Protocol of ICU
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Transcript of Protocol of ICU
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PROTOCOLS OF INTENSIVE CARE UNIT
INTRODUCTION
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment
unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility
that provides intensive care medicine.
Intensive care units cater to patients with severe and life-threatenin illnesses and in!uries, which
re"uire constant, close monitorin and support from specialist e"uipment and medications in
order to ensure normal #odily functions. They are staffed #y hihly trained doctors
and nurses who speciali$e in carin for seriously ill patients. ICU%s are also distinuished fromnormal hospital wards #y a hiher staff-to-patient ratio and access to advanced medical
resources. Common conditions that are treated within ICUs include A&', trauma, multiple
oran failure and sepsis
DEFINITION
• An Intensive Care Unit (ICU) is a specially staffed and e"uipped, separate and self-
contained area of a hospital dedicated to the manaement of patients with life-
threatenin illnesses, in!uries and complications, and monitorin of potentially life-
threatenin conditions.
• It provides special epertise and facilities for support of vital functions and uses the skills
of medical, nursin and other personnel eperienced in the manaement of these
pro#lems.
• In many units, ICU staff are re"uired to provide services outside of the ICU such as
emerency response (e rapid response teams) and outreach services. *here applica#le
the hospital must provide ade"uate resources for these activities.
https://en.wikipedia.org/wiki/Intensive_care_medicinehttps://en.wikipedia.org/wiki/Medical_emergencyhttps://en.wikipedia.org/wiki/Human_homeostasishttps://en.wikipedia.org/wiki/Intensive_care_medicinehttps://en.wikipedia.org/wiki/Intensive_care_medicinehttps://en.wikipedia.org/wiki/Critical_care_nursinghttps://en.wikipedia.org/wiki/Critical_care_nursinghttps://en.wikipedia.org/wiki/ARDShttps://en.wikipedia.org/wiki/Trauma_(medicine)https://en.wikipedia.org/wiki/Multiple_organ_failurehttps://en.wikipedia.org/wiki/Multiple_organ_failurehttps://en.wikipedia.org/wiki/Sepsishttps://en.wikipedia.org/wiki/Medical_emergencyhttps://en.wikipedia.org/wiki/Human_homeostasishttps://en.wikipedia.org/wiki/Intensive_care_medicinehttps://en.wikipedia.org/wiki/Critical_care_nursinghttps://en.wikipedia.org/wiki/ARDShttps://en.wikipedia.org/wiki/Trauma_(medicine)https://en.wikipedia.org/wiki/Multiple_organ_failurehttps://en.wikipedia.org/wiki/Multiple_organ_failurehttps://en.wikipedia.org/wiki/Sepsishttps://en.wikipedia.org/wiki/Intensive_care_medicine
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CATEGORIES OF ORGAN SYSTEM MONITORING AND SUPPORT
Advanced respirator sste! !onitorin" # s$pport is indicated % one o&
!ore o& t'e &o((o)in"*
+echanical ventilatory support, ecludin mask (CA) or non-invasive methods, e..
mask ventilation
tracorporeal respiratory support
+asic respirator sste! !onitorin" # s$pport is indicated % one or !ore o&
t'e &o((o)in"*
+ore than /01 oyen #y fied performance mask
The potential for deterioration to the point of needin advanced respiratory support
hysiotherapy to clear secretions at least two hourly, whether via a trachesotomy,
minitracheostomy, or in the a#sence of an artificial airwayatients recently etu#ated after a proloned period of intu#ation and mechanical
ventilation +ask CA or non-invasive ventilation
atients who are intu#ated to protect the airway #ut needin no ventilatory support and
who are otherwise sta#le.
Circ$(ator sste! !onitorin" # s$pport is indicated % one o& !ore o& t'e
&o((o)in"*
2asoactive drus to support arterial pressure or cardiac output
Circulatory insta#ility due to hypovolaemia from any cause
atients resuscitated after cardiac arrest where intensive care is considered clinically
appropriate
Intra aortic #alloon pumpin.
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Ne$ro(o"ica( sste! !onitorin" # s$pport is indicated % one or !ore o& t'e
&o((o)in"*
Central nervous system depression, from whatever cause, sufficient to pre!udice the
airway and protective refleesInvasive neuroloical monitorin, e.. IC, !uular #ul# samplin.
Rena( sste! !onitorin" # s$pport is indicated %*
Acute renal replacement therapy ( haemodialysis, haemofiltration etc.).
GENERAL RE,UIREMENTS FOR INTENSIVE CARE UNITS
'ependin upon the desinated level, function, si$e, and case mi of the hospital and3 or reionthat it serves, an ICU may rane from four to over /0 #eds.
4aer ICU should #e divided into pods of 5-6/ patients
Sta&&in"
• +edical staffin, includin a director, with sufficient eperience to provide for patient
care, administration, teachin, research, audit, outreach7.
• 8ursin staff9 Australian Collee of Critical Care 8urses re"uires 696 for ventilated
patients and 69: for lower acuity patients. 8urse in chare with post reistration ICU
"ualification
• allied health and ancillary staff
Medica( sta&&in"
'irector of the intensive care unit. The responsi#ility for the administrative and medical
manaement of the unit is held #y a physician, whose professional activities are devoted full-
time or at least ;/1 of the time to intensive care, who holds the position of director of the
ICU. The head of the ICU has the sole administrative and medical responsi#ility for this unit
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and cannot hold top-level responsi#ilities in other departments or facilities of the hospital.
The head of the ICU should #e a senior accredited specialist in intensive care medicine as
defined at country level, usually with a prior deree in anesthesioloy, internal medicine, or
surery and have had a formal education, trainin, and eperience in intensive care medicine
as descri#ed #y the IC+ uidelines
Medica( sta&& !e!%ers-
The head of the ICU is assisted #y physicians "ualified in intensive care medicine. The
num#er of staff re"uired will #e calculated accordin to the num#er of #eds in the unit,
num#er of shifts per day, desired occupancy rate, etra manpower for holidays and
illness, num#er of days each professional is workin per week, and the level of care and
as a function of clinical, research, and teachin workload. tended work shifts have
#een shown to neatively impact the safety of patients as well as medical staff. The
num#er of full time e"uivalent (> The reular medical staff mem#ers of the ICU treat patients usin state-of-
the-art techni"ues and may consult specialists in different medical, surical, or dianostic
disciplines whenever necessary
N$rsin" sta&&
@rani$ation and responsi#ilities. Intensive care medicine is the result of close cooperation
amon doctors, nurses, and allied health care professionals (AC). An efficient process of
communication has to #e orani$ed #etween the medical and nursin staff of the ICU. Tasks and
responsi#ilities have to #e clearly defined. ead nurse. The nursin staff is manaed #y a
dedicated, full-time head nurse, who is responsi#le for the functionin and "uality of the nursin
care. The head nurse should have etensive eperience in intensive care nursin and should #e
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supported #y at least one deputy head nurse a#le to replace him (her). The head nurse should
ensure the continuin education of the nursin staff. ead nurses and deputy head nurses should
not normally #e epected to participate in routine nursin activities. The head nurse works in
colla#oration with the medical director, and toether they provide policies and protocols, and
directives and support to the team.
A((ied 'ea(t' care personne(
P'siot'erapists- @ne physiotherapist with dedicated trainin and epertise in critically ill
patients should #e availa#le per five #eds for level III care on a ; day3week #asis.
Tec'nicians- +aintenance, cali#ration, and repair of technical e"uipment in the ICU must to #e
orani$ed. This facility can #e shared with other departments of the hospital #ut a :B-h
availa#ility has to #e orani$ed with priority for the ICU.
Radio(o" tec'nician- hould #e on call around the clock. Interpretation of the medical imain
#y the radioloist must #e availa#le at all times.
Dietician- hould #e on call durin normal workin hours.
Speec' and (an"$a"e t'erapist. hould #e availa#le to consult durin normal workin hours.
Psc'o(o"ist- hould #e availa#le to consult durin normal workin hours.
Occ$pationa( t'erapist. hould #e availa#le to consult durin normal workin hours.
C(inica( p'ar!acist. hould #e availa#le to consult durin normal workin hours. A sufficient
colla#oration with pharmacy is of particular importance with respect to patient safety.
Ad!inistrative personne( @ne medical secretary is re"uired per 6: intensive care #eds. asic
tasks are patient administration, eternal and internal communication echane, and typin of
reports and documents. @ne secretary per si #eds may #e desira#le if she3he is also involved in
arranin la#oratory !ournals and medical files. Another approach is to calculate the num#er of
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medical secretarial assistants as one s supervision. A checklist of the cleanin status must #e
kept. &eular updates should #e provided to ensure cleanin protocols reflect #est practice.
Operationa(
•'ocumented educational proramme
• areed policies
• team approach
• sure capacity for emerencies
• documented procedures for audit
• peer review
• "uality assurance
Site
• separate unit
• appropriate access to ', theatre, radioloy
Desi"n
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• atient cu#icles (E :0 m:), wash #asin, service outlets, appropriate electrical standards,
privacy
• *ork areas, e"uipment and storae areas, staff facilities, seminar room, offices, relatives
area
• "uipment9 appropriate e"uipment and reular system for checkin safety
• +onitorin e"uipment9 for each patient, for unit (.e. as supply alarms), and for patient
transport
• Criteria for a level I, II and III ICU and a ICU
LEVELS OF INTENSIVE CARE UNITS
424 6
• should #e capa#le of providin immediate resuscitation and short-term cardiorespiratory
support for critically ill patients
• will also have a ma!or role in monitorin and prevention of complications in Fat riskG
medical and surical patients
• must #e capa#le of providin mechanical ventilation and simple invasive cardiovascular
monitorin for a period of at least several hours
424 II
• should #e capa#le of providin a hih standard of eneral intensive care, includin
comple multi-system life support, which supports the hospital>s delineated
responsi#ilities
• minimum of H #eds
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424 III
• a tertiary referral unit for intensive care patients
• should #e capa#le of providin comprehensive critical care includin comple multi-
system life support for an indefinite period
• should have a demonstrated commitment to academic education and research
• All patients admitted to the unit must #e referred for manaement to the attendin
intensive care specialist
• all consultants are
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•
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• ::/ D :/0 JUA&
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• 4ihtin D focussed N central lihtin.
• Airconditionin (split 3 central) 9 :/ P or D : derees centirade.
• Cleanin D vacuum cleanin N wet moppin of the floor. fumiation is no loner
recommended.
• 8atural illumination and view - windows are an important aspect of sensory orientationO
helps to reinforce day3niht orientation.
• *indow treatments should #e dura#le and easy to clean, and a schedule for their cleanin
must #e esta#lished.
• Additional approaches to improvin sensory orientation for patients may include the
provision of a clock, calendar, #ulletin #oard, and3or pillow speaker connected to radio
and television
ACCESSORIES
• Q oyen outlets, Q suction outlets (astric, tracheal N underwater seal), two compressed
air outlets and 6H power outlets per #ed.
storae #y each #edside (#uilt in 3 alcove).
• hand rinse solution #y each #edside.
•
e"uipment shelf at the head end (mind the heiht of the care iver).
• hooks N devices to han infusions 3 #lood #as D suspended from the ceilin with a
slidin rail to position.
• infusion pumps to #e mounted on stands 3 poles.
UTILITIES
• electrical D ade"uate sockets (/amps N 6/ amps), enerator supply N #attery #ack up.
•medical as N vacuum pipeline D colour coded and not interchanea#le.
• water from a certified source especially if used for haemodialysis
• handwashin areas D uninterrupted water supply, disposa#le paper towels 3 hand drier. (no
cloth towels please)
• telephones N computers for communication.
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• sterilisin area D lare water #oiler 3 eyser N ehaust fans.
• clean and a dirty utility with no interconnection.
• shelvin N ca#inets off the round for storae.
• waste N sharps disposal
• work areas and storae for critical supplies should #e located immediately ad!acent to
each icu.
• alcoves should provide for the storae and rapid retrieval of crash carts and porta#le
monitor3defi#rillators.
• there should #e a separate medication area of at least /0 s"uare feet containin a
refrierator for pharmaceuticals, a dou#le lockin safe for controlled su#stances, and a
ta#le top for preparation of drus and infusions.
E,UIPMENT
6. +onitorin "uipment:. Therapeutic "uipment
Q. 'iital N Analoue 'isplay
B. Audio N 2isual Alarms/. attery ack Up N Charin
Co!!on e5$ip!ent in an ICU inc($des*
• mechanical ventilator to assist #reathin throuh an endotracheal tu#e or a tracheotomy
openinO
• cardiac monitors includin telemetry, eternal pacemakers, and defi#rillatorsO
• dialysis e"uipment for renal pro#lemsO
• e"uipment for the constant monitorin of #odily functionsO
• a we# of intravenous lines, feedin tu#es, nasoastric tu#es, suction pumps, drains and
cathetersO
• a wide array of drus to treat the main condition(s).
• +onitorin
http://en.wikipedia.org/wiki/Mechanical_ventilatorhttp://en.wikipedia.org/wiki/Intubationhttp://en.wikipedia.org/wiki/Tracheotomyhttp://en.wikipedia.org/wiki/Tracheotomyhttp://en.wikipedia.org/wiki/Telemetryhttp://en.wikipedia.org/wiki/Pacemakershttp://en.wikipedia.org/wiki/Pacemakershttp://en.wikipedia.org/wiki/Pacemakershttp://en.wikipedia.org/wiki/Defibrillatorshttp://en.wikipedia.org/wiki/Defibrillatorshttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Medical_monitorshttp://en.wikipedia.org/wiki/Intravenous_fluidshttp://en.wikipedia.org/wiki/Nasogastric_intubationhttp://en.wikipedia.org/wiki/Pharmacologyhttp://en.wikipedia.org/wiki/Mechanical_ventilatorhttp://en.wikipedia.org/wiki/Intubationhttp://en.wikipedia.org/wiki/Tracheotomyhttp://en.wikipedia.org/wiki/Telemetryhttp://en.wikipedia.org/wiki/Pacemakershttp://en.wikipedia.org/wiki/Defibrillatorshttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Medical_monitorshttp://en.wikipedia.org/wiki/Intravenous_fluidshttp://en.wikipedia.org/wiki/Nasogastric_intubationhttp://en.wikipedia.org/wiki/Pharmacology
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• ed side and central monitors, 6: lead CK recorders, intravascular and intracranial
pressure monitorin devices
• Cardiac output computer
•
ulseoymeter
• ulmonary function monitorin devices
• pired C@: analy$ers
• K monitors
• atient3 #ed weihers
• n$ymatic #lood lucose meters
•&adioloy
• M ray viewers
• orta#le ray machine
• Imae intensifiers
• &espiratory therapy
• 2entilators, #edside Nporta#le
• umidifiers, oyen therapy devices Nairway circuits
• Intu#ation trolley
• +anual self inflatin resuscitators
•
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• Infusion pumps and syrines
• 'ialytic therapy
• aemodialysis machine
• eritoneal dialysis e"uipment
• Continuous arterio venous hemofiltration setts
• 4a#oratory
• lood as analy$er
• elective ion electrode analy$ers
• @smometer
• ematocrit centrifue
• microscope
• ardware
• 'ressin trolleys
• 'rip stands
• ed restraints
• eatin3 coolin #lankets
• ressure distri#ution mattresses
• terili$in e"uipments
T@&AK A&A3&2IC A&A
• +ost ICUs lack storae space.
•
They should have a total of :/-Q01 of all patient and central station areas for storae.
• Clean and dirty utility rooms should #e separate each with its own access.
• 'isposal of soiled linen and waste must #e catered for.
• A la#, which estimates #lood ases, electrolytes, haemolo#in, is a must.
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• Kood communication systems, staff loune, food areas must #e marked out.
• There should #e an area to teach and train students.
Re&erences
6.
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:. rilli &L, pevet$ A, ranson &', Camp#ell K+, Cohen , 'asta L
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9ALAND7AR
NURSING MANAGEMENT
TOPIC* Protoco(s and standards o& intensive care $nit
SU+MITTED TO SU+MITTED +Y
&espected +am +s. &avneet Raur imranpreet kaur
4ecturer +.c (8) II ear
+ental ealth (sychiatric) 8ursin +edical urical 8ursin