Which Milk Warmer Do You Use?

[mgturtle]

I am aware of 2 hospital grade milk warmers used in different NICU's:

• Medela Waterless Milk Warmer
  
• Creche Innovations Penquin Warmer
  

Does anyone use anything different? Anything better?

[Efelliot81, BSN]

Medela in my unit

[NICUmiiki, DNP, NP]

We have a Medela warmer in every room. We change the liners Q12H. I don't really have any issues with it.

[vanilla bean]

Medelas at every bedside. Liners changed Q24H.

[katierobin23]

We just started using the Medelas, but our policy is to only change the liners when soiled or torn. Has any research been done to justify changing more frequently? Very curious to see if we're in the wrong! Each liner is labeled with a patient label and stored in a biohazard bag either next to the warmer or in the baby's bed. We have one warmer per room, but some of our rooms are semi-private so there is some sharing sometimes between two babies...which makes me a little uncomfortable, but the theory is with good hygiene between babies it shouldn't be an issue.

Interesting to hear about what other units do :)

[karnicurnc, MSN, APRN, CNS]

From Medela's waterless warmer user guide:

"Medela Disposable Inserts are a limited use item. Medela

recommends changing the inserts every 12 hours. Inserts should

be changed if human milk comes in contact with the inserts.

Inserts should also be changed if visible damage has occurred

that would offer the potential for human milk to come in direct

contact with the warmer."

https://www.medelabreastfeedingus.com/for-professionals/products/516/waterless-milk-warmer

[karnicurnc, MSN, APRN, CNS]

We have used the Medela warmer for years, but only had 1 per pod of 12 infants, so it was not very useful except for the one person who got to it first for that round of feedings. We have also used warm tap water in Styrofoam cups for years (a horrible practice, I might add.) We will be installing 60 Creche Penguin micro-fridges and individual well warmers in January. There is a fair amount of literature to support banishing the cup of water warming method and to support storing and warming infants feedings in a precise and controlled manner. Eliminating 1 case of surgical NEC per year would pay for the fridges and warmers for a 60 bed unit like ours.

From the Pediatrix STOP NEC Collaborative: "NEC is also associated with greatly increased healthcare costs, estimated at $200,000 during the 1st year of life."

References

Ganapathy V, Hay JW, Kim JH, Lee ML, Rechtman DJ. Long term healthcare costs of infants who survived neonatal necrotizing enterocolitis: a retrospective longitudinal study among infants enrolled in Texas Medicaid. BMC Pediatr. 2013;13:127.

Bisquera JA, Cooper TR, Berseth CL. Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics. 2002;109:423-428.

Want to read more about contaminated hospital water?

"Contamination of Hospital Tap Water

For 40 years, hospital tap water has been identified as a potential source of nosocomial infections from bacteria and other contaminants including Cryptosporidium parvum,

Legionelle spp, E Coli and Pseudomonas aeruginosa. 25-29 Patients at high risk of infection due to waterborne pathogens include AIDS patients, organ transplant recipients, oncology patients and neonates. 30 Healthcare-associated infections from

water supplies have been identified in hospital nurseries. As recently as 2009, 23 strains of Pseudomonas aeruginosa were found in the water supply of a children's hospital in the US. 31 In another report Buyukyavuz, et al, 26 identified Staphylococcus and Klebsiella pneumoniae in hospital tap water used to heat infant milk. These bacteria were determined to be directly responsible for an outbreak of septicemia in the hospital's

neonatal intensive care unit.

Squier 28 and Angelbeck 30 have explained the process of microbial contamination of hospital tap water. A slime layer or biofilm containing microorganisms adheres to the lumen of pipes and fixtures in municipal and hospital plumbing systems and in hospital water tanks. Patient exposure to waterborne microorganisms can occur through any exposure to tap water including bathing, drinking, contact with medical equipment wet

with water or health care provider hands rinsed in water. When tap water is used to warm infant feedings, there is potential for contamination of not only the container and the milk but also the nurse's hands. Squier recommends using dry-warming devices to

heat fluids that come in contact with patients. In concurrence, the CDC in their 2003 Guideline for Infection Control in Health-Care Facilities, 32 suggested facilities remove sources of contaminated water whenever possible. These guidelines clearly recognize that moist environments and water-based solutions can serve as reservoirs for waterborne microorganisms in hospital settings."

Reference

http://www.nicmag.ca/pdf/NIC-25-3-MJ12-Medela-Supplement.pdf

[TiffyRN, BSN, PhD]

We used a graduate cylinder of warm/hot water for warming for years. Then our unit had an outbreak of Klebsiella with some pretty serious outcomes. Out went the graduate cylinders, any tap water on infant's faces and one time use of bath tubs. No source of the Klebsiella was ever found in spite of culturing anything that would stand still including every water source.

For the longest we had milk warmer cabinets but those were shared areas and there were some near misses in administering wrong milk that had been left in there. So for the longest, we had nothing. I repeat. . . nothing. If the kid was in a giraffe, we could stick the milk in there, otherwise, we had to remember to set the milk out 30-60 minutes before the feed and hope we achieved room temperature by the time we fed. Seriously.

We initially got 12 waterless medela warmers, so approximately 1 for every 6-10 kids. Of course every kid had their own warmer bag and coming from a time when we had to remember to take milk out 30-60 minutes early, it was not difficult to coordinate our warming times.

Now every kid has a warmer. We also have evaluated the changing of the bags every day as we did at the beginning (and it took about a year to educate our secretarial staff how to order enough warmer bags for the unit, we were constantly out). There was an article in "Advances in Neonatal Care" about frequency of changing the bags. It was a simple study, where cultures were done of the bags. They found that unless visibly soiled, those bags were not growing anything for up to a week (not sure on the exact details, it's been a year or two). After review by our manager (and the potential to save a ton of money), we went to changing those bags once a week. No problems associated with that have been identified so far and we are a large unit (50+ beds) that strongly utilizes EBM and donor EBM.

[NJNICUCCRN]

We use penguins. Love them!!

[SteveNNP, MSN, NP]

When I was a bedside RN, we used pink water jugs with warm water. The unit then used the Penguin for awhile, and then in a push to avoid contact with tap water, we now have a Medela waterless warmer at every bedside. I believe at the time it was a risk for contamination with waterborne pathogens that an immunocompromised preemie might contract. There also was concern for uneven/overheating causing breastmilk component damage.

[sgrella13]

Hey TiffyRN - can you link to the article you are referring to regarding the bacterial colonization in the liners? I searched everywhere and cannot find.

[vintage_RN, BSN, RN]

We use little plastic beakers with warm tap water, put the feed in a plastic bag into the beaker. We also have very high NEC rates. I don’t know what the correlation would be, as the feeds are prepared sterily in syringes for tube feeds and wouldn’t come in contact with the water. Interesting..