Giraffe Warmer Clinical Participant Guide Rev A

Giraffe Warmer *

Clinical Participant Guide Maternal-Infant Care

Customer Support Center: 800-345-2700

Notice The materials contained in this document are intended for educational purposes only. This document does not establish specifications, operating procedures or maintenance methods for any of the devices referenced. Always refer to the official written materials (labeling) provided with the device for specifications, operating procedures and maintenance requirements. Proprietary Training Material Property of GE Healthcare. Use of these materials is limited to agents and employees of GE Healthcare or other parties expressly licensed by GE Healthcare. Unlicensed use is strictly prohibited. Note! This participant guide is not intended to replace the User’s Reference Manuals that you received with the device. Please refer to the disclaimer notice at the end of this participant guide for more information. *GE, GE Monogram, and Giraffe are trademarks of General Electric Company Copyright © 2013 General Electric Company. All rights reserved.

i

Giraffe Warmer Clinical Participant Guide

Contents 1 Welcome... 1.1

5 Patient Probe Panel... 5.1

Icons Used in This Manual ... 1.2 Terms You Should Know ... 1.3

6 Bed and Scale... 6.1 Bed Components Overview... 6.1

2 Giraffe Warmer Overview... 2.1

Bed and Scale Features ... 6.2

Overview Objectives... 2.1

Hands-on Activity... 6.4

Device Description... 2.1 Giraffe Warmer Components ... 2.2

7 Operational Overview... 7.1

More About: Grab and Go Cylinders... 2.6

Control Panel... 7.1 Timer ON/OFF... 7.2

3 Upper Assembly Components... 3.1

Menu Key... 7.3

Radiant Heat Engine... 3.1

Callback Timer ... 7.4

Lights... 3.2

Scale Key ... 7.5

Alarm Light and Alarm Silence ... 3.3

Trends ... 7.8 SpO2 Key ... 7.10

4 Resuscitation Unit... 4.1

Setup Key... 7.11

Suction ... 4.1

Help Key... 7.13

T-piece Overview... 4.2

Alarms... 7.14

T-piece Setup... 4.4

Hands-on Activity... 7.18

Bag and Mask Overview... 4.6 Bag and Mask Setup... 4.8

8 Admitting a New Patient ... 8.1

Resuscitation System Back View... 4.9

Warmup Mode... 8.1

Hands-on Activity... 4.10

Admitting a Patient... 8.2 Hands-on Activity... 8.3

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9 Resources... 9.1 Use of the Giraffe Warmer Recommended Steps ... 9.1 Temperature Monitoring Guidance Card... 9.3 Alarm Priorities ... 9.4 Cleaning the Giraffe Warmer... 9.6 Giraffe Warmer Reusable Skin Temperature Probe Cleaning Guidelines... 9.8 Warmer Maintenance Schedule... 9.10 Troubleshooting Guide... 9.11 Options... 9.14

Appendix Skills Overview... A.1

iii

1 Welcome

1 Welcome

1 Welcome

We would like to take a moment to thank you for choosing GE Healthcare for your patient care needs. Our goal is to provide you with the best training available and continue to support you while you use our devices.

Program Description This session is designed to give participants an overview of the Giraffe Warmer from a clinical perspective. This will include an overview and description of the features and benefits, a brief description of the clinical use of the device, and demonstrations related to clinical use of the device. Note that some of the items listed in this participant guide are optional items and may not have been purchased for your warmer.

Program Objective The objective of the session is to provide hospital clinical staff with an overview of the device so they can clinically understand the use of the device once training is completed for their care area of use within the hospital. This is not a substitute for basic clinical on-site training offered by GE Healthcare.

Participant Learning Objectives At the completion of this session, the participant will be able to: • Provide a description of the device and how it is used clinically • Identify the components on the front, back and sides of the device • Describe the features of the heater, lighting and all accessory options on the bed • Navigate the control panel on the front of the device • Identify the components on the optional resuscitation unit and describe how it is used clinically • Identify and discuss the patient admission process specific to care area of use • Demonstrate weighing procedure using in bed scale, if option is available • Successfully disassemble and reassemble the bed

1.1

Giraffe Warmer Clinical Participant Guide

Icons Used in This Manual Note! Represents information which is additive in terms of helping the participant better understand specific tasks, activities and processes.

Lesson Objective: Appears at the beginning of each chapter, and includes a list of lesson objectives for the subject matter.

Activity icon: A workshop, return demonstration, practice session, exercise, or other activity to practice teaching points.

Tips and Reminders icon: Contains helpful and important information.

More about: Represents optional or additional features your warmer may have.

Terms You Should Know: A list of terms the participant should understand in the chapter.

1.2

1 Welcome

1 Welcome

Terms You Should Know Baby mode: Heat output controlled by the use of a patient skin temperature probe and selection of Baby mode. Commonly referred to as Servo Control by other manufacturers. DISS: Diameter Index Safety System is a set of internal and external diameters for hose fittings. Each medical gas is “keyed” to provide a safety system designed against attaching a hose to the wrong medical gas. ELBW: Extremely Low Birth Weight Grab and Go or Airtote: Names used to reference e-cylinder air or oxygen tanks that are equipped with a built in regulator, flow meter, and auxillary flow side port to deliver medical gases. HFOV: High Frequency Oscillating Ventilation iRes: Integrated Resuscitation System LBW: Low Birth Weight L&D: Labor and Delivery NICU: Neonatal Intensive Care Unit psi: A measurement of gas pressure that indicates pounds per square inch. Radiant Heat: Heat energy emitting from a warm element that warms a human and objects rather than directly heating the air. Resuscitation: a process to restore breathing. SpO2: Oxygen saturation measured by pulse oximetry. Thermoregulation: Temperature control of the neonate. A critical physiological function that is strongly influenced by physical immaturity, extent of illness and environmental factors. VLBW: Very Low Birth Weight

1.3

2 Giraffe Warmer Overview

2 Giraffe Warmer Overview Overview Objectives By the end of this chapter the learner should be able to:

2 Giraffe Warmer Overview

Identify all the main components used on the Giraffe Warmer.

Device Description Patients: Neonates or infants cared for on a radiant warmer.

Needs:

• Surgical, ECMO • Ventilated, cooling, or complex care support • Total patient access • Developmental care support • Family involvement • Thermoregulation

Infant radiant warmers provide infrared heat in a controlled manner to neonates who are unable to thermoregulate based on their own physiology. Infant radiant warmers may be used to facilitate the neonate’s transition to the external environment or to provide a controlled open environment. An optional, integrated SpO2 monitoring feature may be used for continuous noninvasive monitoring of functional oxygen saturation of arterial hemoglobin (SpO2) and pulse rate (measured by an SpO2 sensor). An optional integrated resuscitation system may be used to provide the basic equipment required for pulmonary resuscitation of infants. Pulmonary resuscitation includes practices necessary to establish a clear airway and provide oxygen or air/oxygen mixtures and/or manual ventilation to the infant.

2.1

Giraffe Warmer Clinical Participant Guide

Giraffe Warmer Components Front View 1. Observation lights

1

2. Recessed radiant heater

2

3. Procedure light 4. Alarm light

3

5. Control Panel

4

6. Cable management clip

Giraffe

?

7. iRes resuscitation system (optional)

5

8. Rear panel 9. Side panel 80

60

10. Bed/mattress

100 12

8

40

0

140 20

0

24

kPa

6

120

16

4

20

160 180

(mm Hg)

VACUUM

11. Scale (optional) 12. Bed level indicator

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4 2

20 10

L/min

% O2 50

5

10

40

6

7

70 80

7

8

1 kPa -1 0 0 (cmH2O)

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-10

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M A N O M E T E R

L/min 5

10

90

21 0

5

3

30

13. Tilt Mechanism

60

50 40 30

100 0

15

15

100

14. Front handle

10

15. Locking wheels 16. Bag and mask holder

8 9

Giraffe

11 12 13 14

Giraffe

15 Figure 2.1 Giraffe Warmer Front View 2.2

2 Giraffe Warmer Overview

Right Side View 1. Patient probe panel 2. Skin temperature probe 3. Scale jack 4. Mounting rail 6. Storage drawers (option of 1 or 2 drawers)

2 Giraffe Warmer Overview

5. Height adjustment pedals for base

1

7. Chest tube hanger 8. Flip-down side panel 9. X-ray tray

2

10. Baby Susan rotating mattress with optional integrated scale

3 4

10 9 8

7 6

5 Figure 2.2 Giraffe Warmer Right Side

2.3

Giraffe Warmer Clinical Participant Guide

Left Side View 1. SpO2 port (optional) 2. Bed level indicator 3. Key Lock for top drawer or single drawer 4. Suction collection canister 5. Cable management clip

1 Masimo Port

Nellcor Port

5

2

Giraffe

800

400 300 200 100 400

4

20

3 Figure 2.3 Giraffe Warmer Left Side

2.4

2 Giraffe Warmer Overview

Back View 1. Mains circuit breaker 2. Power cord inlet 3. iRes resuscitation system (optional)

5. Integrated air and oxygen yoke for non-grab and go eCylinder tanks (with optional resuscitation system) 6. Oxygen cylinder (customer supplied)

1 10

7. Giraffe Warmer Serial Number. It is important to have this number ready when calling customer service.

2

9

8. Air cylinder (optional)

3

Note! See More about Cylinders on the next page if your warmer is equipped with Grab and Go cylinders.

4

9. Maneuvering handle and cord wrap

5

10. RS-232 connector

8

6

7

Figure 2.4 Giraffe Warmer Back View

2.5

2 Giraffe Warmer Overview

4. Hose inlets (with optional resuscitation system)

Giraffe Warmer Clinical Participant Guide

More About: Grab and Go Cylinders Your Giraffe Warmer may be equipped with Grab and Go Cylinders (customer supplied). The purpose of these cylinders is to provide air and oxygen tank medical gas support. 1. The five foot DISS hose attaches to a 55 psi port on the side of the Grab and Go tank. 2. The opposite end of the DISS hose attaches directly into the back of the iRes. 3. Turn the knob to AUX to turn on medical gas flow via the auxillary hose port. Medical gas will flow toward the iRes resuscitation system.

1

4. Tank pressure gauges on front of iRes system will register zero while the Grab and Go tanks are in use. Refer to the pressure gauges on each of the Grab and Go tanks for current pressure.

2

5. The e-cylinder holder mounts to side Mounting Rails. Note! The mounting bracket for the e-cylinders will not easily fit into the back Mounting Rails due to the angle and width of the bracket.

5

Figure 2.5 Giraffe Warmer Back View With Grab and Go Cylinders 2.6

2 Giraffe Warmer Overview

2 Giraffe Warmer Overview

1. DISS hose attachment. 2. External DISS port screw. 3. Auxillary medical gas flow selection. 4. Grab and Go medical gas pressure gauge.

1

2 3

4

Figure 2.6 Giraffe Warmer Side View With Grab And Go Cylinders 2.7

3 Upper Assembly Components

3 Upper Assembly Components Radiant Heat Engine 1. In Manual mode, the warmer controls radiant heater output from a heater power percentage setting that you enter using the control panel. In Baby mode, the warmer controls radiant heater output based on temperature readings from a probe attached to the baby’s skin (skin probe) and a set temperature (set temp) you enter using the control panel.

2

1

3 Upper Assembly Components

2. The reflective dish consists of two parabolic curves that provide even heat distribution over the bed surface while minimizing heat to the Clinician. 3. Focused heat pattern on the mattress.

Figure 3.1 Reflective dish

3

Figure 3.2 Heat pattern 3.1

Giraffe Warmer Clinical Participant Guide

Lights 1

2

?

3

PIP 10

0

100

Figure 3.3 Giraffe Warmer Lights

1. Observation lights: The standard observation lights are dimmable. 2. Procedure light: The procedure light provides a more intense spot light to illuminate a precise area during procedures. The procedure light can be directed at any point on the mattress and is activated using the switch on the light handle. 3. Dimmer knob: Turns light on and off, and controls intensity of observation lights.

3.2

3 Upper Assembly Components

3 Upper Assembly Components

Alarm Light and Alarm Silence

Giraffe

? Baby Temp (ºC)

35.5

Baby Cold - Check Temp Probe

Timer On/Off

Set Temp

36.5

Adjust Set Temp ( )

25% 50% 75% 100%

Mode

Manual Baby Pulse Rate SpO2 200 100

140 94 100 85

Menu

Monday, August 17, 2012

•

12 03 PM

PIP

Figure 3.4 Hands Free Alarm Silence 10

0

• The two areas in the NICU, Newborn nursery or L&D that tend to have the highest concentration of germs are the scrub sink and the alarm silence button on equipment. To help counteract this issue, the Warmer has a Hands Free Alarm Silence. • Pass your hand slowly within six inches in front of the alarm light to silence the alarm. 100

50

• The alarm light has two infrared emitters and a detector in it to allow for hands-free silencing of alarms.

Note! See page 9.4 for alarm priority table.

3.3

4 Resuscitation Unit

4 Resuscitation Unit Suction 1. For the integrated system, check that a clean suction canister is properly installed and attached to the tubing in the Mounting rail. 2. Attach desired length of suction tubing to the suction canister patient outlet.

4

3 Figure 4.1 Suction Features

Suction Vacuum Gauge

Figure 4.2 Attach suction tubing

3. Turn the suction control switch On.

5. Once you have set the desired vacuum level, attach the suction catheter or meconium aspirator of your choice. 6. Turn the suction control switch off until ready to initiate resuscitation or airway support measures to avoid wasting gas. Suction Canister Care: • As part of the operator maintenance, it is recommended that the suction tubing between the regulator at the base of the resuscitation box and the canister be replaced every three months.

Suction tubing

Suction tubing is secured inside the Mounting Rail, connecting to the suction outlet at the base of the resuscitation system

Giraffe

1

4 Resuscitation Unit

4. Occlude the connective tubing, and then adjust the suction control knob to a desired pressure between 60 to 120 mmHg.

2 Suction canister bracket attached to the Mounting Rail

800

400 300 200 100 400

20

• Always assure that a clean suction canister and tubing are properly installed and connected prior to each use. • Attach the desired length of suction tubing to patient port on the suction canister.

Figure 4.3 Suction Canister and Tubing

4.1

Giraffe Warmer Clinical Participant Guide

T-piece Overview There are two options of resuscitation for delivering positive pressure with the resuscitation system. We will begin with the description of the T-Piece option. 1.

PIP control knob: A PIP (Peak Inspiratory Pressure) control knob and a flowmeter control medical gas supplied to a dedicated T-piece outlet. Pressures from 0 to 30 cmH2O (0 to 30 kPa) can be selected without restriction. Pressures up to 45, +/- 5cm H20 can be selected after pushing in the yellow override release and then turning the knob.

2.

The airway pressure manometer: Allows the Clinician to see pressure throughout the respiratory cycle. The airway pressure manometer displays both PIP and PEEP (Positive End Expiratory Pressure).

3.

The primary flowmeter control: Located on the right side of the resuscitation system, it is used to adjust the flow delivered to the patient. A second flowmeter control and outlet (on the left) is provided for free flowing oxygen (blow-by) and is designed for resuscitation only. A manual resuscitator may be attached to the secondary flowmeter, but must be used with an independent airway pressure manometer. Both flowmeters allow for adjusted flows of 0-15 lpm.

4.

T-piece gas outlet: The T-piece circuit is attached to this outlet.

5.

T-piece circuit: Consists of tubing, a T-piece fitting with a PEEP control knob, and an end cap. A face mask or endotracheal tube is also necessary to use the system. GE Healthcare T-piece circuits are available with or without a face mask.

6.

Air and Oxygen tank gauges: Present with the blender option only. This applies to both the T-Piece and Bag and Mask resuscitation systems. Gauges register with use of traditional e-cylinder tanks secured into the rear yoke of the resuscitation system.

7.

Oxygen connection tubing: For free flow oxygen to the secondary outlet.

8.

Secondary gas outlet: Always a traditional flowmeter adapter.

9

Blender control knob: Regulates FiO2 from 21 to 100% from both medical gas outlets. Inlet ports on the back of the device allow attachment to medical gas supplies.

10. Medical gas switch: Toggle switch that turns on flow of medical gases to flowmeters and blender.

80

60

100 12

8

40

140 20

0

0

120

16

4

20

24

kPa

160 180

(mm Hg)

VACUUM

60

50 40

4 2

20 10

% O2 50

5

40

10

21

8

PIP 1 kPa -1 0 0 (cmH2O)

60

-10

L/min 70 5

80

10

100 0

bar 100xkPa psi

00 40

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2000 150

50

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bar 100xkPa psi

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2500 200 250

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500 0

2500 200

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2 kPa 30 (cmH2O)

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1500

O2

70 7

90

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0

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3

30

L/min

5

kPa (cmH2O)

AIR

00 40

Figure 4.4 T-Piece Without Connections

4.2

4 Resuscitation Unit

80

60 8

40

100 12

4

20

140 20

0

0

120

16

24

kPa

160 180

(mm Hg)

VACUUM

50 40

2 20 10

9

L/min

% O2 50

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6

3

80 8

1

PIP 0 (cmH2O)

60

2

-10

L/min 70 5

80

10

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90

30 21

0

2 kPa 30 (cmH2O)

1 kPa -1 0

40

10

70 7

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5

kPa (cmH2O)

100 0

15

15

4

8

bar 100xkPa psi

100

2000 150

50 500

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0

200 250

0 150

00 40

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bar 100xkPa psi

250 0

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250 0 1000

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3000

O2

100

3500

0 150

AIR

4 Resuscitation Unit

60

00 40

6

7

5

Figure 4.5 T-Piece With Connections

4.3