In this section
Statewide incubator care guideline
Clinical management of babies requiring an incubator for inter-hospital transfer in Victoria (without a PIPER Neonatal escort)
In 2014, sixteen portable transport incubators funded by the Victorian Department of Health and Human Services (DHHS, then Department of Health) were deployed in selected 'host' health services throughout Victoria (Appendix
1). The incubators were provided as resources for use within these health services as well as within and between regions. For consistency, a single brand and model (V808) portable transport incubator was deployed.
The Paediatric Infant Perinatal Emergency Retrieval (PIPER) service in collaboration with Ambulance Victoria (AV) and DHHS, have developed these clinical and operational guidelines to ensure standardisation and competency in the management and utilisation of the portable transport incubators.
The choice of platform for interhospital transport of babies who require an incubator depends on the baby's illness acuity, age, weight, and effective use of resources. The options for the inter-hospital transfer of small babies (less than 5 months corrected age) are summarised in Table 1.
Transport incubator secured to an ambulance stretcher.
Transfer of low acuity babies from a maternity service without a newborn service to a maternity hospital with a level 3 to level 5 newborn service.#1
Stable babies who require rapid transfer to a level 6b newborn service. This system will enable a much faster response and transfer time compared to using a PIPER neonatal transfer.
Relatively well babies who require back transfer from a newborn service or between services.
For example Ararat to Ballarat, or Portland to Warrnambool.
Bile stained vomiting in a "well" baby.
Ballarat to Ararat
* This may include Non-Emergency Patient Transport services.
# All levels of newborn care referred to in this document align with Defining levels of newborn care for
Victorian health services (2015)1
Suitability to transfer a baby without a PIPER Neonatal team is determined after consultation between referring hospital clinical staff, the PIPER Neonatal Consultant and Ambulance Victoria while taking into account clinical, logistical and other factors.
Host services and paramedics within each region have been provided with training opportunities including education on the use of incubators, in-service training and online tools. Parker Health will provide ongoing education and training during their regular site
visits to 'host' services.
It is the responsibility of the host service to ensure that clinical staff develop and maintain knowledge with regard to using the incubator, using the harness to secure a baby to the incubator, and accessing online tools2, 3. A checklist that details equipment items
required when the incubator is dispatched and returned has been developed to ensure the incubator remains in a "ready to use" condition4.
It is the responsibility of Ambulance Victoria to ensure that paramedics are aware of online educational tools and are educated and supported to use the incubators to ensure they are comfortable with their operation including the procedure for securing the
incubator to a Stryker stretcher5.
Host services are responsible for the ongoing care and maintenance of the incubators and are expected to develop local policies that govern their use including:
The transport incubators are appropriate for use in transporting small babies (less than five months corrected age) that are not ill enough to need a PIPER neonatal escort, but require transfer in an incubator for clinical or restraint purposes. The transport
In most instances, after the incubator has been secured to an ambulance stretcher, a paramedic will accompany the baby to the receiving health service. The need to send a referring health service nurse/midwife/doctor to escort the baby to the receiving service should be a rare event and should
reflect a consensus between the PIPER neonatal consultant, health service staff and Ambulance Victoria staff.
The V808 transport incubators should not be used as the choice of transport platform when:
The baby requiring transport is clinically unwell or where there is a significant risk of deterioration in transit. These babies must be transferred using a PIPER Neonatal team with their infant transport system.
Using an infant car seat type restraint system secured to an ambulance stretcher. V808 incubators are not appropriate for use using this type of restraint system.
criteria for inter-hospital transfer without a PIPER Neonatal escort
(See Flow Chart - Appendix 2)
Neutral thermal environment (NTE): an environment in which a baby with a normal body temperature has a minimal metabolic rate and therefore minimal oxygen consumption.
6.1.1 Start and test the incubator as per V808 operation video2.
6.1.2 Incubator air control: Set the desired internal temperature as per V808 operation video.
NOTE: Do not turn the incubator off. The fan does not work with the incubator off so there is no air movement within the canopy and carbon dioxide may accumulate.
6.1.3 Place the baby into the incubator.
6.1.4 Skin temperature monitoring.
6.1.5 Monitoring of incubator oxygen.
6.1.6 Pulse oximetry.
6.1.7 Frequency of observations: Option to use observation charts from referring hospital.
Document half hourly:
Skin temperature, heart rate, respiratory rate, SpO2, color, oxygen concentration or flow rate of sub nasal oxygen and baby activity.
6.2.1 Operation should align with accreditation requirements, particularly those relating to the following National Safety and Quality Health Service (NSQHS) standards9:
It is important that all staff are given appropriate training and opportunity to familiarize themselves with the harnesses and incubator settings.
Ensure self-inflating bag (240mL) and appropriate size mask accompanies the baby. AV may have this in their vehicle.
All AV vehicles have suction if required. Paramedics may need to source Fg 8-10 suction catheters from the referring hospital.
6.2.5 Securing incubator to AV stretcher – Ambulance Victoria Work Instruction: Securing the Atom V808 Transport
Capsule Incubator to a Stryker Stretcher5. A video of the procedure can be found here https://vimeo.com/198932740/6b238d3c92
It is recommended that host services check the working order of the incubator on a weekly basis.
To ensure the battery is fully charged and in correct working order for when a transfer is required, it is important to ensure that the Atom V808 Transport Incubator is plugged into a power source and
turned on at all times so it is providing a moderately warm temperature inside the incubator. No damage will occur to the incubator by having it plugged in and turned on at all times.
Having the incubator plugged into a power source and turned on at all times to provide a stable admission temperature ensures that, in the event of a transfer, the incubator is at a stable temperature which will prolong the battery running time. Please note that the incubator
cannot run in battery mode if the unit has not been pre-heated.
As part of your weekly check you should ensure that the Atom V808 Incubator is:
Plugged into a power source and turned on with a stable admission temperature set.
"Host" Health Services
(Download an A4 version of Appendix 2)
Public health services (host services) that have been allocated V808 transport incubators are responsible for their ongoing care and maintenance. Host services are also expected to develop local policies that govern the use of the incubators within their region including:
The following questions are presented as a means of detailing the scope of material that should be addressed by health services in developing local policy and procedures for the management and operation of statewide V808 incubators:
[Adapted from: Gardner SL., Carter BS., Enzman-Hines M. and Hernandez JA. 2011]
Note: for this table, Scopes and Ahmed had the wall of the incubator 1 to 2oC warmer than the ambient air temperatures. Generally, the smaller infants in each weight group require a temperature in the higher portion of the temperature range. Within each time range, the younger the infant, the higher the temperature required.