Transcutaneous Bilirubins

[niccilam]

I am wondering if anyone is using transcutaneous bili meters in the well-baby nursery. What protocols are you using with the meter (i.e. day that bili is done, at what level do you get a serum bili, etc.)

Thanks in advance.

[babyktchr, BSN, RN]

We have used it for quite some time, it seems. We have a graph on every baby chart. The are done routinely at 24 hours, unless otherwise specified by MD. We log the result on a chart and if it is in the 75% -tile or above, we draw a serum. It is all age related though. If the serum vs. the TCB is more than 2 points off, the meter is whisked off to biomed for recalibration (and usually back to company for rehab).

[Elvish, BSN, DNP, RN, NP]

We usually do transcutaneous bili on day of discharge between 0500-0700. Our criteria are:

-anybody who looks jaundiced

-anybody whose mom is BFing for the first time

-anybody less than 48hrs old at time of discharge

-anybody with feeding/weight loss issues

We don't have any standing orders for +Coombs, much to the chagrin of a lot of nurses. Generally we get a bilichek q12 hours x 24 hours unless otherwise specified by peds.

We do a serum bili if the bilichek is at or above guidelines for phototherapy acc to the AAP graph (age also taken into account). Standing orders also say if bilichek is >15 to do a serum total & direct.

Also, anyone under 37 weeks gets an automatic total serum bili with their PKU.

[misty1998]

All of our babies get a bili done day of discharge. We obtain it, while we are getting their PKU. Since they are already poked and bleeding might as well do it. Some of our docs will order one sooner if babe looks jaunice or if + coombs.

[RNmommy]

Right now, I am working at a facility that does not own a TC bilimeter At my previous job, we did a TC bili at 36h with the PKU, that way, if it plotted out to above the 75th percentile on the Bhuttani graph, we could do a serum at that time. What I love about having a TC bilimeter on the unit is that you can spot check any baby, anytime. Every hospital i have ever worked in does T and D bili, H&H and retic on coombs + babies at 24 hours of age or earlier for perceived jaundice.

[BirthCenterRN]

We use it. The routine is to do it at 5am on the day of discharge and PRN. If the level is high risk for age, gestation, and risk factors then we get a serum within one hour. (http://www.bilitool.com is a great resource if you don't want to do the math on your 11th hour of working:)). We then call the MD with the serum results if they are still high. If the serum is lower we just leave a message for the MD because they come at 7am anyway.

I love the TCB. It saves alot of pokes to those tiny feet.

[QTBabyNurse, BSN, RN]

the last facility i worked in we did tcb q8h with the assessments. any results over 10 got a tsb drawn. coombs test was run on the cord blood at delivery along with an abo group and type.

the facility i work in now doesn't use a tcb at all, but they draw tsb on the morning of d/c home on all babies.

[crysobrn]

We do them with the pku. Then plot it on the graph, if it's elevated we have a lab drawn in the am. Then we generally recheck on the morning of discharge and again graph, and if high draw another bili in the am.