Transcutaneous bilirubin monitoring (bilichek)
- 1. Bili Chek: Transcutaneous Bilirubin Analyzer NLC P/P# 6600.0216
- 2. Purpose: To analyze total serum bilirubin (TSB) in a noninvasive and pain-free manner.
- 3. Policy: • The Bili Chek Analyzer has been clinically proven to be accurate in patients within the following parameters: • Gestational Age of 27 to 42 weeks • Postnatal Age of 0 to 20 days • Infant Weight of 950 to 4995 grams • The Bili-Chek should not be used in the following situations: • Following exchange transfusion • If the measurement site on the forehead contains excessive bruising, birthmarks, hematomas, or excessive hairiness due to erroneous results. • If unable to use the forehead, it is recommended to use the sternum as an alternative measurement site.
- 4. Testing procedure 1. Initializing the Unit: Install a fully charged battery pack into the battery compartment of the unit. Press and release either the F1 (blue) or F2 (gray) button on the front of the Bili Chek unit to turn the device on. The device will perform a self-test, momentarily displaying all LCD indicators. When the self-test is complete, the home screen will be visible, displaying the last measurement, time and date (or an error code message, if applicable). 2. The first time the Bili Chek is used, it is necessary to enter the set-up mode and program the display settings before proceeding. Refer to the User Instruction Manual for complete set up instructions. 3. The Bili Chek does not have an off switch, and will automatically turn off if is idle for a 60 seconds.
- 5. Calibration 1. Remove a new BiliCal disposable tip from its foil pouch and apply it to the optical sensor on the Bili Chek handheld device before each use. 2. Firmly press the BiliCal on the Bili Chek handheld device to ensure proper seating of the tip. 3. With the home screen displayed, press and release the trigger button (the blue button located on the hand grip) to start calibration. 4. Three dashes (---) will flash in the display window, and the Measurement Status Indicator (MSI) will be amber if the BiliCal is properly seated, indicating that the device is ready to calibrate. (If the BiliCal is not properly seated, the mSI will be red, and an EO1 error message will be displayed). 5. Press and release the trigger button again. The dashed lines will stop flashing, indicating that the Bili Chek is calibrating. 6. The MSI will be amber colored and a beep will be heard. The display window will read (005) to indicate that the calibration was completed successfully. If there is a failure in calibration, and error message will be displayed, and one will be unable to proceed with the testing. Refer to the trouble shooting section of the User Instruction Manual.
- 6. Performing the Patient Test 1. After performing the calibration, pull on the BiliCal tab and peel away the protective covering from the disposable tip and discard. 2. Press and release the trigger button. The device is now activated and ready to take a measurement (005) will be displayed and blinking. 3. Gently press the bili cal against the infant’s forehead or sternum. The MSI on the display will change from amber to green, and the 005 will stop blinking when the proper pressure is applied. 4. Hold the Bili Chek handheld device steady until the measurement is complete (for about 1-3 seconds). The device will beep if the audible alarm is enabled.
- 7. 5. Perform a series of five (5) measurements by lifting and replacing the BiliCal on the center of the infant’s forehead of sternum. Press and release the trigger button before each measurement. The current measurement will be indicated on the display (005…003..001). 6. Upon completion of the five (5) measurements, a final beep will sound, and the test result will be displayed along with the current time and date. Remove and discard the disposable tip. 7. Place the blue protective tip cover onto the Bili Chek handheld device. 8. The Bili Chek will turn off automatically.
- 8. Documenting the Results 1. Document the infant test result, date, and time in the infant’s chart, on Jaundice Teaching Sheet and the electronic Newborn Discharge Information Sheet. 2. Notify the infant’s physician as appropriate. 3. Obtain follow-up measurements in accordance with physician orders. 4. QA documentation Procedures: The BiliChek performs internal calibration controls prior to each patient test. The device will not permit testing to occur if the calibration does not meet the control specifications. In order to document completion of the calibration prior to each test, a “Quality Documentation Record” should be completed (refer to Appendix A). An individual record should be maintained for each BiliChek device, and tracked by serial number.
- 9. Cleaning and Maintenance 1. Cavicide wipes are used to clean the Bili Chek after each use. 2. To clean, wipe the Bili Chek with a Cavicide wipe, being sure to clean the display window carefully. 3. Do not immerse the Bili Chek in water or any liquid. If liquids spill onto the unit, wipe immediately with a cloth and let unit dry before use. 4. Do not attempt to clean and/or reuse the BiliCal Disposable Tip.
- 10. Use During Phototherapy 1. Prior to the initiation of Phototherapy, the measurement site on the infant’s forehead or sternum must be covered with a photo-opaque patch material. The patch must remain in place throughout phototherapy. 2. To take a measurement during phototherapy: Turn off the phototherapy lights (fiber optic or overhead), remove the photo- opaque patch, perform the Bili Chek measurement, replace the photo- opaque patch, resume phototherapy as ordered. 3. Clinical studies indicate that up to 48 hours may be required before the skin treated by phototherapy returns to the bilirubin level of an unexposed site; therefore measurements from an unprotected site are not reliable.