Patient Information - Intensive Care Unit

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  • Organisation

    An Intensive Care Unit (ICU) is a special department of a hospital or health care facility that provides critical care and life support for acutely ill and injured patients.

    The ICU is run and staffed by specialist doctors and nurses who have undergone extensive training in intensive care. Other members of the team include: pharmacists, dietitians, physiotherapists, occupational and speech therapists, radiographers, social workers and other administrative staff .

    A person is admiited to ICU                                                  

    • after major surgery  

    • after major trauma  

    • during serious illness such as heart attack or kidney failure    

    • during serious chest infection    

    • after transplant surgery

  • Visiting Hours

    Each hospital may have specific visitor policy. The ICU may allow visitors at any time of the day or night, provided patient’s privacy is maintained during procedures and medical examinations.

    Too many visitors at one time can be very tiring for patients. Visitors may be limited to immediate family or special friends, which includes a limit on the number of people at the bedside to one or two. This is to avoid any disturbance to other patients in the next bays. Also, respect the privacy and confidentiality of other patients in the unit.

    Keep your phone to silent and do not bring in any gifts for your loved ones. Do not visit your loved ones if you are not feeling well.

    If you are visiting at the time of ward rounds, you may be asked to leave when the doctors arrive to see your loved one. You may also be asked to leave during the nurse’s handover.

  • Communication

    Your family member or friend has been admitted to the ICU because they may be very sick requiring intensive treatment and care. In the absence of intensive treatment, they may have serious long term effects on their health, including death.

     

    If it is your or your family member's first visit to an ICU, it is normal for you to feel helpless, and desperate to know everything you can about their chances of recovery. 

    In cases where ICU stay is prolonged; the medical and nursing staff will keep you informed of your or your loved one's progress. Staff will also schedule discussion sessions to discuss the progress and to answer your questions.

    Intensive care treatment may not always be favourable for your patient, and this will be reviewed in length with you by the medical staff. You may also be asked to decide on withdrawing or not initiating specific treatment depending on the clinical condition.

  • Discharge

    You or your family member will be discharged home once you/family member has recovered and well enough to go home.

    Intensive care treatment may not always be favourable for your patient, and a  discussion undertaken in length with you or next of kin by the medical staff.

     

    You may be asked to decide on withdrawing or not initiating specific treatment. If appropriate, the medical staff may also talk to you about organ donation.

  • Procedures & Consent

    Patients are usually transferred to another ward in the hospital when they no longer need continuous monitoring and support.

     After admission to ICU, most of the patients are connected to monitors. The monitors continuously monitor patient’s blood pressure, heart rate and oxygen saturation and many other indices to facilitate patient’s management. Some patients may be on a breathing machine (ventilator) to help breathe; some may be on dialysis or undergoing some other ICU intervention.

    ICU treatment is complex and involves various procedures and specific treatments. All procedures include some risk to the patients and are undertaken when benefits are thought to outweigh risks.

    The number and type of procedures performed depend on the severity of your or your loved one's illness and the length of time in ICU.  It is possible that sometime these procedures may be urgent. 

    ​Seeking consent for each procedure may delay the treatment. Therefore, you or your family members may be asked to sign a consent form that covers all these procedures and treatment at the start.

    There can be various complications during these procedures , sometimes at the beginning, during and after the procedure. All precautions are taken to minimise these risks. All procedures are performed and supervised by experienced staff.

  • ICU Procedures-Arterial Line

    Usually inserted by the doctor, it is a thin plastic tube into an artery in the wrist or placed at the elbow, groin or foot.

    An arterial line monitors blood pressure regularly and continuously. It also helps the nurses to take blood samples when required.

    These lines may stay in place for a long time until the patient is in ICU and is changed periodically.

    Arterial lines are generally safe although they may occasionally require multiple attempts for insertion.

  • ICU Procedures- Central Lines

    Central Venous Catheter (CVC), it is a thin plastic tube inserted into large veins in the neck beneath the collar bone or groin.        

    It helps to deliver large volumes of fluids, medications such as antibiotics, life-saving medications etc.

    The CVC may stay in place for several days and changed regularly when required for a more extended period.     

    These are done with proper techniques to prevent infections. These line insertion may sometimes require several attempts.                                                    

     

    Infection may be a significant complication. Coated tubes and sterile dressings are used to reduce the chance of infection

    During insertion, there may be a risk of damage to other arteries and nerves or risk of puncturing the lung during insertion in the neck.

    Chest X-rays are routinely done to check the position of central lines. 

     

     

    Pulmonary artery (PAC) is also known as the Swan Ganz Catheter.

    Similar to the central line, it is a plastic tube inserted into large veins in the neck beneath the collar bone. The tube is inserted into the right side of the heart into the main blood vessel in the lungs called pulmonary artery.   

    Measurements are recorded continuously to monitor pressures within the heart and lungs. It is also used to deliver medications to support blood pressure and heart function.

    PAC insertion may have all complication as in central line. During insertion of PAC, there may be some irregularity of the heart rhythm. 

     Chest X-rays are routinely done to check the position of PAC. 

  • ICU Procedures- Dialysis

    Also known as haemodialysis, haemofiltration, Renal Replacement Therapy 

    Patients primarily require haemodialysis when a patient has kidney failure. Haemodialysis may also be necessary when the kidney is affected by infection or drug overdose.

     The Vascath procedure starts with the insertion of a plastic tube into a large vein in the neck or groin. The vascath catheter facilitates blood flow to the dialysis machine that removes toxins and returns blood.

    Depending on the recovery of kidney function measured by various blood tests, dialysis is performed for consecutive days.

  • ICU Procedures- Intra Aortic Balloon Pump

    Also known as Intra-Aortic-Balloon-Pump (IABP). This procedure is performed in patients requiring support to maintain their blood pressure, which is needed to supply blood to our body adequately.                          

    It is mostly done in patients who may present to the hospital with a severe heart attack and require angioplasty or surgery.

    It is a long inflatable large bore tube with a large balloon at the tip. It is inserted through an artery in the groin and positioned in the aorta, the main blood vessel which runs out of the heart.                

    The tube is attached to a console that sits at the bed end. It beats in time with the heart and helps in the pumping of blood to the rest of the body

    There may be a risk of impaired blood supply to legs and intestines. There is also a small risk to form blood clots. Patients are monitored continuously for any complication while on balloon pump.

  • ICU Procedures- ECMO

    Also known as Extra Corporeal Membrane Oxygenation.

    ECMO is a complicated and very high-risk procedure. Patients on ECMO are the very sick; when their heart and or lungs do not respond to conventional treatment.

    The ECMO machine puts the patient's heart and lung into rest while the patient is on intensive management with life-saving medications.

    The procedure is performed by a trained team of doctors and nurses. It involves the insertion of plastic tubes in the neck or the groin. Blood is drawn out of the body through these tubes into the ECMO machine. Oxygen is added to the blood in the machine and returned into the body, keeping the patient alive while the heart and the lungs recover.

    Patients are monitored continuously for any complications and deterioration. There is a risk of bleeding when the plastic tubes are inserted at the start of the procedure. The patient is put on blood thinner medications to minimise the risk of clotting while on ECMO. This may cause an increased risk of bleeding from other sites.

  • ICU Procedures- Intubation

    Intubation is the insertion of a breathing tube, also called endotracheal or ET tube into the windpipe (trachea).

    The breathing tube is usually connected to the ventilator or breathing machine. Often, it remains for 2-3 days in patients who had any surgery or maybe prolonged in certain situations.

    The breathing tube may be accidentally dislodged or may be malpositioned in the oesophagus. There is a risk of infection while the patient has the breathing tube in.

    A ventilator is a life-saving machine that allows patients to breathe through the endotracheal tube.

    It has large tubings coming out of the machine, as shown in the picture. The ventilator connects to the breathing tube. The patient is usually sedated when connected to this machine.

    A patient may be connected to the ventilator from a few days to several weeks, depending on the patient's severity of illness. The patient is gradually weaned off the ventilator as the patient can breathe or allowed to breathe of his or her own.

    In situations where prolonged ventilator support is required, a tracheostomy is usually performed.

  • ICU Procedures- Tracheostomy

    When a patient is on a ventilator for a prolonged period, a tracheostomy is usually performed.  This procedure involves inserting a plastic tube directly into the windpipe through the front of the neck.

    Having a tracheostomy is more comfortable than breathing through a breathing tube. It also helps to wean off the patient from the ventilator.Patient can speak and even swallow while the tracheostomy tube is on.

References

  • Intensive Care: Information for Families and Patients  Alfred ICUs

  • Information about Procedures and Treatments  Alfred ICU

Disclaimer

This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about ICU services, or procedures does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time  completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.

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