preparaion of patient in ICU before arrival

1. PREPARATION OF PATIENTS
BEFORE ARRIVAL TO ICU
GUIDELINES
DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL CUM NURSING SUPERINTENDENT
ELMCH , ERA UNIVERSITY

2. MEANING OF ICU
• Intensive care refers to the specialised treatment given to
patients who are acutely unwell and require critical medical
care.
• An intensive care unit (ICU) provides the critical care and life
support for acutely ill and injured patients.
• Unless you are an emergency admission, you will need a
referral from your doctor or specialist to be admitted to ICU.

3. WHO IS CARED FOR IN ICU?
• Patients may have a planned admission following surgery, an
unexpected admission after an accident or be admitted because
of a sudden and critical deterioration to their health.
• ICU teams are multi-disciplinary, made up of highly skilled
intensive care nurses, doctors and specialists trained in
providing critical care for patients with a variety of medical,
surgical and trauma conditions.

4. WHAT ARE THE TWO TYPES OF ICU?
• Medical intensive care units (MICUs) which provide care for
patients with medical conditions who do not require surgery.
• Long term intensive care units (LTAC ICUs) which provide care
for prolonged critical care needs patients.

5. TYPE OF PATIENT TO BE ADMITTED ICU
• Some hospital ICUs specialise in providing care for particular health
conditions or injuries including:
• major trauma
• severe burns
• respiratory failure
• organ transplants
• complex spinal surgery
• cardiothoracic surgery.

7. PREPARATION OF PATIENT BEFORE ARRIVAL
OF ICU
• Area to be check the patient arrival to ICU
• From emergency
• From out patient services
• From referral of various of health Centre through emergency
Dept/direct admission
• From operation theatre
• From various of ward /department of hospital internal

8. PREPARATION OF PATIENT
• Checking of patient condition followed by doctor order and patient
family /relative consent for admission of patient to icu
• Informed and written consent as per policy of hospital
• Preparation of patient personal hygiene/removing of patient
belongingness /dress code for ICU
• Preparation of equipment /devices/instruments accessories need to
give life support for the patient while entry to ICU
• Preparation of health team capable to transfer patient to ICU with
support of mobile/movable full equipped bed with accessories/
transporter ventilator /monitorwith accessorie etc.

9. ICU LOCATION
• LOCATION • The CCU has to be ideally located in a separate area with
easy accessibility to the emergency department, operation Room,
radiology department, catheterization lab and blood bank
• The unit must have sufficient big lift, ramps and a wide corridor that
can be facilitate smooth transfer in and out of the patients • The ICU
should have a single entry and exit with an anteroom
• There should be provision for emergency exits in case of disasters

10. FLOOR SPACE
• The recommendation varies from country to country
• Floor space: 125 to 150 sq ft per patient is recommended. It may vary up to
250 per sq ft • The floor space for a separate room should be much higher at
least 300 ft2 per patient
• The bed space between two beds should be 4 – 4.5 sq ft • The beds are
separated with a removable partition • The head end should have enough
space for easy patient access for intubation or resuscitation
• Two bigger rooms or two separate rooms should be available for patients
requiring isolation precaution or for the immuno compromised patients
• The room should be big beside procedures such as ECMO and renal
transplant therapy and for those who have a large number of gadgets
attached to them
• 100 % to 150% extra space is recommended for other than patient care area

11. OTHER FACILITIES
• An ICU should have storage space for ventilators, monitors, infusion pumps,
room for doctors office, nurses office, toilets.
• Facility should be provided for medical storage (gloves, medicines, airways,
suction tips, catheters, Ryles tubes) • Other facility to be provided are : medicine
preparation area, equipment storage area, secretarial and computation facility,
clean linen storage, seminar room with a small library and dirty utility room
• An ideal ICU should have a clear cut zoning with patient care areas, support
areas, dirty utility, and toilet in other areas • For movement of dirty utility there
should be a separate pathway
• There may be provision of RO purified water access within ICU • There should
be a minimum of two to three oxygen outlets, two to three vacuum outlets and
one to three compressed air outlets
• 16-18 electric outlets are recommended • There should be sufficient natural
lighting available. Wall mounted or ceiling mounted pendent type lights are
preferable to save space and for good illumination
• Hand washing facility should be easily accessible. Isolation ICU should have

12. EQUIPMENT NEED WHILE TRANSPORTATION OF
PATIENT

13. PREPARATION OF ICU CUBIC/PATIENT UNIT
• Equipment that may be used on an ICU includes:
• a ventilator – a machine that helps with breathing; a tube is
placed in the mouth, nose or through a small cut in the
throat (tracheostomy)
• monitoring equipment – used to measure important bodily
functions, such as heart rate, blood pressure and the level of
oxygen in the blood

14. PATIENT ICU ROOM
EQUIPMENT/DEVICE/INSTRUMENTS
• ICU ROOM
• Bedside trolleys, drug cart and emergency cart • Patient Lifting
devices • Portable X Ray machine • Picture archiving & communication
system is preferable • Bedside ultra sound and echo machines
• Renal replacement therpay • IABP or Ventricular Assist Device
• Bedside bronchoscopy machines
For every patient the following monitors should be available: • ECG
Monitor • Pressure Monitor • Temperature Monitor • End Tidal CO2
monitor • Pulse Oximeter • Non Invasive arterial pressure monitoring
• Pulse Oximeter • Bedside (ABG) lab and ECMO are optional and may
be available

15. CONTINUED
• For safe handling and maintenance of equipment the medical,
nursing and other allied health personnel have to be trained
periodically • The various sizes of endotracheal tubes,
tracheostomy tips, nasogastric tubes, airways, suction tips & ICD
tubes should be available
• Catheters, ECG leads, gloves, gowns, masks, goggles, drugs, IV
fluids and refrigerator should be available to store medications •
Adequate amount of medications should be stored at the
bedside as well as in the central stores

16. PREPARATION OF PATIENT ICU SINGLE CUBIC

19. CONTINUED
• IV lines and pumps – tubes inserted into a vein (intravenously)
to provide fluids, nutrition and medication
• feeding tubes – tubes placed in the nose, through a small cut
made in the tummy or into a vein if a person is unable to eat
normally
• drains and catheters – drains are tubes used to remove any
build-up of blood or fluid from the body; catheters are thin
tubes inserted into the bladder to drain pee

20. PATIENT AND FAMILY SUPPORT SERVICES
COUNSELLING
• Counselling
• Admission to ICU because of critical illness or accident can
have a huge physical and emotional impact on your life and
your family.
• Some ICUs have a dedicated counsellor to provide support for
patients and their families. These counsellors are highly
experienced and have a thorough knowledge of ICU
procedures.

21. PASTORAL CARE
• For many people, emotional and spiritual thoughts tend to
surface when someone they care about is in a critical condition
in hospital.
• Many hospitals provide chaplaincy and pastoral counselling
services for patients, families and staff who need
compassionate, professional and spiritual guidance and
support

22. INTERPRETER SERVICE
• An interpreter service is available for patients and families if
English is not your first language.
• These interpreters are specifically trained to interpret medical
terms into other languages. It is important that you use this
service if you are having problems understanding doctors
explaining information or are being asked to provide consent
for medical procedures.

23. REMEMBER OF ICU
• Visiting ICU can be a confronting experience.
• Patients are monitored 24 hours a day.
• Doctors, nurses and specialists are highly trained in delivering
critical care.