Nepal Field Study

Infant Incubator Project

Jan 21-27, 2007

Field Team:

Timothy Prestero, DtM

Matt Eckelman, YaleUniv.

Incubator Design Directives

Features and Design Considerations

Features

System Functions

maintain infant core temperature at 37ºC

isolate baby against germs, dust, insects

humidity control?

Interior Access: Baby Care

Sight and Light

What I need to see
Respiration (chest movement)
O2 (skin color, activity, coughing)
General distress (crying, struggling)
General activity level (active vs sluggish)
Abdominal distension
Mouth (coughing, vomiting, foaming, bleeding)
Nose, ears (bleeding)
Light transmission: what has to pass through the housing
Phototherapy lights (jaundice)
Spot-lighting for inspection, procedures
Portable x-ray camera

Sound: what I need to hear

Baby crying

Tubes and wires: what has to pass throughthe housing

Thin, flexible wires
Skin temperature sensor or “servo” (abdomen, groin, underarm; less desirable to attach to extremities)
Pulse Oxymeter (foot, hand)
EKG (three stick-on chest sensors plus transducer brick)
Thin, flexible tubing
IV drip line (hand/wrist, foot, scalp, umbilical)
Feeding tube (nasal, oral)
Dynamap (sp?) automatic blood pressure sensor
Thick hoses, tubing
O2 line for head box

Ventilator, respirator (inlet and outlet hoses)

Ports and doors: uses and number

1 hand

Feel the baby’s abdomen

Check wires, IV, connections

Adjust blankets

Check hydration (skin pinch)

Weigh the baby (integrated scale)

2 hands

Change diaper (harder method for nurse)

Adjust baby position

Prepare/adjust breathing apparatus

Apply O2 mask

Insert nasal tubes

Set up head box

Check vital signs

Stethoscope (check pulse, respiration)

Take temp (under arm)

Check blood pressure via manual inflating cuff (harder method for nurse)

Check pupil dilation

Draw blood

Measure abdomen with tape

4+ hands

Surgical procedures (see Tape 6: Fri 26Jan, 10h54)

Insert catheter, stent, breathing tube

Draw spinal fluid

Weigh the baby (internal sling scale)

Open front door

Insert x-ray slide under mattress

Remove the baby

Change diaper (easier method for nurse)

Check blood pressure via manual inflating cuff (easier method for nurse)

Weigh the baby (external scale)

Breast or bottle-feed (stable babies)

Kangaroo care (stable babies)

Lift the entire cover

Clean the mattress after the baby has left

Sealed connector or permanent pass-through

Hygrometer (humidity sensor)
Mattress level adjustment (external handles at foot, head)

Control Inputs

Functions

Target interior temperature

Alarms

Interior temperature

Skin temperature

Pulse

Sat O2

Incubator Access: Maintenance

Diagnostics and troubleshooting

Diagnostic error codes (digital readout)

Pin-outs on control boards (check Laxmi video for terms)

Parts replacement (Ray’s “BRTs”)

Sensors

Skin temp sensor (servo)

Internal temp sensor

Pulse oxymeter

Hygrometer

Electronic components

Fuses and/or circuit breaker

Power supply

Heating system

Fan/ventilation

Control/logic boards

Display unit

Mechanical components

Hinges and fasteners

Seals

Incubator cover (if cracked)

System Inputs and “consumables”

Power

Transformer for 110/220V at 50/60 Hz

Voltage regulation for spikes, fluctuations

15-20 min battery backup for blackouts

Consumables (parts designed for replacement)

Air filter

Fuses and/or circuit breakers

Control boards

Data Outputs and Alarms

Data

Vital signs:

Skin Temperature

Pulse

Blood oxygen saturation (sat-O2)

Environmental conditions

Interior air temp (actual)

Internal humidity (wet/dry bulb temp with lookup table)

Exterior/ambient air temp

Alarms

Vital signs

Skin temperature

Pulse

Sat O2

Machine function

Lost sensor signal

Lost external power (on battery)

Bad air filter (low air flow, bad seal?)

Research Questions FOLLOW-UP (post-Nepal email, US research, March trip)

Product Priorities

What is the “number one” feature you would want in an isolette (nurse, doctor, parent)? Any "easy wins"?

How common are problems related to excess O2?

What do you think about an integrated pulse oxymeter?

Kanti NICU (close to US resources) vs rural clinic (no resources)

Where is our target market on this continuum?

What environments will the isolette be designed for? Only city hospital?

Users and Interations

Baby access

ASK: Describe the moment-to-moment care in Nepal

What kinds of procedures will they perform?

What kinds of access do they want/need?

What are their routines: rounds, hand-off, on-call

OBSERVE: Access to baby

What happens in real procedures?

Demonstrate putting the baby in the incubator and hooking them up

How often do they move/remove the baby?

How easy/awkward is it?

How many people does it take?

What roles do the parents play?

Do you ever use Kangaroo care?

How might this affect the incubator design?

Air quality inside the incubator

How often are babies changed in the ICU?

How long will they sit in a dirty diaper (average, worst case)?

Is ammonia build-up a problem? Are there any other problematic gasses or contaminants generated inside the incubator?

For the standard incubator, how many air changes per hour? What is desirable?

Incubator functions and allowances (monitoring and life support)

Incubator vs warming table

Relative advantages and disadvantages

Uses, relationship, existence

Order of use in baby care (warming table for critical, “graduate” to incubator?)

Tell us more about alarms and measurements

From what range do you need to be able to see/hear them?

What control do you need over settings?

How reliable? Any false alarms?

Incubator design

What are we seeing about existing designs?

Allowances inside the incubator for wires, gadgets

Allowances in the housing for access (baby clearance, ports, respirator inlet, bed lift/tilt)

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