3. monitoring & devices used in icu ccu

DEVICES USED IN ICU &
MONITORING
1
Prof. Dr. RS Mehta, BPKIHS

INTRODUCTION
Intensive care unit (ICU) equipment
includes patient monitoring, respiratory
and cardiac support, pain management,
emergency resuscitation devices, and
other life support equipment .
2Prof. Dr. RS Mehta, BPKIHS

Contd…
They are 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.

Contd…
 Neuromedical 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.

Contd…
 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. 6Prof. Dr. RS Mehta, BPKIHS

TYPES OF DEVICES
Intensive care unit equipment includes
 Patient monitoring devices
 Life support and emergency
resuscitation devices, and
 Diagnostic devices.

PATIENT MONITORING
EQUIPMENT
 Arterial line
 Bed side monitor
 Blood pressure device
(sphygmomanometer)
 Blood pressure monitor
 Electrocardiograph(ECG or EKG machine)
 Electroencephalograph(EEG machine)
 Intracranial pressure monitor
 Pulse Oximeter
 Glucometer 8Prof. Dr. RS Mehta, BPKIHS

LIFE SUPPORT AND
EMERGENCY RESUSCITATION
DEVICES
 Mechanical Ventilator
 Laryngoscope
 Airway
 Infusion pump
 Crash cart(Resuscitation cart)
 Intra aortic ballon pump
 Continuous positive air pressure
machine (CPAP)
 Defibrillator

DIAGNOSTIC EQUIPMENT
 Mobile x-ray units
 portable clinical laboratory devices,
 Bronchoscope
 Colonoscope
 Endoscope
 Gastroscope

OTHER ICU EQUIPMENT
Disposable ICU equipment includes
 Urinary catheter
 Urinary drainage collector
 Suction catheter
 Nasogastric (NG) tube
 Intravenous(IV) line or catheter
 Feeding tube
 Breathing tube( Endotracheal tube)

Hemodynamic Monitoring

Overview
 Blood pressure monitoring
◦ NIBP
◦ IBP
 Central venous pressure
monitoring
 Pulmonary artery pressure
monitoring
 Mixed venous oxygen monitoring
 Cardiac output

Why monitor BP?
◦ Alterations inherent
◦ Provides data for
interpretation/therapeutic decisions
◦ Important for determining organ perfusion
(MAP most important, except with the
heart)

Noninvasive Hemodynamic
Monitoring
 Noninvasive BP
 Heart Rate,
pulses
 Mental Status
 Skin Temperature
 Capillary Refill
 Urine Output

Indications for
Arterial Blood Pressure
 Frequent titration of vasoactive drips
 Major surgery involving large fluid shifts
 CVP
 Aortic surgery
 Unstable blood pressures
 Frequent ABGs or labs
 Unable to obtain Non-invasive BP

Supplies to Gather
 Arterial Catheter
 Pressure Tubing
 Pressure Cable
 Sterile Gown
 Sterile Towels
 Sterile Gloves
 Pressure Bag
 Flush – 500cc NS
 Suture (silk 2.0)
 Chlorhexidine Swabs
 Mask

Potential Complications
Associated With Arterial Lines
 Hemorrhage
 Air Emboli
 Infection
 Altered Skin Integrity
 Impaired Circulation

ARTERIAL LINE
DEFINITION:
It is the method of direct continuous
monitoring of systemic arterial pressure
by inserting a catheter into peripheral
artery either in arm or in leg. The
catheter is connected with a transducer
with electrical signals.

PURPOSE:
The arterial line provides a way to
constantly measure a patient's blood
pressure and may be essential to the
stabilization of the patient.
Continuous measurement of arterial
blood pressure in case of open heart
surgery.

 Arterial lines may be useful in patients
with very high or low blood pressures.
The arterial line also provides access
for frequent blood sampling.

COMPLICATIONS:
 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.

NURSES ROLE / NURSING
CARE
 Never give any medication through an
arterial line.
 Always check the pressure of the
pressurized bag and maintain a pressure
of 300mm of hg.
 Cover the cannula cap with adhesive
tape.
 Flush properly the arterial line every hour
and every time after a blood sample is
drawn.
 Always compress the site after removal of23Prof. Dr. RS Mehta, BPKIHS

BEDSIDE MONITOR
 A bedside monitor is
a display of major
body functions on a
device that looks like
a television screen or
computer monitor.

 It is a 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.

PURPOSES:
 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.

NURSES ROLE:
 Check properly each connection so as
to get a desired reading.
 Any abnormality in a reading is
signalled by an alarm so inform doctor
immediately.

Central Venous Line or
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) 31Prof. Dr. RS Mehta, BPKIHS

Common sites for central venous
catheter insertion
1

PROCEDURE
 The most
common
used method
is seldinger
technique.

 In some patients, a central
venous catheter may be inserted
into the elbow vein (anticubital
vein) and advanced into the
subclavian vein.

PURPOSE
 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.
 Serve as a guide of fluid balance in
critically ill patients.
 Determine the function of the right
side of the heart

complication
 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.

 Arterial puncture, cardiac puncture
 Pneumothorax, Hemomothorax
 Air emboli, Thrombosis
 Cardiac temponade
 Cardiac arrhythmias
Carotid Artery Puncture
Perforation of SVC or R.
Atrium/Ventricle
Pleural Effusion

NURSES ROLE
 Monitor for the signs of complications.
 Assess for patency of the CVP line.
 Sterile dressing should be done to
prevent infection( CVP care per the
hospital protocol)
 The length of the indwelling catheter
should be recorded and regularly
monitored.

ICP monitor
 ICU patients who have sustained head
trauma, brain hemorrhage, brain
surgery, or conditions in which the
brain may swell might require
intracranial pressure monitoring.

PURPOSE
 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.

 The ICP monitor is usually inserted by
a neurosurgeon while the patient is in
the ICU or operating room. After using
numbing medicine (local anesthetics),
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.

complication
 Potential complications associated
with ICP monitoring include infection
and brain hemorrhage, which are very
infrequent.

Nurses role
 Optimizing cerebral tissue perfusion.
 Preventing infection.
 Maintaining patient airway.
 Maintaining negative fluid balance.
 Prevent infection( dressing)

PULSE OXIMETER
A pulse oximeter is the device that
measures and displays the oxygen
arterial saturation. The study is called
pulse oxymetry.
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.

Breathing Machine (Mechanical
Ventilator
 A breathing machine
helps the patient
breathe. It is
designed to help
patients who cannot
breathe adequately
on their own. The
breathing machine
does not fix any
problems of the

 It is a device that simply pushes air and
oxygen into the lungs and withdraws
carbon dioxide from the lungs. The
lungs must function in order for the
breathing machine to be effective.

PURPOSE
 A breathing machine
is used whenever a
patient cannot
breathe without
assistance. Doctors,
nurses and
respiratory therapists
all work to make
sure a breathing
machine is not used
any longer than 51Prof. Dr. RS Mehta, BPKIHS

 The goal when a breathing machine
is first used is to get the patient to be
able to breathe on their own, so that
the breathing machine can be
removed.

complications
 Patients who require breathing machine
support are at increased risk to develop
pneumonia. Occasionally, patients may
develop a collapsed lung. Both of these
complications require treatment

NURSES ROLE
 Promoting effective airway clearance.
 preventing trauma and infection.
 Check
 Ventilator functioning properly
 Blockage of air passage
 Too much sputum, secretions
 When sedation drugs are used
 ABG, hypoxia

b. Suction periodically as per need
c. Change the mode setup as adviced.
d. Give sedatives as adviced.

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.

PURPOSE
 Under some circumstances, the rate at
which IV fluids and/or IV medications
are given needs to be closely
controlled.

 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.

NURSES ROLE
 Using aseptic technique and universal
precautions, iv infusion should be set.
 Set the flow rate as prescribed
calculating the amount of fluid.
 Observe for the signs of infiltration or
other complications such as
thrombophlebitis. Fluid or electrolyte
overload and embolism before
administration.

Resuscitation Cart (Crash Cart)
 The resuscitation
cart contains all of
the equipment and
medications needed
for advanced life
support and CPR
(cardiopulmonary
resuscitation).

purpose
 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.

NURSES ROLE
 Keep the resuscitation cart ready all
the time.
 Check the devices and ensure that the
devices are kept in charging.
 Check for the emergency (life saving)
medication for their expiry date.

DEFIBRILLATOR
 A defibrillator is a device that is
designed to pass electrical current
through a patient’s heart. The passing
of electrical current through the heart is
called defibrillation. A defibrillation is
done through pads placed on the
patient’s chest.

purpose
 A defibrillation is used to restore a
patient’s 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).

Complication
 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 patient’s heart rhythm
back to normal.

NURSES ROLE
 Keep the patient in comfortable
position and obtain 12 lead ECG.
 Give the patient 100 % oxygen by
inhalation.
 Apply electrode paste on the DC
paddle, rub it and apply the paste at the
patient’s chest in the second intercostal
space at the right side of breast line
and at the apex of the heart.

 TURN OFF the oxygen to the patient
as a spark from paddle could blow the
oxygen on the fire.
 Be sure to say “ ALL CLEAR”. No one
should touch the patient or the bed
during cardioversion.
 Check the rhythm on ECG monitor.
 Keep the patient in comfortable
position and give 100% oxygen by
inhalation. 68Prof. Dr. RS Mehta, BPKIHS

 Report and record the procedure and
clean the paddle area with spirit swab.
 Keep the difibrilator on continue
electrical charging.

MAINTENANCE OF ICU
EQUIPMENTS
 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.

Contd…
 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.

 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.

Thank you

3. monitoring & devices used in icu ccu

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie 3. monitoring & devices used in icu ccu

Ähnlich wie 3. monitoring & devices used in icu ccu (20)

Mehr von BP KOIRALA INSTITUTE OF HELATH SCIENCS,, NEPAL

Mehr von BP KOIRALA INSTITUTE OF HELATH SCIENCS,, NEPAL (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)