criticool: hypothermia / normothermia policy procedure

NEUROLOGICAL: CRITICOOL: OPERATING PROCEDURE
POLICY
The Physician orders CritiCool™ as a primary route of therapeutic hypothermia or therapeutic
normothermia for the treatment of infants with Hypoxic Ischemic Encephalopathy (HIE).
PROCEDURE
Gather Equipment:
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CritiCool™ with CliniLogger (with or without splitter attached)
Hydrocolloid dressing
Waterproof tape
Lubricating jelly (water soluble)
Rectal temperature probe #9 Fr
Skin temperature sensor
Thermowrap jacket
Sterile water (6 litres)
If using CritiCool™ with splitter: Philips monitor temperature cable
Preparation
1. Obtain CritiCool™ device with water
hoses and clinilogger attached
2. Bring CritiCool™ and appropriately sized
Thermowrap jacket to bedside
3. Plug in CritiCool™ and splitter power
cables
4. Fill the reservoir with 6 litres of sterile
water
Note
 Clinilogger should be plugged in at the back of the
CritiCool™

See table above
 Do not use tap water
 Do not over fill
 Fill to level between two red markings
Policy NN.03.03B
Neonatal Program Policy & Procedure Manual Effective Date:16-APR-2014
Page 1 of 7
Refer to online version – Print copy may not be current – Discard after use
Disclaimer Message
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Generated By
Oct 25, 2016 08:18
Anonymous
NEUROLOGICAL: CRITICOOL: OPERATING PROCEDURE
5. Plug Green sensor into Surface socket of
CritiCool™ (if not already plugged in)
A).If not using splitter:
 Plug GRAY sensor into Core
socket of CritiCool™
B).If using splitter:
 Plug GRAY sensor into Core
socket on splitter
 Plug temperature monitoring
cable into Philips monitor and set
temperature limits to 33.0 and
37.5 degrees Celsius
 Change Philips monitor screen to
CritiCool™ mode
Criticool Splitter:
GRAY sensor
Temperature
monitoring cable
6. Position the Thermowrap in the bed so
the water tubing connectors are
positioned above the infants head.
Connect water tubes to the Thermowrap.
 The tubing/clamps need to lay flat on the mattress to
prevent kinking
 Put the tubing through the slot at the head of the bed,
not through the side ports to prevent kinking
 Check clamps are open
 The Thermowrap will automatically fill once the rectal
probe is in place
7. Turn on
 Machine will alarm for self-test and
errors
NEVER press silence during any phase of
operation
 Once the alarm is silenced it will not re-alarm even if
the condition has not been fixed
8. Select “COOLING” for both Therapeutic
Hypothermia and Therapeutic
Normothermia by pressing ok

9. Perform safety check prior to use to
ensure settings are correct
1. Press Menu
2. Press Settings
3. Press Enter
 Clinilogger should be plugged in at the back of the
CritiCool™
The water level may fall below the two red lines
 Do not top up water
 By using the “cooling” mode the variance of
temperature will be +/- 0.2 ºC of the set point
Policy NN.03.03B
Neonatal Program Policy & Procedure Manual Effective Date:16-APR-2014
Page 2 of 7
Refer to online version – Print copy may not be current – Discard after use
Disclaimer Message
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Generated By
Oct 25, 2016 08:18
Anonymous
NEUROLOGICAL: CRITICOOL: OPERATING PROCEDURE
4. Ensure values are entered as below:
Patient *Neonatal
Adult SP *33.0
Delta T *0.4
5. Press Exit

The ‘COOLING’ Mode set temperature is
33.5ºC
10. For Therapeutic Hypothermia pre-set
temperature is 33.5ºC
11. For Therapeutic Normothermia set
temperature on CritiCool™ to 36.0ºC by
using the up and down arrows
 Check hourly that the set point is at the desired
temperature (33.5 ºC for therapeutic hypothermia and
36.0 ºC for therapeutic normothermia)
12. Place CritiCool™ in ‘standby’ until infant
arrives
 Select ‘menu’
 Scroll down and select ‘standby’
 Select ‘enter’
Application
Note
13. Lay infant, wearing only a diaper, supine
on Thermowrap
 Align cut outs for arms with the axilla
 Align lower flaps with the upper thighs
 Do not wrap infant yet
 Infant must be repositioned according to skin risk
assessment
 Prone position is contra-indicated
Policy NN.03.03B
Neonatal Program Policy & Procedure Manual Effective Date:16-APR-2014
Page 3 of 7
Refer to online version – Print copy may not be current – Discard after use
Disclaimer Message
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Generated By
Oct 25, 2016 08:18
Anonymous
NEUROLOGICAL: CRITICOOL: OPERATING PROCEDURE
14. Obtain rectal temperature probe (#9 Fr)
and measure 5 cm from tip and mark
with pen
15. Lubricate rectal temperature probe and
insert 5cm into rectum. Connect to Gray
sensor
 Use water soluble jelly
 Secure at the rectum with hydrocolloid dressing
and waterproof tape
16. Secure skin temperature sensor and
connect to Green sensor
 Use skin temperature sensor
 Choose a site as close to core of infant as possible
 This sensor must not come in contact with the
Thermowrap (e.g. upper chest, thigh)
 Clean site with water, dry skin and apply sensor
17. Take CritiCool™ off ‘standby’ mode
 Select ‘Menu’
 Select ‘Operate’
 Check temperature is set at (33.5 ºC for Therapeutic
Hypothermia and 36.0 ºC for Therapeutic
Normothermia)
18. Monitor as the Thermowrap
automatically fills
 Correct any alarm conditions identified
 Correct any kinking or leaks
 Allow Thermowrap to fill with water prior to
wrapping around the infant
19. Once Thermowrap is filled, wrap around
the infant’s torso and upper thighs
*Do not use safety pins on any part of
the thermowrap: extra securing tapes are
available if needed*
20. Fold Thermowrap as needed to expose
areas of infant
 Ensure there is no kinking
obstructing water flow in the
system
 Folding the Thermowrap may be done to expose
certain areas of the infant (e.g. umbilical lines)
 If Thermowrap is kinked and obstructing water
flow alarm ‘Check Water Connections’ (see
troubleshooting guide)
21. Check the radiant warmer is off
22. Assess skin integrity
 Utilize Skin Risk Assessment and provide
corresponding care activities based on risk identified
 Cooled infants are at increased risk for fat necrosis
and require frequent position changes and skin
assessment
 Monitor carefully for moisture between the skin and
Thermowrap (moisture can contribute to increased
risk)
 If mildly soiled clean Thermowrap with water and dry
Policy NN.03.03B
Neonatal Program Policy & Procedure Manual Effective Date:16-APR-2014
Page 4 of 7
Refer to online version – Print copy may not be current – Discard after use
Disclaimer Message
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Generated By
Oct 25, 2016 08:18
Anonymous
NEUROLOGICAL: CRITICOOL: OPERATING PROCEDURE
 If extremely soiled or punctured, change Thermowrap
23. Parents may hold infant with
Thermowrap in place to maintain cooling
X-ray
24. Loosen the wrap and slip the x-ray plate
between the infant and wrap
Note
 The Thermowrap shows shadows on any x-ray
Re-warming
25. To re-warm:
 Press menu key
 Scroll to “MODE SELECT”
 Press enter
 Select “CONTROLLED REWARM (for
slow rewarming)”
 Press “OK”
 Machine makes audible tone
 Message “Switching to Re-Warming”
While the screen is visible rewarming
has not started (see picture on right)
 Check rectal probe is correctly placed
 Press “Operate”. Ensure set
temperature is 36.5
 Screen will read “NEONATAL
REWARMING”
Notes
 CritiCool™ will increase the Set Point Temperature
by 0.40C every 60 minutes
 Re-warming to 36.50C will take 7-8 hours
26. Continue therapy on the CritiCool™
device for 24 hours after the infant’s
temperature has reached 36.50C
Once the infant’s temperature reaches 36.50C, the
mode display will stay in “NEONATAL
REWARMING”.
MRI
27. Put CritiCool™ on standby
Note
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28. Allow the Thermowrap to drain and
clamp water tubes
Refer to MRI checklist
The Thermowrap will automatically drain
Draining takes approximately 5 minutes
29. Disconnect water tubes from
Thermowrap
30. Remove skin probe from infant

Leave connected to CritiCool™ for reapplication after
MRI
31. Without splitter: Disconnect rectal probe
from GRAY CritiCool™ core cable and
connect to Philips monitor temperature
cable and plug into X2 transport monitor
Policy NN.03.03B
Neonatal Program Policy & Procedure Manual Effective Date:16-APR-2014
Page 5 of 7
Refer to online version – Print copy may not be current – Discard after use
Disclaimer Message
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Generated By
Oct 25, 2016 08:18
Anonymous
NEUROLOGICAL: CRITICOOL: OPERATING PROCEDURE
32. With splitter: Disconnect rectal probe
from GRAY CritiCool™ core cable on
splitter and connect to Philips monitor
temperature cable
33. Once infant is transported to MRI
remove rectal probe
 Probes are not MRI compatible
 Refer to MRI checklist for thermomanagement
34. Unwrap infant from Thermowrap and
transfer care to MRI team
35. Upon return to NICU, reconnect water
tubes to Thermowrap
36. Unclamp water tubes
37. Take CritiCool™ off ‘standby’ mode
 Select ‘Menu’
 Select ‘Operate’
38. Verify correct mode (neonatal cooling or
re-warm)
Post Procedure
39. Turn the CritiCool™ Device to ‘standby’

CritiCool™ will start from the infants current core
temperature (i.e. if putting CritiCool™ back in the rewarm mode after MRI the infant will be warmed from
it’s current temperature to reach the set temperature)
Note
 Wait while the water drains back into the CritiCool™
 Disconnecting the unit prematurely will cause water
leakage
40. Close the clamps on the Thermowrap
41. Turn off CritiCool™
42. Disconnect the water tubes from the
Thermowrap.
43. Unwrap the infant and discard
Thermowrap
 Thermowraps are individual use items and are
discarded after each infant
44. Assess infant’s skin after removal of
Thermowrap
 A pattern resembling the Thermowrap may appear for
a short period of time on the infant’s skin
45. Remove the rectal and skin temperature
probes and disconnect from the
CritiCool™ unit
 Gray sensor and Green sensor are not disposable
46. Save stored data from CliniLogger
 Remove CliniLogger and ensure labelled with patient
label
 Leave in CNL office at CRN desk
47. Return the CritiCool™ unit, with all
cables and tubing’s connected, to the
aides room
 The grey and green cables and water hoses are NOT
disposable
 Aides will empty and clean CritiCool™ machine
Policy NN.03.03B
Neonatal Program Policy & Procedure Manual Effective Date:16-APR-2014
Page 6 of 7
Refer to online version – Print copy may not be current – Discard after use
Disclaimer Message
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Generated By
Oct 25, 2016 08:18
Anonymous
NEUROLOGICAL: CRITICOOL: OPERATING PROCEDURE
Documentation
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Nursing Flowsheet:
Hourly skin and rectal temperature
Hourly CritiCool™ ‘set point’
Skin integrity
Interruptions to cooling
Physician’s Orders:
 Date and time cooling/ re-warming started
DOCUMENTATION
Nursing Flowsheet
Bedside Information Tool (BIT)
Troubleshooting Guideline
Physician’s Orders – Therapeutic Normothermia Admission
Physician’s Orders – Therapeutic Hypothermia Admission
REFERENCES
CritiCool™ Operating Manual
Policy NN.03.03B
Neonatal Program Policy & Procedure Manual Effective Date:16-APR-2014
Page 7 of 7
Refer to online version – Print copy may not be current – Discard after use
Disclaimer Message
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Generated By
Oct 25, 2016 08:18
Anonymous