"improving intensive care in Scotland"

The critical care bed space

empty ICU bed spaceCritical care beds are able to be moved into many positions with most patients nursed with the head end up unless their condition dictates otherwise (e.g. a spinal injury). Beds can also be moved into a sitting position and some rotate side to side to help relieve pressure and minimise the risk of pressure sores. Special mattresses are often used that also help with this.

There is usually a desk or computer console at the end of the bed, with drawers for storing equipment. ICUs usually don’t have patient lockers, and ask the family to look after patients’ personal possessions. HDUs usually do have a patient locker.

ventilatorThe most important piece of equipment in the ICU is the ventilator, also known as the breathing machine. This is required when the patient is not able to get enough oxygen into and waste gases out of their body by themselves. It is attached to the patient by some tubing. The patient may have a tube going through their mouth into their lungs (often called an endotracheal tube or an ET tube), a tube going through their neck into their lungs (called a tracheostomy or a trachy) or a tight fitting face mask over their mouth and nose. Sometimes the nurse needs to suck phlegm and secretions from the tubes, this is called suctioning.

airway aidsNot all patients need to be on the ventilator, some just need oxygen through a mask over their nose and mouth, or via a small tube up each nostril. When patients come off the ventilator they often require some extra oxygen via such masks. When an ET is removed the patient is said to be ‘extubated’, if they need the ventilator’s help again they will have to be ‘reintubated’ i.e. the ET tube put back in. It is easier to go off and on the ventilator with a tracheostomy, when the tracheostomy is finally removed this is called ‘decannulation’.

monitorEach patient is attached to a machine called a cardiac monitor which monitors their heart rate, the ECG. Small sticky pads are placed on their chest and are connected to a machine. The machine picks up electrical impulses from a patient's heart and can detect any abnormalities. The monitor can also show a patient's blood oxygen levels (called sats), blood pressure and temperature. It is normal for the numbers shown on the monitor to keep changing.

arterial line

There are often other tubes and pipes connected to the patient. These include a small drip going into the artery, often in the wrist but it can be in the elbow, groin or foot where the pulse of the artery can be felt. This is called an arterial line and allows a constant read-out of blood pressure and also samples of blood to be taken painlessly to measure how the lungs are working (called blood gases) and to measure other tests in the laboratory. Many patients require help to maintain a high enough blood pressure to keep the blood flowing in adequate amounts to their organs, so trying to keep the organs working. These drugs may be called inotropes or vasopressors, and specific drugs include noradrenaline and adrenaline. Sometimes extra monitoring is added to give more information about how the heart is working, called cardiac output monitoring, and an echo performed where a probe is used to painlessly scan the heart to get more information.

urine collection bagMost patients require a tube called a catheter placed into their bladder to measure their hourly urine production, this is collected into a bag hanging at the side of the bed.

infusion pumpsThere may be ordinary drips into the veins of the hands and other drips into the big veins in the neck or groin, called central lines. Drips are used for giving fluids, blood transfusions and drugs, central lines are required for heart support drugs, for a special type of food called total parenteral nutrition (shortened to TPN) and to connect to the artificial kidney machine (often called the filter or haemofilter) if the patient's kidneys are not working. Most of these medicines are delivered using pumps which are supported on stands beside the bed.

renal replacement therapyA haemofilter is used when a patient's kidneys are not functioning properly. It works in a similar way to a dialysis machine. The haemofilter removes blood from a vein through a tube then pumps it through a filter to remove excess fluid and waste products. Once it is cleaned, the blood is returned to the patient. Haemofiltration may be done continuously or intermittently for a few hours every day.

NG feedThere may be a tube passing into the stomach via the patient's nose, called a nasogastric or NG tube. This can be used for draining the stomach, giving drugs and liquid feed. Nutrition is very important to a severely ill patient to heal wounds and build strength again. Sometimes as a result of their illness a patient’s gut will not work well enough to absorb adequate food and a replacement is given into their veins directly, called TPN as above. It is not uncommon for patients to develop loose stool and this can be distressing. A special collection device can be inserted to drain this away more comfortably.

chest drainDepending on the patient’s condition there may be drains into the chest called chest or intercostal drains, or abdominal drains. In addition special drains are sometimes used to measure the pressure inside the skull or inside the abdomen.

All this equipment can be quite daunting at first, ask the staff to explain what is around the patient.

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