Bili device that works like a pulse ox?

prmenrs, RN · Nov 8, 2001

There used to be a gizmo that took a reading off the baby's forehead, that was inaccurate also, but gave you a reference pt.

The goal here would be to reduce the number of times the baby got stuck. So, what I might do is to place the monitor on, get a reading, then warm the kid's foot, and send a sample to the lab. Now you know how far apart they are. If the moniter goes up, presumably the lab results would rise also. You could adjust the baby's therapy accordingly.

You would still have to get a real lab result once or twice a day, and I don't know how often you do it now, but that gives you an idea of how you can use this monitor.

When you get a lab, be sure to warm the heel, it really does help. Either use a heel warmer device, or a diaper you've run under WARM, not hot water. You can check the temp of the diaper with a thermometer if you have asbestos hands like me. I like the diaper to be about 100F.

Also, you can use neosporin ointment in a very THIN film over the heel so the blood will "bead up", and you won't have it wasted all over everything but the container you're trying to collect it in!

There is a neonatologist I work with who can often "call" the bili level w/in 0.2 of the lab value!! I can always send him over if you want!!

KRVRN, BSN, RN · Nov 9, 2001

Neosporin oint helps the blood bead better? Doesn't actually make those big fat non-bleeders gimme blood does it? Wouldn't that be nice. Sometimes I have heel warmers on both feet AND both legs ("heck maybe it'll help...") with the big guys.

And prmenrs, I wonder if your neo would've called this one... Had a baby readmitted from home one time with yellow down to the soles of his feet. BUT-- he didn't look omigod dark yellow, just a light shade. Had a bili of 32...certainly didn't look it.

prmenrs, RN · Nov 9, 2001

Kristi-

There is a "pearl" about the farther down the yellow is, the higher the bili is, but don't know the exact #s. So your kid with his yellow feet would have been a high guess from any one.

How high was his crit? My guess is >70!

Another way to get blood out of these turnips is to find a vein way down on the hand, pull the tubing off a butterfly and let it drip into the microtainer. Don't tell anyone you got that from me!!

The neosporin doesn't get the blood out, just helps you waste less of it running down your glove, the heel, etc.

S.

p.s. had my babysitter ask me what could've caused all these little cuts in her friend's baby's foot--the mother-in-law was blaming it on the mother!!

rntmo95 · Nov 9, 2001

:) Thanks for the replies!

I'm a faithful user of the heel warmers. I hate to do PKUs....You would think that with all the techonology in this world that there would be an easier way to get those test results instead of filling five of those darn circles.

Well anyway back to the bili draws..... Its not so much that we have trouble with the sticks and the non bleeders its just the repeat of the labs. After dc'd sometimes they have those babies coming in everyday for a week to get a repeat bili.

prmenrs, do ya think your neonatalogist will come all the way over to Illinois every now and then? :) Ha, Our staff would probably fall over if he walked in, we don't even have an ob/gyn on staff......Needless to say anyone with a "gist" on the end of their title!

Thanks again for the replies and tips!-------mosleyrn

KRVRN, BSN, RN · Nov 9, 2001

I don't recall what yellow foot boy's crit was. I didn't look too close at his other labs, just the bili (he wasn't my pt). I just remember that he didn't LOOK very yellow and the feet weren't all that obviously yellow because he was Asian and somewhat dark-skinned. I've seen yellow feet with lower bili's before. It's kind of scary because they tell the parents to watch out for yellowness and all, but he wasn't THAT yellow. What brought them to the ped's office was that he was too lethargic to eat. Good thing they were on top of that.

KRVRN, BSN, RN · Nov 9, 2001

I mean the feet weren't obviously yellow to the parents. It's just scary because we have that assessment skill, but parents don't.

bbnurse · Nov 10, 2001

Have indeed heard of a bilirubin meter that measures the amount of bili in the skin. Some of the neonatal units are using it to SCREEN those kids at risk. It is much like the glucometers in size and reads like a pulse ox. Costs about $3500. With the JCAHO emphasis on recognition and/or prevention of hyperbilirubinemia and kernicterus, our hospital has one planned this year. Like most screening tools, the results should merely be taken as a screen with confirmatory labs to follow.

imenid37 · Sep 22, 2002

we use the bili meter in our nursery. the #'s it gives are 1.5-2x what serum bili usually turns out to be. if we think they look jd, we use it. if the # is > 18 we have lab do a neonatal bili. (cause the lab gods in our hospital say only the lab may do labs except pku-REAL DUMB).

BBnurse34 · Oct 4, 2002

Thanks for the info. I have been wondering about billimeters. I do most MBRs venipuncture. I hate tearing up those tiny feet.

Mofe'ny · Oct 4, 2002

Hi, I just saw one of those a t a conference. You can check it out at http://www.respironics.com. children's medical ventures was the displayer. Their website is http://www.childmed.com

Personally, I was not impressed. you are supposed to touch the baby's forehead gently with it 5 times and push a button each time. Then it gives you a approximate bili level. Well, it took the reps about 10 minutes of demonstrating to show us how to use it, and get a number. First they would press too hard, then too soft, and each time the machine would beeeeeeeppppp. I don't have the patience for that if the baby is moving around, crying, etc. You would still have to draw a bili if the level was too high. I am not sure about the accuracy of these. The one I saw looked like an ear thermometer, and you were just supposed to touch the babies forehead with the probe.

Our new DR. orders are for a bili on all babies with the "State Newborn Screen." (It's no longer PKU 'because they test for more than just PKU') We can draw a bili 'per RN's discretion', and then just call with the results, if necessary.

Imenid37, our lab is not allowed to draw labs on any of our babies.

finallyRN · Oct 5, 2002

We were actually just inserviced on the new billimeter called "Billi Check" It's the one Mofe'ny described. We have yet to test it on our patients. It seems easy enough to do. Will let you guys know how it works for us.