Intensive Care Unit Equipment

Definition
Purpose
Description
Operation
Maintenance
Health care team roles
Training

Definition

Intensive care unit (ICU) equipment includes patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation devices, and other life support equipment designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure, thereby requiring 24-hour care and monitoring.

Purpose

An ICU may be designed and equipped to provide care to patients with a range of conditions, or it may be designed and equipped to provide specialized care to patients with specific conditions. For example, a neuro-medical ICU cares for patients with acute conditions involving the nervous system or patients who have just had neurosurgical procedures and require equipment for monitoring and assessing the brain and spinal cord. A neonatal ICU is designed and equipped to care for infants who are ill, born prematurely, or have a condition requiring constant monitoring. A trauma/burn ICU provides specialized injury and wound care for patients involved in auto accidents and patients who have gunshot injuries or burns.

Description

Intensive care unit equipment includes patient monitoring, life support and emergency resuscitation devices, and diagnostic devices.

Patient monitoring equipment

Patient monitoring equipment includes the following:

• Acute care physiologic monitoring system—Comprehensive patient monitoring systems that can be configured to continuously measure and display a number of parameters via electrodes and sensors that are connected to the patient. These may include the electrical activity of the heart via an EKG, respiration rate (breathing), blood pressure, body temperature, cardiac output, and amount of oxygen and carbon dioxide in the blood. Each patient bed in an ICU has a physiologic monitor that measure these body activities. All monitors are networked to a central nurses’ station.
• Pulse oximeter—Monitors the arterial hemoglobin oxygen saturation (oxygen level) of the patient’s blood with a sensor clipped over the finger or toe.
• Intracranial pressure monitor—Measures the pressure of fluid in the brain in patients with head trauma or other conditions affecting the brain (such as tumors, edema, or hemorrhage). These devices warn of elevated pressure and record or display pressure trends. Intracranial pressure monitoring may be a capability included in a physiologic monitor.
• Apnea monitor—Continuously monitors breathing via electrodes or sensors placed on the patient. An apnea monitor detects cessation of breathing in infants and adults at risk of respiratory failure, displays respiration parameters, and triggers an alarm if a certain amount of time passes without a patient’s breath being detected. Apnea monitoring may be a capability included in a physiologic monitor.

Life support and emergency resuscitative equipment

Intensive care equipment for life support and emergency resuscitation includes the following:

• Ventilator (also called a respirator)—Assists with or controls pulmonary ventilation in patients who cannot breathe on their own. Ventilators consist of a flexible breathing circuit, gas supply, heating/ humidification mechanism, monitors, and alarms.

KEY TERMS

Apnea— Cessation of breathing.

Arterial line— A catheter inserted into an artery and connected to a physiologic monitoring system to allow direct measurement of oxygen, carbon dioxide, and invasive blood pressure.

Catheter— A small, flexible tube used to deliver fluids or medications. A catheter may also be used to drain fluid or urine from the body.

Central venous line— A catheter inserted into a vein and connected to a physiologic monitoring system to directly measure venous blood pressure.

Chest tube— A tube inserted into the chest to drain fluid and air from around the lungs.

Critical care— The multidisciplinary health care specialty that provides care to patients with acute, life-threatening illness or injury.

Edema— An abnormal accumulation of fluids in intercellular spaces in the body; causes swelling.

Endotracheal tube— A tube inserted through the patient’s nose or mouth that functions as an airway and is connected to the ventilator.

Foley catheter— A catheter inserted into the bladder to drain urine into a bag.

Gastrointestinal tube— A tube surgically inserted into the stomach for feeding a patient unable to eat by mouth.

Heart monitor leads— Sticky pads placed on the chest to monitor the electrical activity of the heart. The pads are connected to an electrocardiogram machine.

Infectious disease team— A team of physicians who help control the hospital environment to protect patients against harmful sources of infection.

Life support— Methods of replacing or supporting a failing bodily function, such as using mechanical ventilation to support breathing. In treatable or curable conditions, life support is used temporarily to aid healing, until the body can resume normal functioning.

Nasogastric tube— A tube inserted through the nose and throat and into the stomach for direct feeding of the patient.

Sepsis— The body’s response to infection. Normally, the body’s own defense system fights infection, but in severe sepsis, the body “overreacts,” causing widespread inflammation and blood clotting in tiny vessels throughout the body.

Swan-Ganz catheter— Also called a pulmonary artery catheter. This type of catheter is inserted into a large vessel in the neck or chest and is used to measure the amount of fluid in the heart and to determine how well the heart is functioning.

Tracheostomy tube— A breathing tube inserted in the neck, used when assisted breathing is needed for a long period of time.

• They are microprocessor-controlled and programmable, and regulate the volume, pressure, and flow of patient respiration. Ventilator monitors and alarms may interface with a central monitoring system or information system.
• Infusion pump—Device that delivers fluids intravenously or epidurally through a catheter. Infusion pumps employ automatic, programmable pumping mechanisms to deliver continuous anesthesia, drugs, and blood infusions to the patient. The pump is hung on an intravenous pole placed next to the patient’s bed.
• Crash cart—Also called a resuscitation or code cart. This is a portable cart containing emergency resuscitation equipment for patients who are “coding.” That is, their vital signs are in a dangerous range. The emergency equipment includes a defibrillator, airway intubation devices, a resuscitation bag/mask, and medication box. Crash carts are strategically located in the ICU for immediate availability for when a patient experiences cardiorespiratory failure.
• Intraaortic balloon pump—A device that helps reduce the heart’s workload and helps blood flow to the coronary arteries for patients with unstable angina, myocardial infarction (heart attack), or patients awaiting organ transplants. Intraaortic balloon pumps use a balloon placed in the patient’s aorta. The balloon is on the end of a catheter that is connected to the pump’s console, which displays heart rate, pressure, and electrocardiogram (ECG) readings. The patient’s ECG is used to time the inflation and deflation of the balloon.

Diagnostic equipment

The use of diagnostic equipment is also required in the ICU. Mobile x-ray units are used for bedside radiography, particularly of the chest. Mobile x-ray units use a battery-operated generator that powers an x-ray tube. Handheld, portable clinical laboratory devices, or point-of-care analyzers, are used for blood analysis at the bedside. A small amount of whole blood is required, and blood chemistry parameters can be provided much faster than if samples were sent to the central laboratory.

Other ICU equipment

Disposable ICU equipment includes urinary (Foley) catheters, catheters used for arterial and central venous lines, Swan-Ganz catheters, chest and endotracheal tubes, gastrointestinal and nasogastric feeding tubes, and monitoring electrodes. Some patients may be wearing a posey vest, also called a Houdini jacket for safety; the purpose is to keep the patient stationary. Spenco boots are padded support devices made of lamb’s wool to position the feet and ankles of the patient. Support hose may also be placed on the patient’s legs to support the leg muscles and aid circulation.

Operation

The ICU is a demanding environment due to the critical condition of patients and the variety of equipment necessary to support and monitor patients. Therefore, when operating ICU equipment, staff should pay attention to the types of devices and the variations between different models of the same type of device so they do not make an error in operation or adjustment. Although many hospitals make an effort to standardize equipment—for example, using the same manufacturer’s infusion pumps or patient monitoring systems, older devices and nonstandardized equipment may still be used, particularly when the ICU is busy. Clinical staff should be sure to check all devices and settings to ensure patient safety.

Intensive care unit patient monitoring systems are equipped with alarms that sound when the patient’s vital signs deteriorate—for instance, when breathing stops, blood pressure is too high or too low, or when the heart rate is too fast or too slow. Usually, all patient monitors connect to a central nurses’ station for easy supervision. Staff at the ICU should ensure that all alarms are functioning properly and that the central station is staffed at all times.

For reusable patient care equipment, clinical staff make certain to properly disinfect and sterilize devices that have contact with patients. Disposable items, such as catheters and needles, should be disposed of in a properly labeled container.

Maintenance

Since ICU equipment is used continuously on critically ill patients, it is essential that equipment be properly maintained, particularly devices that are used for life support and resuscitation. Staff in the ICU should perform daily checks on equipment and inform biomedical engineering staff when equipment needs maintenance, repair, or replacement. For mechanically complex devices, service and preventive maintenance contracts are available from the manufacturer or third-party servicing companies, and should be kept current at all times.

Health care team roles

Equipment in the ICU is used by a team specialized in their use. The team usually comprises a critical care attending physician (also called an intensivist), critical care nurses, an infectious disease team, critical care respiratory therapists, pharmacologists, physical therapists, and dietitians. Physicians trained in other specialties, such as anesthesiology, cardiology, radiology, surgery, neurology, pediatrics, and orthopedics, may be consulted and called to the ICU to treat patients who require their expertise. Radiologic technologists perform mobile x ray examinations (bedside radiography). Either nurses or clinical laboratory personnel perform point-of-care blood analysis. Equipment in the ICU is maintained and repaired by hospital biomedical engineering staff and/or the equipment manufacturer.

Some studies have shown that patients in the ICU following high-risk surgery are at least three times as likely to survive when cared for by “intensivists,” physicians trained in critical care medicine.

Training

Manufacturers of more sophisticated ICU equipment, such as ventilators and patient monitoring devices, provide clinical training for all staff involved in ICU treatment when the device is purchased. All ICU staff must have undergone specialized training in the care of critically ill patients and must be trained to respond to respond to life-threatening situations, since ICU patients are in critical condition and may experience respiratory or cardiac emergencies.

Resources

BOOKS

Brenner, Matthew, MD, et al. Critical Care Medicine. Mission Viejo, CA: Current Clinical Strategies, 2006.

Marino, Paul, L. and Kenneth M. Sutin. The ICU Book, 3rd ed. New York: Lippincott Williams & Wilkins, 2006.

Griffiths, Mark. Management of Cardiovascular Conditions of Adults in Acute Care, 1st ed. Malden, MA: Blackwell Publishers, 2008.

Milford, Cheryl, and Gladys Purvis. “Cardiovascular Care.” In Nursing Procedures, 3rd ed. Springhouse, PA: Springhouse Corporation, 2000.

Skeehan, Thomas, and Michael Jopling. “Monitoring the Cardiac Surgical Patient.” In A Practical Approach to Cardiac Anesthesia, 3rd edition, edited by Frederick A. Hensley, Donald E. Martin, and Glenn P. Gravlee. Philadelphia, PA: Lippincott Williams & Wilkins, 2003.

Woods, Susan, Erika Sivarajan, Sandra Adams Motzer, and Elizabeth Bridges. Cardiac Nursing, 5th ed. Philadelphia: Lippincott, 2004.

PERIODICALS

Brilli, R. J., A. Spevetz, R. D. Branson, et al. “Critical Care Delivery in the Intensive Care Unit: Defining Clinical Roles and the Best Practice Model.” Critical Care Medicine 29 (October 2001): 2007–2019.

Savino, Joseph S., C. William Hanson III, and Timothy J. Gardner. “Cardiothoracic Intensive Care: Operation and Administration.” Seminars in Thoracic and Cardiovascular Surgery 12 (October 2000): 362–70.

ORGANIZATIONS

American Association of Critical Care Nurses (ACCN). 101 Columbia, Aliso Viejo, CA 92656-4109. (800) 889-AACN [(800) 889-2226] or (949) 362-2000. http://www.aacn.org.

National Association of Neonatal Nurses. 4700 West Lake Ave., Glenview, IL 60025-1485. (847) 375-3660 or (800) 451-3795. http://www.nann.org.

National Heart, Lung and Blood Institute. Information Center. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-2222. http://www.nhlbi.nih.gov.

National Institutes of Health, U.S. Department of Healthand Human Services, 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-4000. http://www.nih.gov.

Society of Critical Care Medicine. 701 Lee St., Suite 200, Des Plaines, IL 60016. (847) 827-6869. E-mail: [email protected]. http://www.sccm.org.

OTHER

Advanced Cardiac Monitoring: Ventricular Ectopy vs. Aberrancy. Videotape. RamEx, Inc.

ICU Guide. 2002. http://www.waiting.com/waitingicu.html.

ICU-USA, Society of Critical Care Medicine, 2002. http://www.icu-usa.com/tour/.

“Intensive Care Unit (ICU).” 2008. http://www.painchannel.com/icu/index.shtml.

Jennifer E Sisk, MA

Angela M Costello

Laura Jean Cataldo, RN, EdD

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Intestinal anastomosis seeIleoanal anastomosis