NURSING PATIENT CARE POLICY & PROCEDURE
April 4, 2017
Nursing Manual (Red)
Policy #: 1.49P
Title: Use of Near-Infrared Spectroscopy
(Cerebral and Somatic Oximetry) in the
Pediatric and Neonatal Intensive Care Unit
A. To describe the nursing management of patients who may require Near-Infrared
Spectroscopy (NIRS) in the PICU and NICU. This monitoring allows clinicians to
detect real-time and continuous fluctuations in tissue oxygenation as they occur at
A. The NIRS monitor can be used on an infant or child who is considered at risk for
alterations in cardiac output, regional perfusion or oxygen delivery and
B. All patients that are being monitored with NIRS need to establish baseline of their
cerebral and renal saturations. There is not a standard normal for patients. After
the NIRS somatosensors have been placed and readings are displayed on the
monitor, a period of 30 to 60 minutes should be observed to establish the baseline
reading for the patient.
C. A change of 20% from patient baseline should be considered significant and
warrants an assessment of the patient.
A. Somatic Oximeter Monitor
B. Somatosensors – Two (2) if monitoring both cerebral and renal, one (1) if
monitoring only one region
C. Cables (1-2)
D. Pulse oximetry - Continuous
A. Set up monitor
1. Plug the sensor cable into the preamplifier connector.
a. When two (2) somatic sensors are placed, they must be connected
into the same preamplifier.
2. Turn power on by selecting the green ON/OFF key.
3. Connect sensors to sensor cable.
a. Pediatric sensors are used for patient less than 40 kg.
b. Adult sensors are used for patients greater than 40 kg.
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c. Neonatal sensors are used for infants up to one (1) year. See
placement of the sensors in section IV, B.
4. Press “New Patient”.
5. Monitoring begins with display of patient regional saturation (rSO2) values in
a. The Cerebral sensor should be labeled “C” and be the top reading
on the monitor.
b. The Renal sensor should be label “R” and it should be below the
cerebral reading on the monitor.
6. After 30 minutes to 60 minutes of rSO2 values displaying, set a baseline by
pressing the “Baseline Menu” button followed by pressing “Set Baseline”.
B. Placement of the somatosensors
1. Site selection
a. Place probe over intact skin.
b. Do not place over areas of adipose tissue or area of edema greater
than three (3) centimeters (cm).
c. Do not place over areas of ecchymosis.
d. Before placing sensor, cleanse the skin with soap and water to
remove natural oils for better adherence of the sensor.
a. For infants, place the sensor on the forehead above their eyebrows
and below the hair line.
b. For children, place sensor on the right or left side of the forehead,
above the eyebrow and below the hair line.
a. Place over right or left flank at the level of T10–L2. Do not place
sensor over the spine.
1. Document readings hourly in the Complex Monitor flowsheet of the clinical
a. Go to Complex Monitor.
b. Find Regional Oximetry. May add this section if not present.
c. Document the rSO2 with vital signs.
d. Document location of the sensor a minimum of one (1) time per
2. Compare readings to baseline.
3. If an intervention is delivered (drugs, CPR, O2), compare trends before and
4. If NIRS values are more than 20% from baseline a provider should be
1. Each somatosensory probe should be removed every 48 hours and the skin left
open for one (1) hour to prevent skin irritation or breakdown.
a. Only one (1) probe should be removed at a time.
b. To remove the probe, use adhesive remover pad or saline wipe.
2. After one (1) hour, if skin is intact, replace a new probe in the same location
to continue monitoring the same tissue bed.
3. Document the probe change in:
a. Complex Monitoring
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b. Regional Oximetry
c. Sensor Probe “Changed”. The probe can also be dated and timed
for a visual cue.
E. Trouble shooting the monitor
1. If the monitor is not displaying:
a. If two (2) sensors are being used, check to see if they are both the
same size. For example, both sensors are “pediatric”.
b. Make sure probe has complete contact with the skin.
c. Check the cable and sensor connections. If the connections are
tight and still not providing a reading, change the cable.
2. If rSO2 readings are not consistent or are not displaying:
a. Check patient’s bilirubin level. Hyperbilirubinemia interferes with
the ability of the sensors to function.
b. If the sensor is placed over adipose tissue or edema greater than
three (3) cm the light will not reach the tissue bed. Remove or
move the sensor to another location.
3. If readings are constant without variability, this requires an evaluation of the
a. If the somatosensor is placed over an ecchymosed area, the sensor
will be over an area of non-perfusing tissue which results in a
F. Cleaning equipment
a. Cavi-wipes or bleach wipes should be used to clean the equipment
between patient use per manufacturer’s instructions.
b. Window cleaner should be used for the screen.
V. UWHC CROSS REFERENCE
Near Infrared Spectroscopy (NIRS) Monitoring Quick Reference (see Related section
A. Bernal, N., Hoffman, G., Ghanayem, N., & Arca, M. (2010). Cerebral and
somatic near-infrared spectroscopy in normal newborns. Journal of Pediatric
Surgery, 45, 1306-1310.
B. Drayna, P. C., & Abramo, T. J. (2011). Near-infrared spectroscopy in the critical
setting. Pediatric Emergency Care, 27(5), 432-439.
C. INVO Cerebral/Somatic Oximeter User Manual. “Quick Reference Guide for
Pediatric Use” and “System Inservice Guide for Neonatal Use”. (In PICU and
NICU--paper version) http://www.somanetics.com/invos-system
D. Marin, T. & Moore, J. (2011). Understanding near-infrared spectroscopy.
Advances in Neonatal Care, 11(6), 382-388.
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VII. REVIEWED BY
Clinical Nurse Specialist, Neonatal Intensive Care Unit
Clinical Nurse Specialist, Pediatric Intensive Care Unit
Medical Director, Pediatric Critical Care
Nursing Patient Care Policy and Procedure Committee, March 2017
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive