JOEY BED WARMER

POLICY The Joey Baby Bed Warmer is used to provide warming for infants going through transition or are stable and only require thermal support and meet the criteria listed below. Once the infant’s temperature is stable the infant can be placed in a cot. Applicability Joey Bed Warmer use occurs in the Neonatal Program in the Acute Perinatal Program.

CRITERIA The Joey Bed Warmer provides transitional warming for infants:  Not requiring invasive respiratory support  Oxygen needs are stable and can be provided by nasal prongs  Requiring few changes/interventions for respiratory management  Assessed to be hemodynamically stable  Between 1500 grams and 2000 grams  Small for Gestational Age (less than) < 1500 grams transitioning from an incubator to a crib  Greater than (>) 2000 grams who cannot maintain an axilla temperature (36.50 C to 370 C) with minimal warming (e.g. warm blankets) and bundling.  Requiring phototherapy

SPECIAL PRECAUTIONS

All Infants must be in the supine position when in the Joey Bed. Placing the infant supine supports the practice of back-to-sleep which is in accordance with the Canadian Paediatric Society (CPS), Health Canada and AAP recommendations.

Note: All infants must be in a cot once temperatures are stable without the need for supplemental heat. All staff will model and assure understanding of recommended back to sleep techniques by parents and caregivers.

PROCEDURE Preparation Note 1. Bring Joey Bed Warmer to the bedside. 2. Plug the unit in for 4 hours prior to placing the infant on the mattress. 3. Place the heating pad in the sleeve, directly under the water mattress.

The unit requires 4 hours to heat. Ensure that the unit is functioning properly and that all the unit components are at the bedside prior to use. The heater must be in direct contact with the water mattress sensor at all times. There should NEVER be a sheet between the heater and the water mattress.

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4. The black sensor on the heater must line up directly with the black dotted line on the Joey bed mattress.

5. Ensure the water mattress is filled to Check by standing the water mattress upright. If the bed is the fill line and there is no air in the to be tilted more than 50 degrees, fill 2 centimetres (cm) mattress. over the level mark.

6. Assemble the mattress. Mattress with heater in situ. This side should be placed up with the infant laying on it.

Close up of the heater in the mattress plastic sleeve. This side should be down away from the infant

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7. Make the bed with a thin sheet or Avoid putting receiving blanket over the water bedding between mattress and heater, ensuring the the heater and the blanket is tucked under the lower water mattress. foam mattress. If bedding comes between the heating pad and the water filled mattress, the heat controller will not function properly and alarms will sound.

Correct placement of linen with heater in direct contact with the water filled mattress

8. Place a towel over the prepared bed This will reduce the time required for pre-warming and during the pre-warming stage. prevent the likelihood of nuisance alarms. 9. Hang the control unit where it can be seen.

The Joey Bed Warmer - Front Control Panel should be easily visible for hourly checks of the mattress temperature.

0 10. Press the start button on the front After the self-test, observe the start temperature 37 C on panel. the front panel.

Using the Joey Bed Warmer Note 11. When Joey Bed Warmer reaches 370 Placing an infant on a cold water mattress can lead to 0 C, place the infant on the mattress. hypothermia. A Joey bed temperature of 37 C is comparable to an incubator temperature of 320 C.

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12. Dress the infant in a sleeper and a Avoid multiple layers of clothing or blankets. Excessive cloth hat. Bundle the infant with one between the heated water mattress and the infant will receiving blanket. prevent effective warming.

13. Place the infant supine on the Nests are NOT used in Intermediate Nursery (IN) for infants prepared bed. > 35 weeks gestation. Undertake back to sleep practices for infants in the Provide teaching to parents if nest intermediate side of NICU and in IN as soon as possible. used. Place the infant supine with blankets under the armpits. No covers should be around the head.  Avoid nests whenever possible but these can be used for infant less than (<) 35 weeks gestation or to support infant during phototherapy  Ensure that all side walls are in full upright positions when infant is not being attended to.

14. Cover the infant with several layers of Adjust the number of layers of blankets as the infant’s blankets. Start with 1 to 3 layers of temperature stabilizes. Any infant requiring more than 3 blankets. layers of blankets may not be ready to transition to an open crib.

15. Assess infant’s temperature 30 There is a potential for hypothermia with a mattress setting minutes after transfer to Joey Bed. that is too low or an infant that is covered with insufficient layers of blankets. If axilla temperature is > 37 C, remove one blanket at a time. Monitor 30 minutes  There is also potential for hyperthermia with mattress after removing each layer. setting that is too high, an infant that is dressed in too many clothes or with too many layers of blankets.  Check temperature every 30 to 60 minutes initially and then every 2 to 3 hours until stable (36.50 C to 370 C).

16. Adjust temperature setting for As the infant’s weight increases, the temperature is increases in infant’s weight. controlled by changing the:  Number of layers of blankets and  Mattress temperature in 0.50 C increments.

17. When there is only one blanket Infant may be ready to transfer to regular crib. Continue to covering the infant and the infant’s monitor the infant’s axilla temperature regularly. Maintain 0 0 temperature remains greater than 370 the temperature between 36.5 C to 37 C. C, decrease the water temperature by 0.50 C. 18. Consider transferring infant into a Once the infant is maintaining temperatures with the non-heated crib when the mattress mattress at a low temperature and is dressed lightly in temperature is 35.50 to 360C. clothes, then consider transferring to a regular crib. 19. Phototherapy. If ordered, initiate The infant may require a reduced temperature when phototherapy as per Phototherapy phototherapy is started. Larger infants may not require Policy & Procedure. supplemental heating. Monitor the infant’s axilla temperature  Consider use of phototherapy blanket instead of an every 30 minutes until stable. Avoid overhead light or if additional phototherapy coverage overheating the infant. required.  Do not place infant prone on water mattress. Maintain back to sleep practices.

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A clear plexiglass shield is available to fit The shield is stored in the equipment room. over the top of the Joey Bed to assist in temperature regulation. Plexiglass shield becomes unstable if walls at sides or head If using the plexiglass shield, access the of bed are lowered. infant either by:  Removing the shield or  Lowering the plexiglass wall at the foot of the bed. Post Procedure Note 20. Continue to monitor the infant’s Each infant is unique and may not be ready for a non- temperature when the infant is heated cot. Place the infant back on the Joey Bed with the 0 C 0 transferred to the open, unheated cot. mattress temperature between 35.5 to 36 C. Documentation Record the water mattress temperature hourly in the incubator humidity line on the Nursing Flow Sheet.  Record the infant’s temperature and changes on the Nursing Flow Sheet.  Write a focus note when changing number of layers of blankets.

DOCUMENTATION Nursing Flow Sheet

REFERENCES Baier, J. (04/07) St Boniface Hospital, NICU policy and procedure. Kan Med Bed: Guidelines for use. Dollberg, S & Hoath, SB. (2001). Temperature regulation in preterm infants: Role of skin-environment interface. Neo Reviews, 2(12), 282-291. Engle, WA. (2009). Infants born late preterm: Definition, physiologic and metabolic immaturity and outcomes. Neo Reviews, 10(6), 280-286. Knobel, R. & Holditch-Davis, D. (2007) Thermoregulation and heat loss prevention after birth and during neonatal intensive care unit stabilization of extremely low-birth weight infants. JOGNN, 36(3), 280-287. L’Herault, J., Petroff, L., & Jeffrey, J. (2001). The effectiveness of a thermal mattress in stabilizing and maintaining body temperature during the transport of very low-birth weight newborns. Applied Nursing Research, 14(4), 210-219. Mance, M. J. (2008). Keeping infants warm. Advances in Neonatal Care, 8(1), 6-12. Meyer, M. P., Payton, M. J., Salmon, A., Hutchinson, C., & de Klerk, A. (2001). A clinical comparison of radiant warmer and incubator care for preterm infants from birth to 1800g. Pediatrics, 108(2), 395- 401. Phototherapy. (2011, June). BCW Neonatal Program. Sherman, T. I., Greenspan, J. S., St.Clair, N., Touch, S. M., & Shaffer, T. H. (2006). Optimizing the neonatal thermal environment. Neonatal Network, 25(4), 251-260. Singh, A., Duckett, J., Newton, T., & Watkinson, M. (2010). Improving neonatal unit admission temperatures in preterm babies: exothermic mattresses, polythene bags or a traditional approach? Journal of Perinatology, 30, 45-49. Tunnell, R. (2004). Prevention of neonatal cold injury in preterm infants. Acta Paediatrica, 93, 308-310.

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APPENDIX Joey Bed Warmer - Front Control Panel Appendix A

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