Protocol of ICU

8/17/2019 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

Documents

Protocol of ICU