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.

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

LIFE SUPPORT AND EMERGENCY
RESUSCITATION DEVICES
 MechanicalVentilator
 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
 SkinTemperature
 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
 FrequentABGs or labs
 Unable to obtain Non-invasive BP

Supplies to Gather
 Arterial Catheter
 PressureTubing
 Pressure Cable
 Sterile Gown
 SterileTowels
 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 of
arterial line for 10 min.

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.

CentralVenous 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)

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
lungs.

 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 necessary.

 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.

 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.CARDIAC PACING
 Cardiac Pacing is
the repetitive
delivery of very
low electrical
energies to the
heart to initiate
and maintain
cardiac rhythm.

METHODS
 Percussive pacing
 Transcutaneous
 Epicardial
 Transvenous
 Permanent pacing

Types of PA catheters
1. The thermo dilution catheter:
 is the one described above; using this
catheter, thermo dilution cardiac output &
other divided haemodynamic parameters
may be measured
2. Pacing:
 Some PAC’s have the capacity to provide
intra cardiac pacing

3. Mixed venous oxygen saturation:
 Special fiber-optic PAC can be used to monitor
mixed venous oxygen saturation SVO2
continuously by the principle of absorption and
reflectance of light through blood
 The normal SVO2 is 75% and a 5– 10 %
increase or decrease is considered significant
 A significant decrease in SVO2 may be due to:
(a) a decrease in the cardiac output
(b) increase in metabolic rate
(c) decrease in arterial oxygen saturation.

4. Ejection fraction catheter :
New-catheters with faster thermistor response times
can be used to determine the right ventricular ejection
fraction in addition to the cardiac output
5. Continuous cardiac output measurement
:
Continuous cardiac output measuring PACs contain
an integrated thermal filament at level of the RV
This filament is activated in a programmed sequence
to provide small amounts of heat, which is then
detected in the PA by a thermistor
The data by the device yields a rapidly updated, near
continuous value for cardiac output

PULMONARY ARTERY CATHETER

Components of a Pulmonary Artery
Catheter

POSITION OF PATIENT
3-way tap
manometer
Fluid
Bag
Patient in supine position
Central
Venous
Access

DEFINITIONS
 Cardiac output = CO (mL/min): volume
of blood pumped by heart each minute
• Stroke volume = SV (mL/beat): volume of
blood pumped by heart with each
ventricular contraction
• Heart rate = HR (beats/min)
• Starlings law: the degree to which the
ventricular walls are stretched by returning
blood determines the stroke volume (more
in = more out)

Regulation of Cardiodynamics
 Intrinsic: Within the heart (SV) – force of
contraction related to degree of stretch of
myocardium
 Lots of stretch = increased force production
 Extrinsic: outside the heart (NS: Autonomic or
Hormonal) – Heart rate influenced by both
sympathetic and parasympathetic (autonomic)
nervous system – Stroke volume influenced by
blood pressure

Definition
 Hemodynamic regulation is known as
optimization of heart rate, preload, afterlo
ad, and contractility.
 Heart rate, or heart pulse, is the speed
of the heartbeat measured by the number
of poundings of the heart per unit
of time — typically beats per
minute (bpm).

Contd…
 Preload is the end diastolic pressure
that stretches the right or left ventricle of
the heart to its greatest geometric
dimensions under variable physiologic
demand
 Afterload is the tension or stress
developed in the wall of the left ventricle
during ejection.

MONITORING
 Oxygenation
 Ventilation
 Circulation
 Temperature
 Monitoring patients on ventilator
 Monitoring patients with raised ICP

MONITORING CIRCULATION
 Clinical parameters
◦ Pulse- Rate, Rhythm,
Volume, Character
◦ NIBP
◦ Pulse Oximeter-
Plethysomography
◦ Cyanosis
◦ Temperature
◦ Capillary Refill
◦ Urine Output
◦ Peripheral
Temperature
◦ JVP
◦ Pedal Edema
◦ Basal Rales

Role of
Nurses in
ICU

 ICU nurses play a vital role in the patient’s
care, including the following:
◦ Taking regular blood tests
◦ Changing the patient’s treatment in line with test
results
◦ Giving the patient the drugs and fluids that the
doctors have prescribed
◦ Recording a patient’s blood pressure, heart rate
and oxygen levels
◦ Clearing fluid and mucus from the patient’s chest
using a suction tube
◦ Turning the patient in his or her bed every few
hours to prevent sores on the skin

Contd…
◦ Cleaning the patient’s teeth and moistening
the mouth with a wet sponge
◦ Washing the patient in bed
◦ Changing the sheets
◦ Changing a patient’s surgical stockings, which
help circulation when he or she is inactive
(lying still) for a long time
◦ Putting drops in the patient’s eyes to make it
easier to blink

Nurses role to patient with CVP
 Position the patient in Semi Fowler
position.
 Removes clothing that could constrict the
neck or upper chest
 Provide adequate lightening to visualize
effectively the external jugular veins.
 Prevent the infection from the ports by
change dressing.

Contd…
 Label the date of insertion and change.
 Observe for complication such as
pneumothorax, hemothorax, hematoma,
cardiac tamponade, air embolism and
colonization of micro-organism.

THANK YOU!

Monitoring & devices used in icu ccu

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