ICU ORIENTATION

Vanshika sethi (M.P.T. Neuro)

Air way
What is an airway? An airway is a device that helps keep the mouth and windpipe open so that air can reach the lungs. It may also be used to help prevent biting down on the tongue or breathing tube. Does use of an airway hurt? If a patient is awake, an airway may be very uncomfortable. Normally doctors and nurses will not use it when the patient is awake.

Air way cont.

How long is an airway used? An airway is normally only used for a short time, rarely longer than a few days, and usually only a few hours. The length of time depends on the reason the doctor or nurse is using it. Ask the doctor or nurse why the airway is in place to help determine how long it may be used. Can a patient talk while using an airway? No. However, if a patient is alert enough to communicate, the airway is normally removed. Are there any potential complications associated with use of an airway? Sometimes pressure sores are caused by an airway. These can be prevented by moving the airway from one side of the mouth to the other.

Arterial line
Why does a patient need an arterial line?

Critically ill or injured patients frequently have profound abnormalities in their blood pressure.
The arterial line provides a way to constantly measure a patient's blood pressure and may be essential to the stabilization of the patient. The arterial line also provides access for frequent blood sampling. Blood can be withdrawn from the patient through the arterial line tubing without having to use a needle for each blood draw. How is an arterial line inserted The wrist (radial artery), armpit (axillary artery), groin (femoral artery), or foot (pedal artery). The arterial line is usually sutured (sewed) to the overlying skin to assure that it remains in the artery. The arterial line tubing is connected to the bedside monitor, where the patient's blood pressure is constantly displayed.

Arterial line cont..

How long is an arterial line used? Typically, an arterial line is required for a short period of time. If the information from the arterial line is required for more than five to seven days, a new arterial line may be required. Are there any potential complications associated with use of an arterial line? The major complications associated with the arterial line are bleeding, infection, and rarely, a lack of blood flow to the tissue supplied by the artery.

Bedside Monitor
What is a bedside monitor? A bedside monitor is a display of major body functions The monitor is attached to wires, called leads. At the other end, the leads are attached to sensing devices attached to the patient's body. The sensing device sends electronic signals to the monitor, which displays the readings for the specific body function being monitored. When is a bedside monitor used? The monitor is typically used when the doctor wants to measure functions like the heart rate, respiratory rate, blood pressure and temperature. In addition, special functions such as capnography, oximetry, electroencephalography and pulmonary artery catheter readings are also used in certain situations. The bedside monitor has alarms that signal the nurse if a body function needs attention.

Bedside Monitor
How long is a bedside monitor used? All patients admitted to the ICU have a bedside monitor attached to them. The bedside monitor is normally used the entire time a patient is in the ICU.

Bedside Monitor
Does use of a bedside monitor hurt? Being attached to the bedside monitor does not hurt. How long is a bedside monitor used? All patients admitted to the ICU have a bedside monitor attached to them. The bedside monitor is normally used the entire time a patient is in the ICU. Are there any potential complications associated with use of a bedside monitor? No.

Biohazard Disposal Box

What is a biohazard disposal box? Every patient room in the hospital contains a biohazard disposal box. The purpose of the box is to provide a receptacle for disposable needles or sharp instruments that have been used on patients. This practice decreases the risk of exposing patients, families, and medical staff to disease that may be spread by contacting blood. Hospital staff and personnel are trained to limit everyone's potential exposure to dangerous materials such as blood and germs.

Biohazard Disposal Box

What dangerous or hazardous materials are in the hospital? Dangerous or hazardous materials in the hospital include blood, germs, radiation and used medical supplies. However, the risk of your exposure to them is minimal because hospital personnel are trained to follow procedures that reduce exposure to such materials. How will I know if dangerous material is near? Unfortunately, often you will not. That is why hospital personnel are specially trained to protect you. If you have any specific questions, please ask the doctor or nurse for help. Am I likely to be exposed to dangerous material? Fortunately, no. However, any hospital carries certain risks of exposure.

Breathing Bag
What is a breathing bag (manual resuscitator)? A breathing bag is a device used to temporarily help a patient breathe. When a patient needs help breathing, a respiratory therapist, doctor or nurse places the breathing bag face mask over the patient's mouth and nose. The breathing bag is connected to an oxygen source. The bag is then squeezed and oxygen is pushed into the patient's lungs. If the patient has a breathing tube in place, the breathing bag may be directly connected to the breathing tube. Does use of breathing bag hurt? If awake, the patient may sense the oxygen flowing into their lungs. The breathing bag face mask makes some patients feel uncomfortable.

Breathing Bag
How long is a breathing bag used? A breathing bag is used for a short period of time. If the patient requires help breathing for more than a short period of time, a breathing machine may be used. Are there any potential complications associated with use of a breathing bag? Patients without a breathing tube (endotracheal tube) may experience bloating after needing the breathing bag. This occurs because some of the oxygen intended to go into the lungs goes into the stomach. This problem is temporary

Central Venous Catheter

What is a central venous catheter? A central venous catheter is a special IV line that is inserted into a large vein in the body. Several veins are used for central venous catheters including those located in the shoulder (subclavian vein), neck (jugular vein), and groin (femoral vein). In some patients, a central venous catheter may be inserted into the elbow vein (anticubital vein) and advanced into the subclavian vein. These special IVs are used when the patient either does not have adequate veins in the arms or needs special medications and/or nutrition that cannot be given through the smaller arm veins. Do central venous catheters hurt? Yes, when they are inserted. The doctor numbs the area with an anesthetic before placing the catheter. Once it is in place, it usually does not hurt. Central venous catheters in the shoulder or neck veins can occasionally cause the lung to collapse. After a neck, shoulder or elbow central venous catheter is put in, the doctor gets a chest x-ray to make sure that the catheter is in the proper place and that the patient's lung is still inflated.

Central Venous Catheter..

How long is a central venous catheter used? The amount of time that a central venous catheter remains in a patient varies and may depend upon the patient's condition. The ICU staff monitors the catheter closely and removes it when it is no longer needed. Occasionally, the catheter may need to be replaced. Are there any potential complicatons associated with central venous catheters? Bleeding and infection are complications associated with IV catheters. As previously mentioned, collapse of a lung is a rare complication of central venous catheters. If this occurs, a chest tube (thoracostomy tube) may be required to re-expand the lung.

Chest Drainage Device

What is a chest drainage device? The chest drainage device includes a chest tube and a chest drainage unit. A chest tube is placed to remove air or fluid from around a patient's lung. The chest drainage unit is attached to the chest tube by elastic tubing that allows the air or fluid to drain. The chest drainage unit may be seen attached to the patient's bed or resting on the floor next to the patient's bed. Fluid draining from the chest will be seen in the chest drainage unit. Some chest drainage units have a chamber that bubbles constantly. When is a chest drainage unit used? A chest drainage unit is used when the patient has a chest tube in place.

Chest Drainage Device

Does use of a chest drainage unit hurt? The use of a chest drainage unit does not hurt. How long is a chest drainage device used? A chest drainage device is used as long as the patient needs a chest tube. Are there any potential complications associated with use of a chest drainage device? Chest drainage units are very reliable and rarely have problems. The chest drainage unit needs to be changed when the chambers fill with fluid.

Compression Stockings
What are compression stockings? Compression stockings are plastic wraps that are placed around a patient's legs in order to decrease the chance of blood clot formation. They have compartments that inflate and deflate, gently squeezing the muscles of the legs. The stockings are connected to a small compressor that controls the timing of the inflation/deflation cycles. The squeezing action of the compression stockings improves the circulation in the leg veins, thus decresing the chance of clot formation. Most ICU patients have an increased risk of blood clot formation and compression stockings are one of the measures used to decrease this risk. Unfortunately, no measure is 100% effective at preventing the formation of blood clots in the leg veins of ICU patients.

Compression Stockings
How long are compression stockings used? The stockings should be worn as long as patient is at increased risk of forming blood clots. They should remain on the patient as much as possible, both day and night. The stockings need to be worn to be effective. Are there any complications associated with use of compression stockings? Complications associated with use of compression stockings are very rare. Do the stockings hurt? Not usually. Some patients complain that the stockings are too warm.

Defibrillator
What is a defibrillator? A defibrillator is a device that is designed to pass electrical current through a patients heart. The passing of electrical current through the heart is called defibrillation. A defibrillation is done through pads placed on the patients chest. Why is defibrillation used? A defibrillation is used to restore a patients heart rhythm to normal. Abnormal heart rhythms may be treated with medications while other rhythms need to be treated with defibrillation. Life threatening heart rhythms need defibrillation immediately while other heart rhythms may be defibrillated in a scheduled fashion. Defibrillation may be done using the manual defibrillator or the automatic external defibrillator (AED).

Defibrillator.
Does defibrillation hurt? Patients needing emergent defibrillation are usually unconscious and do not feel the defibrillation. Patients with abnormal but stable heart rhythms needing defibrillation will receive sedation and pain medication before the defibrillation is done. Patients usually have no memory of the defibrillation. Are there any potential complications associated with use of a defibrillator? The defibrillator pads may cause a skin irritation and leave a temporary redden area where they contacted the chest. Unfortunately defibrillation does not always return the patients heart rhythm back to normal.

Dialysis Catheter
What is a dialysis catheter? A dialysis catheter is a specialized type of central venous catheter used for dialysis. How is the dialysis catheter used? The dialysis catheter is placed by the doctor into the patient's shoulder (subclavian), neck (jugular), or groin (femoral) vein. When the patient needs dialysis, the catheter is attached to the dialysis machine by dialysis tubing. The patient's blood flows into the dialysis machine and is filtered to remove fluids and/or toxins, and then returned back to the patient. The dialysis catheter is usually used for dialysis only.

Dialysis Catheter
Does the dialysis catheter hurt? The insertion of the dialysis catheter causes some discomfort. The doctor uses local numbing medication to lessen this discomfort. Once in place, the dialysis catheter rarely causes discomfort. What are the potential complications associated with the use of the dialysis catheter? The potential complications of the dialysis catheter include bleeding, infection, lung collapse and incorrect position within the vein.

Dialysis Machine
What is a dialysis machine? A dialysis machine is a machine that cleans the blood of toxins when the kidneys are not working. The patient's blood enters the dialysis machine and goes through a special filter that works like the kidney to remove fluid and toxins from the blood. The use of the dialysis machine is termed hemodialysis. A patient undergoing hemodialysis must be connected to the hemodialysis machine by tubing that allows blood to flow to and from the dialysis machine. The tubing is connected to the patient by way of a dialysis shunt or catheter. When is a dialysis machine used? A dialysis machine is used when a patient's kidneys cannot effectively clean the blood. Does use of a dialysis machine hurt? The use of the dialysis machine does not hurt.

Dialysis Machine
How long is a dialysis machine used? The dialysis machine can be used for a short period of time or for a long period of time, depending on what is wrong with the kidneys. Are there any potential complications associated with use of a dialysis machine? The potential complications associated with the use of the dialysis machine are very uncommon and include bleeding and infection. During dialysis a patient's blood pressure may vary due to the fluid shifts.

ECG pad
What is an ECG pad or EKG pad? An ECG pad is a small device that is placed on the body to detect the electrical activity of the heart. They are placed on the body and connected to wires (leads) that lead into an ECG machine (electrocardiograph), which displays the information on a bedside monitor and/or prints it. Why are so many ECG pads required? To adequately monitor the heart two to seven pads may be required. Do ECG pads hurt? ECG pads do not hurt. Due to the adhesive used to hold ECG pads on the skin, when they are removed there is a small pull on the skin. How long are ECG pads used? Most, if not all, patients in the ICU, have ECG pads and heart rhythm monitoring. The pads are used as long as the patient remains in the ICU.

Liquid Tube Feeding Pump

What is a liquid tube feeding pump? A liquid tube feeding pump is a specialized pump designed to accurately deliver liquid tube feeding to a patient. How does the liquid tube feeding pump work? The dietician and doctor determine the amount of liquid tube feeding that a patient needs for each day. This amount is entered into the liquid tube feeding pump by the nurse. The tube feeding pump delivers the liquid tube feeding to the patient at a constant rate over a twenty four hour period.

Liquid Tube Feeding Pump

The liquid tube feeding will be seen at the patients bedside usually hanging from an IV pole. The tube feeding is usually in a container that is connected to the feeding pump. The tube feeding flows through the feeding pump into the patient through a nasogastric, nasoduodenal, jejunostomy, or gastrostomy tube. Not all patients receiving liquid tube feedings need a liquid tube feeding pump. The nursing staff may safely give a measured amount of liquid tube feeding to patients several times daily. What are the potential complications associated with the use of the liquid tube feeding pump? Liquid tube feeding pumps are very reliable. If the device malfunctions the patient may receive too little or too much liquid tube feedings for a twenty four hour period. This usually poses little danger to the patient. In addition, the liquid tube feeding pump has an alarm system that will sound if the device does not function properly.

Gastrostomy Tube
What is a gastrostomy tube? A gastrostomy tube is a flexible plastic hollow tube placed into the stomach through the skin overlying the stomach. The purpose of gastrostomy is to provide a way to give patients food and medications. When is a gastrostomy tube necessary? Gastrostomy tubes are necessary and should be considered when patients can not swallow normally or safely for prolonged periods of time. How is a gastrostomy tube placed into a patient? The gastrostomy tube is insertion is a surgical procedure done either in the operating room or at the patient's bedside with a special type of endoscope called a gastroscope. The gastrostomy performed in the operating room requires general anesthesia. The operating surgeon places the gastrostomy tube directly into the stomach after making an opening in the skin overlying the stomach. The gastrostomy performed at the patient's bedside involves the use of an endoscope, a lighted flexible tube that is inserted through the mouth into the stomach. The endoscope enables the doctor to see whatever is at the end of the flexible tube. The patient receives sedation plus a local anesthetic. The gastrostomy tube is inserted through the skin into the stomach while the doctor is looking into the stomach through the endoscope. After the gastrostomy tube is placed, if the patient has a nasogastric or feeding tube, they may be removed. Does a gastrostomy tube hurt? Whether the gastrostomy tube is placed into the patient in the operating room or at the patient's bedside, medications are given to prevent the patient from feeling pain during the procedure. After the gastrostomy tube is in place it may be sore for a short period of time. Usually it does not hurt and most patients do not realize that it is there. Are there any potential complications associated with a gastrostomy and G tube? Complications associated with the gastrostomy tube insertion include bleeding, infection, and improper tube placement.

Gastrostomy Tube
Does a gastrostomy tube hurt? Whether the gastrostomy tube is placed into the patient in the operating room or at the patient's bedside, medications are given to prevent the patient from feeling pain during the procedure. After the gastrostomy tube is in place it may be sore for a short period of time. Usually it does not hurt and most patients do not realize that it is there. Are there any potential complications associated with a gastrostomy and G tube? Complications associated with the gastrostomy tube insertion include bleeding, infection, and improper tube placement. The gastrostomy performed in the operating room requires general anesthesia. The operating surgeon places the gastrostomy tube directly into the stomach after making an opening in the skin overlying the stomach. The gastrostomy performed at the patient's bedside involves the use of an endoscope, a lighted flexible tube that is inserted through the mouth into the stomach. The endoscope enables the doctor to see whatever is at the end of the flexible tube. The patient receives sedation plus a local anesthetic. The gastrostomy tube is inserted through the skin into the stomach while the doctor is looking into the stomach through the endoscope. After the gastrostomy tube is placed, if the patient has a nasogastric or feeding tube, they may be removed.

Gastrostomy Tube
Does a gastrostomy tube hurt? Whether the gastrostomy tube is placed into the patient in the operating room or at the patient's bedside, medications are given to prevent the patient from feeling pain during the procedure. After the gastrostomy tube is in place it may be sore for a short period of time. Usually it does not hurt and most patients do not realize that it is there. Are there any potential complications associated with a gastrostomy and G tube? Complications associated with the gastrostomy tube insertion include bleeding, infection, and improper tube placement.

Intra-Aortic Balloon Pumping

What is intra-aortic balloon pumping? Intra-aortic balloon pumping is a temporary emergency measure to help the heart pump more blood and improve blood flow to the heart. What is an intra-aortic balloon pump (IABP)? An intra-aortic balloon pump (IABP) is a device that provides the assistance to the heart. How does the IABP work? The IABP includes a large tube inserted through a catheter into an artery in the groin area (femoral artery). The tube is then passed into the aorta. The aorta is the largest blood vessel in the body and the first blood vessel leading from the heart to the body. Once in place, the IABP tube is attached to a balloon pump machine. The balloon pump machine pumps special air into the tube, causing the balloon on the tube to inflate and deflate at specific times during a heart beat. The inflation helps push blood forward into the body and also backward into the heart's blood vessels. The pumping action helps both the body and the heart get more blood. How long is an IABP used? Usually only a short time. The IABP is typically a temporary measure used to stabilize a patient while waiting either for surgery or for the heart to regain function after a heart attack, procedure or surgery. Does intra-aortic balloon pumping hurt? Patients with an intra-aortic balloon pump usually feel little to no discomfort. However if patients experience discomfort, pain medications are given. Are there any potential complications associated with intra-aortic balloon pumping? There are extensive potential complications associated with intra-aortic balloon pumping, some of which are very serious. These are best discussed with your doctor or nurse.

Intra-Aortic Balloon Pumping

How long is an IABP used? Usually only a short time. The IABP is typically a temporary measure used to stabilize a patient while waiting either for surgery or for the heart to regain function after a heart attack, procedure or surgery. Does intra-aortic balloon pumping hurt? Patients with an intra-aortic balloon pump usually feel little to no discomfort. However if patients experience discomfort, pain medications are given. Are there any potential complications associated with intra-aortic balloon pumping? There are extensive potential complications associated with intra-aortic balloon pumping, some of which are very serious. These are best discussed with your doctor or nurse.

ICP Monitoring
What is intracranial pressure monitoring (ICP)? ICU patients who have sustained head trauma, brain hemorrhage, brain surgery, or conditions in which the brain may swell might require intracranial pressure monitoring. The purpose of ICP monitoring is to continuously measure the pressure surrounding the brain. If the pressure surrounding the brain gets too high, it can cause decreased blood flow to the brain and potentially lead to brain damage. What is an ICP monitor? The ICP monitor consists of a small plastic tube connected to a bedside monitor, which continuously displays the pressure surrounding the brain.

ICP Monitoring
How is ICP monitoring performed? The ICP monitor is usually inserted by a neurosurgeon while the patient is in the ICU or operating room. After using numbing medicine (local anesthetic), the neurosurgeon makes a skin incision and inserts the ICP monitor into the brain through a very small hole created in the skull. The ICP monitor is usually inserted in the left or right top-front part of the brain. Some ICP monitors can drain spinal fluid if necessary. How long is ICP monitoring used? The monitor remains in place as long as there is concern regarding elevated pressures surrounding the brain. If the pressures surrounding the brain are abnormally high, doctors and nurses institute measures aimed at controlling the pressures to prevent brain injury.

ICP Monitoring
Does ICP monitoring hurt? Most patients who need ICP monitoring are unconscious and feel little to no pain with this procedure. Are there any potential complications associated with ICP monitoring? Potential complications associated with ICP monitoring include infection and brain hemorrhage, which are very infrequent. What is an intravenous (IV) infusion pump? An intravenous (IV) infusion pump is a machine that carefully controls the rate at which IV fluids and/or IV medications are given.

Infusion Pumps IV
Why are intravenous (IV) infusion pumps used? Under some circumstances, the rate at which IV fluids and/or IV medications are given needs to be closely controlled. Do intravenous (IV) infusion pumps hurt? No. How long are intravenous (IV) infusion pumps used? Intravenous (IV) infusion pumps are used as long as precise control of the intravenous infusion rate is needed. Are there any potential complications associated with intravenous (IV) infusion pumps? These pumps are very reliable. Mechanical problems are possible, but very rare. If the IV infusion pump does not work correctly, an alarm will sound.

IV catheter
What is an intravenous (IV) line or catheter? Note that the words "line" and "catheter" are often used to mean the same thing by the medical staff. A catheter is a hollow, flexible tube used to either drain fluid (e.g., urine or excess fluid) from a body cavity or provide fluid (e.g., blood, drugs, or nutrients) to the body. Intravenous means "within a vein or veins", so an IV line or catheter is always used in a vein. An IV line or catheter, which is placed in one of the patient's veins, connects to IV tubing, which in turn connects to an IV bag containing the blood, fluid, nutrients, or medication to be supplied. Sometimes doctors and nurses refer to this entire system as an IV line or catheter, or just as an "IV". Do IV catheters hurt? Yes, when they are inserted. The doctor numbs the area with an anesthetic before placing the catheter. Once it is in place, it should not hurt.

IV catheter
How long is an IV catheter used? The amount of time that an IV catheter remains in a patient varies and may depend upon the patient's condition. The ICU staff monitors the catheter closely and removes it when it is no longer needed. Occasionally, the catheter may need to be replaced. Are there any potential complications associated with IV catheters? Bleeding and infection are rare complications associated with IV catheters.

Nasogastric (NG) Tube

What is a nasogastric (NG) tube? A nasogastric (NG) tube is a flexible plastic tube that goes through the patient's mouth or nose into the stomach. It is designed to remove stomach contents or provide a route to give medication or food to a patient who cannot swallow. The portion of the NG tube outside of the patient may be plugged closed, connected to a delivery device or connected to a suction device. NG tubes may be inserted while the patient is in the emergency department, operating room, ICU, or regular hospital ward. Does a NG tube hurt? The insertion of the NG tube is somewhat uncomfortable for an awake patient but once in place the NG tube usually causes very little irritation. Some patients, however, remain uncomfortable as long as an NG tube is in place.

NG tube
How long is a NG tube used? That depends upon why the patient required the NG tube. Frequently a critically ill or injured patient's stomach does not function well because of the underlying illness or injury. That is, the stomach does not empty normally and the solids or liquids remain in the stomach unless they are drained. These patients are usually sick to their stomach and vomit. When this stomach condition occurs, an NG tube is necessary until the stomach function returns. Some patients require a NG tube after surgery until the effects of the surgery and anesthesia on the stomach wear off. If the NG tube was needed due to abnormal swallowing, then it remains in place until the swallowing improves or another option is considered. Are there any potential complications associated with use of a NG tube? Rarely, sores develop in the nose or mouth due to pressure caused by a NG tube. How is the NG tube kept in place? Typically, tape is used to secure the NG tube to the patient's nose and hold the NG tube in place.

Pressure Bag Or Pressure Pump

What is a pressure bag or pressure pump? A pressure bag, also called a pressure pump, is a special bag used with an IV bag. The IV bag contains fluids (blood, medications or nutrients) and connects via IV tubing to an IV line in the patient. IV fluids normally drip into the IV line. The pressure pump is used to help the IV fluids either run faster or continuously flow into the patient. When is a pressure bag used? A pressure bag is used when a critically ill or injured patient requires a rapid administration of fluids or blood products because of an emergency situation, such as low blood pressure or bleeding. The IV fluids or blood products can be given much more quickly when a pressure bag is used. The pressure bag is wrapped around the IV bag and inflated with a hand held pump to a desired and measured pressure. The increased pressure surrounding the fluids causes them to flow faster into the patient. What are the potential complications of using the pressure bag? The pressure can burst the IV bag. If this rare event occurs, it causes no harm to the patient.

Pulmonary Artery Catheterization

What is pulmonary artery catheterization? Pulmonary artery catheterization is a procedure performed to provide information regarding the patient's blood circulation, specifically, the pressure and amount of fluid or blood in the circulation and an assessment of the pumping action of the heart. What is a pulmonary artery catheter? A pulmonary artery catheter, also called a right heart catheter or a Swan-Ganz catheter, is a specialized central venous catheter designed to provide information about the blood and heart. When is pulmonary artery catheterization used? ICU patients frequently have profound disturbances in heart or lung function secondary to a critical illness, severe trauma, or high-risk surgery. The doctors and nurses attempt to rapidly restore the heart and lung function to normal. When initial therapies do not stabilize a patient, the doctors may use pulmonary artery catheterization to help guide their therapy.

Pulmonary Artery Catheterization

How is a pulmonary artery catheter used? The pulmonary artery catheter insertion is performed at the patient's bedside in the ICU. The pulmonary artery catheter is inserted through a specialized central venous catheter called an introducer sheath. As the pulmonary artery catheter is inserted, it passes through the right-side heart chambers (atrium and ventricle) into the lung blood vessels where it rests. Occasionally, the doctors need fluoroscopy, which is a special type of Xray, to help guide them during the pulmonary artery catheter insertion. The catheter is connected to the bedside monitor where the information about the blood and heart are displayed. Doctors and nurses use information provided by the catheter monitor to continuously adjust fluids and medications, in order to optimize the patient's heart and lung function. Does pulmonary artery catheterization hurt? The patient feels some discomfort as the introducer sheath is inserted. No pain is felt, however, when the actual pulmonary artery catheter is inserted.

Pulmonary Artery Catheterization

How long is pulmonary artery catheterization used? The pulmonary artery catheter remains in place until the information it provides is no longer necessary to stabilize the patient. Typically, a single catheter does not remain in the patient for more than four or five days. If the catheter information is still required after four days, a new pulmonary artery catheter is inserted. Are there any potential complications associated with pulmonary artery catheterization? Use of pulmonary artery catheterization is associated with potential complications that are infrequent but include serious heart rhythm disturbance, blood clot formation around the catheter, lung collapse, and catheter related infections.

Pulse Oximetry
What is pulse oximetry? Pulse oximetry is the study of arterial oxygen saturation, the amount of oxygen dissolved in the blood. A pulse oximeter is the device that measures and displays the oxygen arterial saturation. How does pulse oximetry work? The pulse oximeter is a small device that has to be in contact with the skin to detect the oxygen saturation. The device is usually place on the patient's finger, earlobe, toe or nose. The pulse oximeter gives off light that determines the oxygen saturation of the blood. The pulse oximeter is connected to a digital screen where the arterial saturation is constantly shown. Does pulse oximetry hurt? Pulse oximetry does not hurt. Are there any potential complications associated with use of the pulse oximeter? There are no complications associated with the use of pulse oximetry. Under certain circumstances the pulse oximeter may give false readings.

Resuscitation (crash) Cart

What is a resuscitation (crash) cart? The resuscitation cart contains all of the equipment and medications needed for advanced life support and CPR (cardiopulmonary resuscitation). When is this cart needed? This emergency equipment is used only if the patient's heart or lungs stop working. The cart is brought to the patient's bedside when the patient's heart or lungs are failing or have failed.

Stethoscope
What is a stethoscope? A stethoscope is a device used to listen to different parts of the body. The most common body parts examined with a stethoscope are the lungs, heart, and abdomen (stomach). The stethoscope allows the medical staff to hear sounds within the body that are important for diagnosis and care of the patient. Often the stethoscope is used for repeated examinations to follow a patient's condition. Although a simple device, the stethoscope provides doctors and nurses with valuable information. Is the stethoscope an accurate device? A stethoscope can pick up crude sounds. It is not considered one of the most accurate tools but is simple to use and does not hurt. Are all stethoscopes the same? No. Stethoscopes vary in quality. There are many varieties of stethoscopes, some of which are inexpensive and of limited quality, while others are expensive and transmit sound much more accurately.

Suction Catheter
What is a suction catheter? A suction catheter is a flexible, long tube attached on one end to the breathing tube (endotracheal or tracheostomy tube). The other end of the suction catheter is connected to a collection container (suction canister) and a device that generates suction. When is a suction catheter used? Critically ill or injured patients who require a breathing (endotracheal) tube or tracheostomy tube need occasional suctioning to remove secretions from the airway. The respiratory therapist, nurse, or ICU technician suctions a patient by inserting a small flexible tube called a suction catheter into the breathing tube. The purpose of suctioning is to keep the airways clear of secretions and hopefully prevent plugging of the airways. Does it hurt to use the suction catheter? Most patients say yes. It creates an urge to cough and can cause a burning sensation in the lungs. Fortunately, the discomfort only lasts a short time. How often is the suction catheter used? The frequency of suctioning is determined by the amount of secretions that the patient produces. The breathing tube is suctioned whenever fluid builds up in the lungs.

Tracheostomy Tube
What is a tracheostomy tube? A tracheostomy tube is a small tube designed to be directly placed into a patient's windpipe through the neck. The surgical procedure of inserting a tracheostomy tube into a patient's windpipe is called a tracheotomy. When is a tracheostomy needed? A tracheostomy tube may be needed for ICU patients requiring longterm mechanical ventilation, patients unable to cough effectively to clear secretions, and patients with an obstructed or blocked airway. The decision to perform a tracheostomy on a particular patient depends upon the circumstances surrounding that patient and often follows use of breathing (endotracheal) tube.

Tracheostomy
How is a tracheostomy performed? The tracheostomy can be performed in the operating room or at the patient's bedside. Typically light anesthesia is required during the tracheostomy procedure. The tracheostomy tube can be inserted either of two ways - the open technique or the percutaneous technique. The open technique involves a small incision made in the lower part of the neck just above the windpipe (trachea). Subsequently, an incision is made in the windpipe (trachea) and the tracheostomy tube is inserted. The percutaneous technique involves the formation of a small opening in the trachea that is gradually dilated to the size of the tracheostomy tube.

Tracheostomy
Either technique is an acceptable approach to inserting a tracheostomy tube in a critically ill or injured patient. After the tracheostomy tube is secured, the patient's breathing tube is removed. The advantages of a tracheostomy tube over the breathing tube are: the patient is usually more comfortable, the patient may be able to drink or eat with the tracheostomy tube in place, and the tracheostomy tube may make it easier for the patient to breathe. Most tracheostomy tube insertions performed on ICU patients are temporary. Patients may be able to speak with a tracheostomy tube in place once they are able to breathe spontaneously (i.e., are off the breathing machine [mechanical ventilator]). How long is a tracheostomy used? Sometimes tracheostomy tubes are used only for days, weeks or even months and then removed. Under other circumstances the tracheostomy tube may be left in place for the rest of the patient's life.

Tracheostomy
Does a tracheostomy hurt? Numbing medicine (local anesthesia) or general anesthesia is used during tracheostomy tube placement. The procedure is usually associated with minimal to no discomfort. Are there any potential complications associated with a tracheostomy? The potential complications associated with the insertion of a tracheostomy tube are bleeding and infection. With time, tracheostomy tubes need to be replaced. This is accomplished by removing the existing tracheostomy tube and replacing it with a new tube through the existing opening in the windpipe. This is performed with little to no discomfort to the patient.

Foley catheter
What is a urinary catheter (Foley catheter)? A urinary or Foley catheter is a soft tube that is placed into the urinary bladder to drain urine. The catheter is inserted into the urethra, the tube in the body that leads from the urinary bladder to outside of the body. The Foley catheter is connected to a urinary drainage bag. Why is a Foley catheter used? Many critically ill patients loose the ability to control urination. In order to keep patients dry and to measure the amount of urine made a Foley catheter is used. Does a Foley catheter hurt? A Foley catheter may sting for a few minutes following insertion. Some patients have the feeling that they have to urinate while the catheter is in place.

Foley catheter
How long is a Foley catheter used? A Foley catheter is used until the patient can regains the ability to control urination or when the measurement of the amount of urine is no longer needed. Are there any potential complications associated with use of a Foley catheter? Sometimes urinary tract infections occur when Foley catheters are left in place for extended periods.

Wound Drain
What is a wound drain? A wound drain is typically a plastic tube that provides a way for unnecessary body fluids or air to flow out of the body from a wound. After surgery, some patients require wound drains. The wound drain is inserted while the patient is in the operating room receiving general anesthesia. The purpose of the drain is to remove fluid and/or blood from the area of surgery. This helps the healing process. Not all patients need wound drains following surgery. One end of the wound drain is placed within the wound and the other end may be connected to a suction collection device. The fluid may be collected in a drainage bag, plastic bulb, plastic carton, or onto a dressing.

Wound Drain
How long is a wound drain used? That depends on the type of surgery and the amount of fluid or blood draining from the wound. The surgeon closely evaluates the wound drain daily and decides when it should be removed. The nurses check on the drain frequently and empty it when necessary. Does a wound drain hurt? No. Usually the patient does not know that the wound drain is present unless they are told. The wound drain may sting when it is removed. Are there any potential complications associated with the use of a wound drain? The wound drain is usually not associated with significant complications.

Intubation
What is an intubation? Intubation is a general term referring to the placement of a tube into a patient's body. The most common use of this term in the ICU refers to placing a breathing tube into a patient's airway (endotracheal intubation). Why is endotracheal intubation needed? Endotracheal intubation is necessary when patients can no longer cough and clear secretions or breathe on their own. How is endotracheal intubation done? Patients needing endotracheal intubation usually have a serious condition preventing them from breathing on their own. An endotracheal tube (breathing tube) can be inserted through the mouth or through the nose then advanced into the airway. Some patients do not require much sedation when the endotracheal tube is inserted through the nose.

Intubation
The breathing tube is slowly advanced into the nose passage and then slips into the patient's airway. Patients always require sedation when the endotracheal tube is inserted through the mouth. The person placing the breathing tube uses a small device called a laryngoscope to move the patient's tongue out of the way to see the airway. The endotracheal tube is then inserted while looking directly at the airway. Does endotracheal intubation hurt? If the breathing tube is placed through the nose, the patient will feel some discomfort. The patient will receive sedation and pain medications for this. If the breathing tube is placed through the mouth, the patient will receive anesthesia. After the tube is in place most patients have temporary difficulties with gagging that slowly lessens with time. Patients can not speak or eat while the breathing tube is in place.

Intubation
Are there any potential complications associated with use of an endotracheal tube? Yes. The mouth, teeth, and upper airway can be damaged while the tube is being placed. After the tube is in place the vocal cords can be injured. The presence of the endotracheal tube places the patient at risk for pneumonia.