bilimeter readings

[asher315]

I read an article last night about phototherapy and it said the bilimeter reading should be about 50 (whatever their measurement is). Our P&P says 12-14 (whatever). What is every one else using as a guide for effective phototherapy?

Thanks,

asher315

[dawngloves, BSN, RN]

What type of bili light are you using?

[justjenny]

Are you talking about the irradiance of the lights??

We typically will start out with a "white" bili light if there is no real concern but frequently utilize "blue" lights and sometimes multiple banks of "blue" lights depending on how fast the bili is climbing.

We don't have a set policy with specific numbers for phototherapy...it is kind of like a "trial and error" of sorts...using the same equipment for years you know what works best for certain kids (ie: do they have a "set up" +++DAT, etc)

Jenny

[Mags4711, RN]

Nursing does not monitor the lights, our biomedical engineers go through on a regular basis and check and test them to assure their proper functioning. It's interesting to me that in some places, nursing monitors the lights. Fascinating!

[SteveNNP, MSN, NP]

We monitor the intensity level for our lights regularly throughout the shift with a bilimeter. Our rule of thumb is 10 for single, 20 for double, and 30 for triple photo. If it's higher than that, the light's probably too close to the baby anyway....

[Jokerhill]

You need to check the light intensity at least each shift to make sure everything is working correctly. The bulbs get weak, the light is to far away ect. But to use the Bili meter you have to do it one light at a time, turning off the ones you are not checking. But to answer your question it depends on the type of light you use. And the best way to find out what it should be is to go onto their web site and check. We use three different brands of lights and all are different.

[Mags4711, RN]

Apparently we're in the serious minority here. It looks like just about everyone monitors their lights. I'm off to write an email to the Medical Director and ask why we don't.

[nell]

We have a Neo who has done research on hyperbilirubinemia and for serious phototherapy he wants blue lights and however many it takes to get a reading greater than 35 (our new lights are >35 each). We check and document the reading each shift.

nell

[asher315]

Thank you for all the input. Nell, you answered it best. The bilimeter reading depends of the strength and type of lights as well as how close they are to the baby. Now I know why it seems to take forever to get the bili levels down.

Thanks again,

asher315

[RainDreamer, BSN, RN]

Biomed only checks to make sure the lights/equipment is working properly. But we have to use a bilimeter to make sure the light is at the right intensity for the baby and that the baby is getting the ordered phototherapy (single, double, triple, etc).

We have a few different lights too and each one has a tag on it that says what the measurements should be at. It has a chart and says what number it should be. Easy enough.

And I always document that I checked the level and that it was in the correct range. Otherwise, what if the baby's bili shoots up and you end up in court? How could you prove that the baby was under the correct ordered phototherapy?

[Love_2_Learn]

I agree that each phototherapy light manufacturer has their own parameters. One of our nurse practitioners taught us that using the overhead phototherapy that comes attached to a regular radiant heat warmer can be adequately effective when the reading is as low at 6 when you are using it on a micropreemie with very thin skin. A baby nearer term with super high total bilirubin would require multiple banks of lights along with possibly a biliblanket and aluminum foil applied around the radiant heat warmer sides to help increase the intensity and the doctors might want a reading of 35-40 or more. If it's too high, the child would possibly be a candidate for partial exchange transfusion to help rid the body of the excess bilirubin. I did find it interesting to learn that the thinner skinned preemies need less intense phototherapy light irradiance readings than the babies who have thicker skin. I suppose this is why some doctors order the phototherapy intensity to be at different levels and different numbers of phototherapy lights. Also remember that the extra lights/heat can potentially cause some dehydration, so monitoring the baby's temperature and hydration is important as is removing the lights/mask briefly every so often for family to bond and feed whenever possible.

[twinkletoes53]

We check our bililights each shift, and document the radiometer reading in our flowsheet. We want a reading of a minimum reading of 10. I read a lecture recently, where the professor said that you cannot overradiate the babies, so it doesn't matter how how the reading is. For high bilis, we try to get the radimeter readings >20. We use blue bank lights, biliblankets, or spotlight phototherapy. On the spotlights, each one has a tape measure attached. Instructions that come with the light say not to put the light closer than 18 inches to the baby's skin.