GE Healthcare - Product Features

Why is there no top inner wall on the Giraffe® OmniBed®?

First, we need to look at the function of an inner wall. Convective airflow within a Care Plus® incubator (as well as some other types of incubators) has traditionally been unidirectional. This means that warm air must traverse from its origin underneath a mattress deck, up the front wall, over the top wall, and down the rear walls of the device. As the air travels along the Plexiglas surface of the device wall from the point that it enters the infant compartment, it (the air) progressively cools slightly along the path. Air cooling results in a temperature decrement of the upper, top, and back walls. This decreased wall surface temperature acts as a potential source of radiant heat loss to the infant in a single-wall device. The addition of a second wall inside the incubator coupled with active channeling of the warm air between the Plexiglas layers has been found to be an excellent method of reducing this source of radiant heat loss. A second wall inside the incubator can maintain a higher temperature than the outer wall because the cooler nursery air temperature does not affect the inner wall. In summary, airflow patterns are partially responsible for the need of an inner wall.

Second, we need to look at how the airflow design of the Giraffe® OmniBed® can reduce the need for an inner wall. In this new microenvironment, the effect of warming the hood surface is accomplished through bi-directional airflow. This reduces the distance that the warm air must travel in order to heat the hood. The Giraffe® OmniBed® airflow patterns are directed up both the side Plexiglas walls. Air returns are relocated to the ends of the beds. The longest path the air must take to warm the Plexiglas surface is now half way around the hood instead of all the way around the hood.

Third, we validated the effectiveness of this design in laboratory and clinical conditions. An experiment was conducted to compare thermal performance inside an GE Healthcare Giraffe OmniBed®, GE Healthcare Care Plus® 4000 Incubator, Hill-Rom/Air-Shields Isolette® Incubator and a Drager 8000 IC Incubator. The experiment measured the core temperature of an infant simulator when placed in an incubator set to 37 degrees C. These results showed that the Giraffe® OmniBed® was comparable to the Care Plus® 4000 incubator in thermal performance and better than the Isolette or 8000 IC Incubators. The advantages of eliminating the inner wall without significant sacrifice in thermal performance are: simplified cleaning, reduced parts, less attenuation of phototherapy light transmission, and improved patient visibility.

Giraffe OmniBed

Does the baby get cold when changing between closed and open bed operation (Giraffe OmniBed)?

When converting from a closed bed to an open bed warmer, the Giraffe OmniBed supplies an even distributed blanket of heat from the radiant heater head to gently, effectively warm the baby. The radiant heater is quickly brought up to temperature using our “turbo mode” technology. Turbo mode accelerates the heater until it comes up to the operating temperature necessary to keep the baby warm. In addition, the convective air heater, underneath the patient bed, remains on at a low level during radiant warmer operation so that the bed and bed platform remain gently heated.The surrounding sidewall panels radiate residual heat and act as a temperature buffer, warming the baby during the radiant heater power up.

Maintaining the convective air heater in idle state during radiant warmer mode also helps to preserve thermal stability when the OmniBed is reconverted from open bed to closed bed state. This intentional product design shortens the time for the bed to reheat when it is changed to incubator mode. This solves an important problem in neonatal care because quicker air temperature response translates to minimal patient temperature changes during equipment tranfers. During clinical trials, numerous babies under 750-grams were studied. A 545-gram, 23-week baby lost only 0.3 degrees C during transition from open to closed bed. Full infant temperature recovery occurred within 4 minutes. In addition, the presence of our patented “Boost Air Curtain” provides a gentle boost in fan speed for 45 minutes to efficiently warm air within the incubator compartment when the canopy is closed from a radiant warmer mode. NOTE: Boost air curtain operates for 90 minutes when the Giraffe OmniBed is turned on from a “cold” start. This is automatic. The boost air curtain operates for 20 minutes when the clinician activates the boost air curtain for procedures.

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What is the best way to preheat the Giraffe OmniBed?

Deciding to preheat the Giraffe OmniBed in open bed or closed bed mode is up to the clinician. It is also dependent upon where the bed is when the baby is to be admitted. If the clinician is admitting the baby onto the bed in labor and delivery as a radiant warmer and the bed will be used predominantly in the radiant warmer mode for the first several hours of life, then the clinician may want to take advantage of our “warm-up mode”. The bed has been factory-shipped so that the power on the bed goes through “warm-up mode” for 10 minutes. At the end of the 10 minutes, the icon on the accessory control panel changes to read “preheat zone”. The power control bar will now automatically cut back to 25% power and can remain there 24 hours/day, 365 days/year without ever provoking a nuisance alarm. However, some clinicians may want to change the factory default preheat zone from 25%. In the biomedical setup screen, this default can be changed to operate at 10 to 50% power, in 5% increments. Of course, once the baby is placed onto the warmer and the control mechanism is changed to baby control mode, the output of the heater will be driven by the skin surface temperature of the baby and normal alarm sequences are activated.

If the Giraffe OmniBed is to be converted to an incubator in the first several hours of life, then the clinician will most likely find it easiest to preheat in incubator mode just like pre-warming of any incubator. This means that Ohmeda Medical personnel recommend use of our “Comfort Zone” chart to help guide the choice if the appropriate pre-warm air temperature using gestational age, postnatal age, and birthweight of the expected admission into the bed. Then, the clinician can simply allow the bed to warm while awaiting the admission. At admission, the canopy can be activated and the bed can be converted to a radiant warmer. NOTE: The “Comfort Zone” chart does not set the air temperature. This clinician must do this using the temperature up/down buttons.

If the clinician is prewarming a Giraffe Incubator in readiness for an admission, then the same “Comfort Zone” chart can be used to help the clinician select the appropriate air temperature for the microenvironment. NOTE: The “Comfort Zone” chart does not set the air temperature. The clinician must do this using the temperature up/down buttons.

Can the Giraffe® OmniBed® be used to transport from labor and delivery or to the operating room?

If any incubator were properly pre-warmed before being disconnected from power, the thermal chamber would maintain the internal temperatures for a short period of time. The magnitude and duration of the integrity of this environment has not been studied in conventional devices. Currently, most hospitals use pre-warmed incubators to transport babies within the hospital. Data collected during our user validation trials showed that thermal stability of an extremely low birthweight baby was generally preserved if the transit time between power sources was under 10 minutes. Therefore, it is our recommendation that good clinical judgment should be exercised when transporting an infant in an un-powered warming device. Of course, the clinician could always consider use of chemical blankets to help preserve thermal stability during an un-powered transport.

What is the best way to admit a baby to the Giraffe® OmniBed®?

GE Healthcare has developed admission guidelines to support the proper use of Giraffe® products. The admission guidelines are available free from Ohmeda Medical.

Does the Giraffe® OmniBed® maintain temperature with both doors open?

Part of the purpose of the “boost air” curtain is to protect against entrainment of ambient cool nursery air. Of course, the entrainment becomes greater with multiple doors and/or portholes open

Will the small heater in the canopy actually keep a tiny baby warm?

Yes, GE Healthcare studied tiny babies extensively during our user validation trials. The heater head performed beyond expectations. It puts the heat where it belongs, on the baby and not on the caregiver. The heat distribution pattern matches the round shape of the mattress perfectly because it has been intentionally focused on the mattress like a spotlight on a stage.

Does the overhead heater work halfway down (or halfway up) if I only want partial heat?

No. The Giraffe OmniBed is either a radiant warmer or an incubator. It is never both. If a clinician fails to fully open or fully close the OmniBed, then an alarm is displayed that reads “In Transition Heat Off”. If this is not attended to in a timely fashion a more urgent alarm will be given.

Has the humidifier been tested to avoid the spread of pseudomonas aeruginosa?

Historically, pseudomonas aeruginosa was the most common pathogen linked to use of ambient relative humidity. However, there are at least 3 other microorganisms which are of concern to neonatal caregivers: serratia marcescens, candida albicans, and eschericia coli. To determine the role of humidity in microbial colonization of an enclosed micro-environment, laboratory research was conducted on the Giraffe® products. A Giraffe® humidification system was cleaned with a germicidal detergent utilizing a dilution of one ounce per gallon of water at the start of the study (Cavicide, active disinfecting ingredient: diisobutylphenoxyethyl dimethyl benzyl ammonium chloride). The enclosed micro-environment was run in air control mode at 35 degrees C and actively humidified at 65% RH through a servo-controlled mechanism. Sterile, distilled water was added at the start of the study and as needed to the water reservoir. After reaching temperature and humidity equilibration, a known inoculum of one of four different micro-organisms (P. aeruginosa, S. marcesens, E. coli, or C. albicans) reconstituted to 106 to 108 cfu/ml H2O was placed into the reservoir on day 0 and baseline cultures were obtained. Bacterial cultures were taken at five points including the humidification reservoir near the immersion heater, the reservoir seal at entry to the Giraffe®, along the path of airflow at both the east and west doors, and the center of the mattress. Semi-quantitative bacterial swabs were repeated at 24h, 48h, 72h, and 168h. The testing of each micro-organism was done serially over a four week period. Results showed that pseudomonas aeruginosa and candida albicans could be cultured from the water bath for only up to 24 hours. It was never cultured at any point that could be accessed by the baby and was never recovered after 24 hours.

Is the humidifier reservoir autoclavable?

Yes. The reservoir may also be chemically disinfected. Refer to the operators’ manual that was shipped with the OmniBed® for instructions.

Why is the humidifier reservoir so warm?

As a result of the infectious outbreaks in the 1950’s and 1960’s, GE Healthcare changed its methodology of providing micro-environmental humidity. The humidification system with the Giraffe® OmniBed® is an immersion heater that sits within a bath of sterile, distilled water. The temperature of this water bath reaches a temperature of 52 degrees C to 58 degrees C which by itself is bactericidal to most mesophilic microorganisms (that is, organisms which tend to thrive at human body temperature and act as pathogens). Therefore, the temperature to which the water bath of the humidifier was designed to achieve was purposeful. As an added measure of safety, engineers designed the immersion heater so that a small amount of water is boiled just before the humidity is disbursed into the air circulation within the infant compartment. By using this technology, sterile humidity is created and offered to the infant in a gaseous vapor state, leaving no airborne water droplets to act as vectors of infectious microorganisms.

What is the typical time between refills in the humidifier?

Different environmental conditions, temperature and humidity set points will determine the length of time between reservoir refills. During user validation of the Giraffe products, GE Healthcare determined that the reservoir will require refilling approximately every 12 hours in a 22.5 C environmental temperature, with a 34 C air temperature set point and a 70% relative humidity set point.

When does the Giraffe® OmniBed® rainout?

The answer to this question depends upon nursery temperature conditions. Under static laboratory conditions, rainout occurred @ a set point of 75-80% under ambient test conditions of 23 degrees C, 45% RH. Dynamic testing in nurseries during our user validation study showed that when the Giraffe was set to 65-70% RH in typical nursery conditions of 72.7 + 2.2 degrees C (22.5 degrees C), 27.9 + 12.5% RH, no rainout was documented by the clinicians. Interestingly, it has been noted that during evaluations in Germany and Sweden, no Giraffe rainout was noted when the devices were set to 85-90% RH while Drager 8000 IC in the same nurseries at the very same time had significant rainout. Use of the Giraffe hood cover should permit the clinician to use even higher levels of humidity without rainout due to the insulation effect around the Plexiglas hood.

Should the “boost air curtain” button always be used for open door procedures?

In most cases, the answer is yes. However, in philosophies surrounding developmental care, neutral thermal requirements are different for each baby. Larger babies may not require the support of the “boost air curtain”. The advantage of not making the feature automatic, but rather under the control of the clinician means that the clinician may use their judgment about the infant’s needs and may also avoid the commonly noted phenomenon of patient temperature “overshoot” that has been a historical problem in incubator care.

How long does the Giraffe® OmniBed® operate in boost air mode?

The boost air curtain operates for 20 minutes with clinician activation of the “boost air curtain” button; 45 minutes when the bed is being converted from open to closed bed state; 90 minutes when the bed is started and warmed as an incubator.

What effect does swaddling have on “COMFORT ZONE” chart?

The “Comfort Zone” temperature recommendations were developed to assist the clinicians in making decisions while caring for an infant in air control mode. The chart was derived from research conducted by Sauer, Dane, and Visser (1984). This table assumed no swaddling and no added humidification. However, in a recent study conducted by Mary Short (1998) and funded by Ohmeda Medical, data suggest that slightly lower air temperature settings (up to 2.9 degrees C) may be required for swaddled babies cared for in air control mode. While there is little clinical data to support the necessary adjustment in a humidified environment, consultants available to Ohmeda have suggested that a reduction in air set temperature may also be necessary if the infant is nursed in a humidified environment

Can X-rays be taken through the OmniBed® canopy?

In most cases (except Siemens machines) an x-ray may be taken with the canopy up or down. For Siemens machines, x-rays will need to be taken with the canopy down. If the canopy is up, there is no need to move or remove the heat source during an x-ray. An x-ray head will fit underneath the canopy while the heater continues to warm the baby. Some radiology technicians are not familiar with shooting an x-ray under a radiant heater when the film focal distance is less than 100 cm. For your convenience, a protocol from one of our clinical settings is provided for shooting a film at 65 cm is available. An x-ray cassette tray is provided to place the cassette without disturbing the baby. Use the grid pattern to properly position the cassette relative to the baby. The tray is tucked up very close to the mattress to minimize x-ray magnification. The in-bed scale contains a central window that will not obstruct x-rays. Currently, the products do not have exterior aligning markings for the x-ray cassette. However, the mattress support is made of clear plastic and mattress can be raised on one end slightly to see the cassette and position it properly

How should I use the two temperature probes?

The flexible design of the Giraffe® family of products is such that it supports use of two temperature probes. Common applications for two temperature probes include the practices of co-bedding or two-point (tummy-toe differential) temperature monitoring. If the Giraffe® OmniBed® is used for co-bedding twins, two temperature probes should be used. Two probe inputs have been provided to monitor both babies. The temperature from the probe plugged into jack # 1 will display on the left thermal display, while the temperature from the probe in jack # 2 will appear in the right upper corner of the graphics accessory control screen. We recommend constant temperature monitoring of both babies while co-bedding. Since the Giraffe® products cannot choose which baby to use for temperature control, the unit will default to air control mode and will lock out the baby mode when the second probe is inserted. The clinician will have to determine which infant should guide selection of the air temperature. The second probe also may be used to measure a second skin temperature on the same baby, such as “tummy-toe” measurements. Some experts suggest that a widening gap between the core and peripheral temperature may be an early marker of infection. Again, air mode must be used whenever two probes are inserted into the jack panel.

Do fitted sheets need to be used for the round mattress?

No, you can use your standard sheets that you currently use as sheets for your radiant warmer or incubator, but custom fitted sheets are available through GE Healthcare (part no. 6600-0850-800).

How can a clinician offer high frequency oscillation to a baby?

Two solutions are available. First, the Giraffe® corner grommets have been designed to aim conventional ventilator or high frequency ventilator tubes toward the center of the mattress. The Sensormedics HFOV tube now has a 45-degree fitting available. Using the 45-degree fitting with our special angled corner grommets allows the ventilator tubing to feed into the corner and conveniently ventilate the baby at either the north or south end of the bed. Unlike many other incubator setups, the Giraffe® OmniBed® main access doors can remain functional during HFOV use. The rotating mattress also helps reposition the baby without unnecessary disturbances. Second, an accessory Plexiglas panel (part no. 6600-0838-800) is available that mounts to any of the four porthole doors when they are opened to facilitate placement of a rigid tube oscillation-type device into the Giraffe® OmniBed®.

Will existing accessories for Care Plus® Incubators and Ohio® Infant Warmer Systems fit the Giraffe® dovetail rail?

Most accessories will fit. The dovetail mounting system has been included as a standard feature for Giraffe® products.

How does a clinician offer care to an infant with a gastroschisis silo?

The Giraffe® accessory support arm is available for this purpose. On each of the corners of the translation deck is a hole to mount support arms. The gastroschisis silo may be hung from a support arm mounted through these holes. If the mattress were pulled out, the support arms would move with the baby. These support arms can be ordered to support this need or to support common ventilator circuits.

What are the sound pressure levels inside the Giraffe® OmniBed®?

Extremely low sound levels were part of the Giraffe® OmniBed® design requirements. Under normal closed bed operation, if no interventions are taking place, the fan operates in “Whisper Quiet” mode. In “Whisper Quiet” mode, the Giraffe® products can be expected to generate less than 46 dbA + 3 dBA. This is extremely quiet compared to any other microenvironment available. Each 3 dbA reduction in sound pressure realizes a 50% reduction in noise exposure for the infant. Even if an intervention must take place, the Giraffe® OmniBed® is still extremely quiet. Clinician activation of “Boost Air Curtain” increases the fan speed to 1500 rpms in order to create a strong blanket of air to serve as a barrier against cool air entry from a cool NICU into the infant’s microenvironment. The “Boost Air Curtain” may be deactivated by the user, or is automatically deactivated after 20 minutes. Based upon our user validation study data, the Giraffe® OmniBed® operates in “whisper quiet mode” (basal operating conditions with fan @ 1000 rpms) 82% of the time, generating a static sound pressure level of 46dBA + 3 dBA. 18% of the time, the bed operated at a higher fan speed (1500 rpm) either automatically or under activation by the clinician for the purposes of a procedure. During this time frame, the static sound pressure levels may exceed 49 dBA.

Why should I use hood covers?

Hood covers can block ambient NICU light and sound from reaching the infant while still facilitating patient visualization.

What is the best way to do an ultrasound of the head or an echocardiogram of the heart?

Watch a technician do a procedure. As developmental care has become an international standard of care, most clinician’s have embraced the concept of early incubator care. However, that change in practice has also made some procedures more challenging. It can be difficult to maneuver a transducer through a porthole without placing an ergonomic strain on the technician. Now, with the availability of the Giraffe OmniBed, the clinician can simply raise the canopy and complete the procedure in a timely fashion without transferring the baby or subjecting him or her to the stress of a longer procedure because the equipment is difficult to maneuver.

Why should I protect the baby from ambient light in a Giraffe OmniBed or Giraffe Incubator?

Part of the design consideration of the Giraffe family of products is that they had to support control of light in addition to providing outstanding thermal performance. Once of the negative impacts of a radiant warmer is that is doesn’t protect the infant from light sources like the NICU or exam lights. Furthermore, there placement of a “hood cover-like” device over a radiant warmer presents a thermal hazard as heat vents out the top of these devices. The unique design of the canopy in both the Giraffe OmniBed and the Giraffe Incubator allows for full-time placement of a protective cover in BOTH the radiant warmer and incubator modes. Heat is not vented out the top of the Giraffe OmniBed radiant warmer but rather, through the back of the heater head. This protects the baby at all times from both direct and indirect light sources in the NICU environment.

Are there any special considerations when I am transferring an infant into a family member’s arms through the east/west door?

No special considerations are necessary when transferring a baby into a family member’s arms. This transfer can be done in either the radiant warmer or the incubator mode. In fact, the clinician and the family member will probably find the transfer less stressful to the baby if the bed is converted to a radiant warmer because of the added space that is gained with the canopy in the elevated position. In addition, the process becomes as simple as:

Having the family member sit perpendicular to the bed along the east or west side of the bed

Removing the east or west door (it is probably easiest if the family member sits on the same side as ventilation equipment)

Verifying that the baby is supine

Converting the bed into a radiant warmer configuration (if baby in OmniBed), if desired

Rotating the Baby Susan mattress 90 degrees so that the baby is perpendicular to the family member’s arms and lies along the east-west axis of the bed

Sliding the baby out into the family member’s arms.

Changing the controller to manual mode (radiant warmer)/air control mode (incubator)

After the visit is completed, it is recommended that the baby be returned to the device in the reverse process. When returning to incubator configuration, GE Healthcare recommends that the baby’s temperature be allowed to re-stabilize in air control mode before returning to baby control mode.

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