Steps

Rationale/Points of Emphasis

1 Select and obtain an isolette, crib, or bed based on the child’s age, developmental abilities, level of consciousness, and medical condition (see Clinical Guidelines earlier).

Children placed in inappropriately selected beds are at risk for falls, strangulation, and other bodily injuries due to the incompatibility between the physical structure of the bed and the size and motor capabilities of the child. Critically ill children may require a specialty bed that includes devices to assist in turning the child and to prevent skin breakdown.

2a Position the isolette, crib, or bed away from electrical appliances, electrical outlets, oxygen and suction outlets, equipment cords, window cords, and shelves that may be easily within reach of the child.

2b Explain these safety precautions to the child and family.

The young child is likely to be attracted to objects within reach and may attempt to play with them or place them in his or her mouth, which can lead to accidental injury.

Child safety may be impacted by the family’s correct use and positioning of isolette, crib, or bed.

3 Ensure that the isolette, crib, or bed wheels are locked.

Prevents rolling of the isolette, crib, or bed.

4 Ensure that side rails on the isolette, crib, or bed are operating correctly (Figure 16-1).

Figure 16-1 Latch and secure both top and side rails when the child is in the crib.

Side rails that are not operating correctly may be difficult to raise or may not latch properly once in a raised position. Side rails that do not latch properly may drop down, leaving the child vulnerable to falling out of the isolette, crib, or bed.

5 Demonstrate to family members how to operate the side rails. Reinforce importance of keeping the side rails fully raised at all times when the child is in the isolette, crib, or bed.

Family members must share equal responsibility in ensuring that side rails are up at all times.

Steps

Rationale/Points of Emphasis

1a Prewarm double-walled isolette before placing infant in the isolette. Time to prewarm may vary.

Isolettes circulate warm air around the infant. Prewarming decreases the heat loss from conduction from the mattress.

1b Follow manufacturer’s directions for setting the temperature of the isolette.

Ensures safe use of equipment.

1c To achieve a thermal neutral environment, regulate isolette temperature to achieve an abdominal wall temperature of 36.5°C.

The infant’s temperature is maintained within a specific environmental range, called the thermal neutral zone (TNZ), in which the rates of oxygen consumption and metabolism are minimal and internal body temperature is maintained because of thermal balance.

2 Place infant in the double-walled isolette with porthole covers.

Preterm infants require placement in these environments because they are unable to initiate thermogenesis due to their limited stores of fat and insufficient amounts of other chemicals, such as glucose, liver enzymes, and hormones.

3 If using a temperature probe, place the servo temperature probe on the infant over a solid muscular area (i.e., not over a hollow organ such as lungs or stomach), and ensure that the infant is not lying on the probe wires.

Servo temperature probes allow monitoring temperature without disturbing the infant and also allow monitoring temperature trends.

4a Monitor infant’s temperature every 30 minutes for 2 hours when first placed in isolette and then as indicated by infant’s acuity level.

A probe placed over a hollow organ does not provide a consistent reading of body temperature. For instance, a probe placed over the stomach fluctuates temperature readings based on the temperature of the feeding.

4b If using a temperature probe, verify probe temperatures with electronic thermometer every 4 hours and as needed.

Ensures that deviations from normal temperature are detected promptly.

4c Change temperature probe site every 12-24 hours.

Correlates temperatures to ensure accuracy because probe temperatures also control the environmental temperatures.

Probe electrodes can dry out and thus not adhere to the skin well. Poor skin adherence may alter probe readings. Accidental dislodgment can lead to overheating.

caREminder

Minimize the number of entries into the isolette, because entering the isolette changes the ambient temperature of the environment.

5a Provide infant with age-appropriate visual stimulation such as black-and-white printed patterns.

Provides visual stimulation to the infant to enhance neurobehavioral development.

5b Review with family importance of keeping objects out of isolette that would be hazardous to the infant (e.g., lotion bottles, medications, extra diapers).

Prevents infant from chewing and subsequently aspirating or suffocating on potentially dangerous objects or substances.