watch for...if phlebotomy draws the serum TBILI....they tend to squeeze the foot. I know I have seen a few newbies doing it, and that just messes up the test. I try to do them myself if I can.

[Elvish]

Originally Posted by babyktchr

The one thing I know we really watch for...if phlebotomy draws the serum TBILI....they tend to squeeze the foot. I know I have seen a few newbies doing it, and that just messes up the test.

Ditto. We *often* get hemolyzed samples.

[Buggs]

We use the TCB on all our babies at the time we draw their newborn screenings. The babies of vag deliveries are usually 24-36 hrs old, and the c/s babes are usu. @ 48hrs old. (We do the screens on night shift just before their discharge in the am. If the TCB is 2 or closer points to light level (we have a graph to plot them on as part of the documentation) we must draw a serum level. Of course, if our nursing judgement indicates that we think the baby needs a serum at ANY time, we have a standing order to draw one. Sometimes a serum is sent with the newborn screen because the parents want it checked. So far I have not personally found any huge discrepancies. But, I do keep in mind that it is a SCREENING tool, and my judgement can be more reliable at times, so I send a serum if I doubt the TCB. The way I look at it is the TCB is a ballpark number, but if it's close or in question, send the serum. Hope this helps.

[SmilingBluEyes]

It's only a ballpark figure. like said before me. I also notice color and sometimes that is a better predictor than the meter. I have found the numbers to vary like this too; unfortunate as I hate to stick babies for serum bili's for less than a really good reason. But I guess, not missing a high bili for any reason is darn good reason. I will check serums for really yellow kids even if the meter does not show a problem.

[RNmommy]

At my old job, we used the Bilicheck. It was recommended around the time that I moved, to do the procedure on the substernal area, rather than the forehead. Our Unit Educator said that there was better correlation with serum bili when the test was done that way. Makes sense, as jaundice is first visible in the nose and forehead region. We tracked the TCB result vs the serum result, and often the TCB would be at leat 1 point higher. There, we checked all babies at 24h. If the result was at or above the 90th percentile on the Bhutani gragh, we drew a serum.

At my new job, we use the Minolt and there seems to be better correlation with serum results. Here we wait until 36h to do the routine screening (unless, of course baby is coombs + or obviously icteric) and draw a serum if the result is at or above the 75th percentile on the bhutani graph.