TRANSPORTATION OF

CRITICALLY ILL
NEWBORN

Lidia, M.Kep
Yani Setiasih, S.Kep.,Ners
 GOLD STANDARD : intra uterine (mentransfer bayi yang
berpotensial sakit saat masih dalam kandungan)
 Meskipun tidak tersedia rawat inap pre-delivery: ibu dengan bayi
potensial sakit lebih baik melahirkan di rumah sakit tersier
dibandingkan rumah sakit primer

 Risiko transport extra uterine : Neonatal pre-transport

 Jauh stabilization – Caring for
 Stabilisasi saat transpot infants the STABLE way.
Infant. 2005: 1(1) 34-37
 Pendamping
 Terpisah dari ibu
 Penilaian negatif dari media dan lingkungan sekitar

PENDAHULUAN
 Tujuan rujukan adalah stabilisasi secepatnya dan mendapatkan
pelayanan kesehatan yang lebih baik sehingga mendapatkan
outcom e yang lebih baik.
 Tujuan tersebut dapat dicapai jika dilakukan dengan:
 Tepat waktu
 Tepat tempat
 Tepat orang
 Tepat cara

 Mendapatkan hasil baik  persiapan dan sistem yang baik

 Metode rujukan : ACCEPT method  dewasa  pediatrik dan

neonatus?

Paediatric and Neonatal Safe Transfer and Retrieval, 2008

Infant Transport, Gomella, 2009

PENDAHULUAN
• SISTEM TRANSPOR KURANG
TERORGANISIR
• FASILITAS TERBATAS DAN SULIT • MORBIDITAS MENINGKAT
DIJANGKAU • 75% MENGALAMI
• KELUARGA TIDAK MAMPU KOMPLIKASI SERIUS
• KURANG TENAGA KESEHATAN • BERESIKO HIPOTERMIA,
MENDAMPINGI NEONATUS, HIPOGLIKEMIA DAN
SEHINGGA CARE END ROUTE SIANOSIS
TIDAK TERJADI
• SISTEM KOMUNIKASI YANG
BURUK
• AKSES TRANSPORTASI FASYANKES
TERSIER TIDAK ADA
PERMASALAHAN NEONATAL TRANSPORT
 TRANSPORTATION OF
NEWBORN
Delivery room Emergency

NURSERY UNIT IN THE

HOSPITAL OF REFERAL

REFER TO OTHER
HOSPITAL
 Incubator Transport

Kangaroo
Mother care

METHOD OF TRANSPORTATION
 NEONATUS PERLU TRANSFER
EMERGENSI KE FASILITAS PELAYANAN
KESEHATAN TERSIER (NICU) KARENA:
• MASALAH MEDIS
Neonatal • MASALAH OPERASI
transport
• MASALAH POST PARTUM

RAY J. NEONATAL TRANPORT IN CHALLENGE IN OUR COUNTRY.JKIMSU

Transpor Bayi Sakit

Pastikan bayi stabil (prinsip “STABLE”)

Pertahankan suhu tubuh bayi selama transport

Gunakan t-piece resuscitator dengan kandungan

oksigen campuran dari udara tekan dari
kompresor dan udara bebas untuk bayi yang
mengalami distres napas
Pastikan infus perifer atau kateter umbilikalis
terpasang bila asupan nutrisi pada bayi
kurang baik.

Siapkan tim perujuk yang dapat melakukan

resusitasi bayi sederhana.
SEBELUM MERUJUK, UPAYAKAN
BAYI DALAM KEADAAN STABIL

S.T.A.B.L.E
 Peaditric and Neonatal Safe Transfer and
Retrieval, 2008

The systematic approach to transfer of a neonate

•A Assessment
•C Control
•C Communication
•E Evaluation
•P Preparation and packaging
•T Transportation
• THE FIRST THING TO DO IS ASSESS THE SITUATION.

• SOMETIMES THE CLINICIANS INVOLVED IN THE

TRANSPORTATION HAS ALSO BEEN INVOLVED IN THE CARE
GIVEN UP TO THAT POINT.
• INCREASINGLY, HOWEVER , THE TRANSPORTER WILL HAVE
BEEN BROUGHT IN SPECIFICALLY FOR THAT PURPOSE AND
WILL HAVE NO PRIOR KNOWLEDGE OF THE BABY’S CLINICAL
HISTORY
ASSESMENT
Paediatric and Neonatal Safe Transfer and Retrieval, 2008
 Paediatric and Neonatal Safe Transfer and Retrieval, 2008

Identification of the clinical

Once assessment is team leader
complete, the transport Identification of the
organiser need to take tasks to be carried out
control of the situation Allocation of tasks to
individuals or teams

CONTROL
• TIM NEONATAL TRANSPORT
2 ATAU 3 PROFESIONAL TENAGA KESEHATAN (DOKTER, PERAWAT,
PARAMEDIS LAINNYA)
 Paediatric and Neonatal Safe Transfer and Retrieval, 2008
• CURRENT (LOCAL) CLINICAL TEAM

CONSULTANT IN CHARGE

CLINICIANS AT BEDSIDE

REFFERING DOCTOR/NURSE

LEAD NURSE

People • TRANSFER TEAM

who TRANSFER COORDINATOR SHOULD DISPERSE INFORMATION TO:

CONSULTANT IN CHARGE
need to CLINICIAN(S) UNDERTAKING TRANSFER

know AMBULANCE PROVIDERS

about a • RECEIVING TEAM

TRANSFER COORDINATOR OR RECEIVING UNIT COORDINATOR DISPERSES

transfer INFORMATION TO:

CONSULTANT IN CHARGE

RECEIVING DOCTORS

RECEIVING NURSING STAFF

• THE BABY’S RELATIVES

COMMUNICATION
KEY ELEMENTS IN ANY COMMUNICATION

What is What are the

Who you are needed (from (relevant)
the listener) baby’s details

What the What has been

problem is done to address What happened
the problem

What is needed
from the listener
• KONDISI DAN TATALAKSANA BAYI SEBELUM DAN SELAMA
TRANSPORTASI HARUS SELALU DI DOKUMENTASIKAN
• JANGAN LUPA INFORMED CONSENT
 Paediatric and Neonatal Safe Transfer and Retrieval, 2008

The aim of evaluation is to assess:

- Is transfer appropriate for this baby?
- What clinical urgency does this baby have?

Critically ill • Specialist treatment

babies • Specialist investigations
unavailable in the
require referring hospital
transfer • Specialist facilities
because of unavailable in the
the need for referring hospital

EVALUATION
 Transfer categories

Emergency Urgent Non-urgent

Time critical:
stable/unstable stable/unstable elective
 Have the aim of ensuring that transport
proceeds uneventfully and with no
deterioration in the baby’s condition

1st stage (preparation) involves

completion of stabilisation and
preparation of transfer team personnel
and equipment

2nd stage (packaging) involves the final

measures that need to be taken to
ensure the security and safety of the
baby, equipment and staff during the
transportation itself

PREPARATION AND PACKAGING

Paediatric and Neonatal Safe Transfer and Retrieval, 2008
 DUKUNGAN TERMAL:
 INKUBATOR TRANSPORT (FASILITAS LENGKAP)
 TRANSPOR SECARA SKIN TO SKIN (FASILITAS TERBATAS)
 TERMOMETER/MONITOR SUHU DISERTAI PROBE
 PLASTIK, SELIMUTINSULATOR, PELINDUNG PANAS

PERALATAN SELAMA TRANSPORTASI

 DUKUNGAN RESPIRATORI:
 TABUNG OKSIGEN
 NASL KANUL
 PERALATAN CPAP: NASAL PRONGE DAN PIPA ET
 FLOWMETER
 OXYGEN ANALYZER
 VM
 LARINGOSKOP
 PLESTER

PERALATAN SELAMA TRANSPORTASI

 PERALATAN LAIN:
 ALAT SUCTION+KATETER SUCTION
 FEEDING TUBE
 SARUNG TANGAN STERIL
 STETOSKOP
 PULSE OXYMETRI
 ALAT PERIKSA GULA DARAH
 PERALATAN INFUS PARENTERAL+OBA-OBATAN

PERALATAN SELAMA TRANSPORTASI

 • Nature of illness
• Urgency of transfer
Factors • Mobilisation time
affecting
• Geographical factors
mode of
• Weather
transfer
• Traffic condition
• Cost

TRANSPORTATION
Paediatric and Neonatal Safe Transfer and Retrieval, 2008
 KEMUNGKINAN YANG DAPAT TERJADI
SELAMA TRANSPORTASI
• ALTERATION IN AIRWAY: RESPIRATORY DISTRESS/FAILURE,
PNEUMOTHORAX
• HYPOGLYCEMIA
• HYPOTHERMIA
• SHOCK: HYPOVOLEMIC, CARDIOGENIC, SEPTIC
• INTRAVENTRICULAR HEMORRHAGE (IVH)

Nancy Young, Transporting the Sick Neonate Intrafacility & Interfacility

TERIMA KASIH