Published Feb 26, 2014
I recently took a staff position after 4 years of traveling and am having some questions regarding isolette practices. I have always been taught that the top should not be "popped" unless it is an emergency situation (intubation, codes, line placement, etc). But, I find a my new job that they practice is to open this isolettes with every assessment, x-ray, etc.
I am looking to see how other people practice. Any articles, policies, etc that people may have regarding this issue.
Luckyyou, BSN, RN
We don't pop unless the excrement is hitting the fan.
NicuGal, MSN, RN
We don't pop up unless we have an OR or something big going on.
Hi, we're a level IV Nicu in California and popping the top at our facility isn't seen as a big deal. There's no policy stating we can't unless it's an absolute must. It's pretty much whatever works best for the care providers and whatever would be safest for baby.
I'm assuming you mean a Giraffe where the top opens up? Isn't the point (one of many) of having an isolette is that the heat is constant. We do everything through portholes except for intubation. Lines are placed with the baby on an open care warmer.
We try to limit popping the top, but it's not really a huge deal in most cases. If the baby's temp is stable enough, we can pop the top if we need a better angle or more room to accomplish a task. There is a radiant heat source when the top is up, so the babies really don't tend to get cold if it's only open briefly. If the bed is humidified, we leave the top down at all times except in emergencies.
Now, I will say that on admission little babies do get cold many times during line placement, but I feel like that has more to do with the lack of humidity than anything else and using a radiant warmer would likely have the same result.
We have a "golden hour" quality improvement initiative where the goal is to get all admission tasks finished within one hour of birth and get the bed closed as soon as possible...it's hit or miss whether it is accomplished or not.
Bortaz, MSN, RN
We try to limit popping the top, but it's not really a huge deal in most cases. If the baby's temp is stable enough, we can pop the top if we need a better angle or more room to accomplish a task. There is a radiant heat source when the top is up, so the babies really don't tend to get cold if it's only open briefly. If the bed is humidified, we leave the top down at all times except emergencies.
Agreed, this is my practice as well.
There is data that speaks to the possibility of it taking hours for the box and baby temps to stabilize after having the "top popped." I only open if ABSOLUTELY necessary. And it usually isn't.
I only pop the top when necessary. It depends on what I'm doing and the babies size. If they are a micro-preemie I'd only open for an intubation or re-taping the ETT. I see a lot of newer nurses that open it all the time. We don't really have a policy.
HyperSaurus, RN, BSN
We only have 3 giraffes where the top even has the option to be 'popped'. We don't usually pop the top, with the exception of some procedures
I try to dissuade them from even popping when reintubating (if it is a semi-controlled situation). The trays slide out and spin, so the lower half of the baby can remain in the warm environment. I even do tub baths in pink basins with the tops down (even on intubated babies). I admit, I may be a bit of a freak about certain things. (Hey, the first step is owning up to it, right? :-) )
I work in a level III NICU in NJ. Here, we open the isolette frequently. It seems to me, especially if a baby is on an oscillator or Jet vent, that it would be impossible to reposition the little ones without doing so. The tops of the Giraffes have heaters attached to ISC so it's not a big deal, the kids are still getting warmth.
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