University of Port Harcourt Intensive Care Nursing Lecture Notes 2023 PDF

**UNIVERSITY OF PORT HARCOURT** COLLEGE OF HEALTH SCIENCES FACULTY OF CLINICAL SCIENCES DEPARTMENT OF NURSING **LECTURE NOTES** **ON** **INTENSIVE CARE NURSING** BY **MAGNUS CHINEDU APUANU** ***PhD(c), DPA(c), MSc.(Midwifery), MSc.(OH&S), MSc.(Medical Education), MPA(Executive), MPH, PGDE,...

**UNIVERSITY OF PORT HARCOURT** COLLEGE OF HEALTH SCIENCES FACULTY OF CLINICAL SCIENCES DEPARTMENT OF NURSING **LECTURE NOTES** **ON** **INTENSIVE CARE NURSING** BY **MAGNUS CHINEDU APUANU** ***PhD(c), DPA(c), MSc.(Midwifery), MSc.(OH&S), MSc.(Medical Education), MPA(Executive), MPH, PGDE, PGCert(Nuclear Science), AdvDip(Critical Care Nursing), BNSc, RN, RM, RPHN, RCCN, RNE, AEP, CMC, MNIM, MISPN, FIMC, FCP.*** **COURSE CODE: NSC510.2** **COURSE TILE: INTENSIVE CARE NURSING** **OCTOBER, 2023.** **CONTENT OUTLINE** 1. Introduction to Critical Care Nursing 2. History and Evolution of Critical Care Nursing 3. Principles and Practice of Critical Care Nursing 4. Role of the Critical Care Nurse 5. \*The Intensive Care Units (ICU) -- organization, classification, types, admission criteria, \* 6. Equipment Used in the Intensive Care Unit 7. Ventilatory Support (Mechanical Ventilation) 8. Commonly Used Drugs in the ICU 9. Ethical And Legal Implications of Critical Care Nursing 10. Assessment of Patients in Critical Care Nursing 11. Nursing Care of Specific Patients in the ICU (Patient Care Assignment) 12. Monitoring of Critically Ill Patients in the ICU **CRITICAL CARE NURSING** **INTRODUCTION** Critical illness is a condition where life cannot be sustained without invasive therapeutic interventions. The Centers for Medicare & Medicaid Services defines critical illness or injury as "acutely impairing one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition." The care of critically ill patients is a challenging and highly specialized area of health care practice. Advances in technology and medicine mean that increasing numbers of severely ill patients are surviving with a corresponding need for intensive nursing care. Critically ill patients are often managed in an intensive care unit (ICU) within a hospital where sophisticated equipment is available to enable frequent monitoring of vital signs, assisted ventilation and, when life-threatening crises occur, and rapid resuscitation measures. The critical care setting is a fast-paced environment where the patients have life-threatening conditions and need intense, round-the-clock care by a team of multi-professionals. Technology is abundant and readily available to assist in managing these complex, acutely ill patients. Treatment varies, but often includes mechanical ventilation, multiple invasive lines, hemodynamic monitoring, and administration of many medications and fluids. **\ ** **CONCEPT OF CRITICAL CARE NURSING** **Critical Care** Critical care, also known as ***Intensive Care***, refers to the specialized care provided to patients with acute, life-threatening illnesses or injuries. It is a branch of healthcare that focuses on the treatment and monitoring of individuals who are in a critical or unstable condition, often requiring intensive medical intervention and constant observation, and involves multiple skills and specialties. Simply put, it is the direct delivery of care for a critically ill patient. It is a multi-disciplinary service branch of healthcare in which care is optimally delivered to critically ill patients by a team of highly trained personnel. Critical care involves a high level of expertise, teamwork, and advanced medical technology to support and improve the chances of recovery for critically ill patients. **Critical Care Medicine** Critical care medicine is a medical specialty that focuses on the diagnosis, treatment, and management of patients who are critically ill or experiencing life-threatening medical conditions. This field of medicine is also commonly referred to as "Intensive Care Medicine\" or \"ICU Medicine.\" Critical Care Physicians, known as ***Intensivists***, are highly trained to provide specialized care for patients in critical condition. **Critical Care Nursing** Critical care nursing is a specialty of nursing that focuses on providing intensive care to patients (and their families) who are critically ill or facing life-threatening medical conditions. It deals specifically with human responses to life-threatening problems, such as trauma, major surgery, or complications of illness. These problems deal dynamically with human responses to actual or potential life-threatening illnesses. The human response can be a physiological or psychological phenomenon. The focus of the critical care nurse includes both the patient's and family's responses to illness and involves prevention as well as cure. Critical Care Nurses, also known to as ***ICU Nurses or Nurse Intensivists***, play a crucial role in delivering specialized care, ensuring patient safety, and supporting the recovery of individuals facing life-threatening medical conditions. **HISTORY AND EVOLUTION OF CRITICAL CARE NURSING** The history of Critical Care Nursing can be traced back to the 19th century when Florence Nightingale, the founder of modern nursing, recognized the importance of specialized care for severely ill and injured soldiers during the Crimean War (1853-1856). Nightingale mentioned in her notes in 1859 that, "it is not uncommon in a small country hospital to have a recess or small room leading from the operating theatre; in which patients remain until they have recovered from immediate effect of operations." Nightingale\'s work laid the foundation for nursing care in critical and acute care settings. The specialty of modern critical care has its roots in the 1950s, when patients with polio were cared for in specialized units. It was pioneered by a Danish Anesthetist, Dr. Björn Ibsen, in 1952 when an artificial "Iron Lung" for ventilatory support was first implemented in Copenhagen, Denmark, during the polio outbreak. The development of the \"iron lung,\" a negative-pressure ventilator, became a critical tool in caring for patients with polio. Nurses played a crucial role in operating and monitoring patients in iron lungs during polio epidemics. In the 1960s, recovery rooms were established for the care of patients who had undergone surgery, and Coronary Care Units were instituted for the care of patients with cardiac problems. These units were designed to care for patients with complex medical conditions, respiratory failure, and post-operative complications. Nurses working in these units needed advanced training and skills to manage critically ill patients. The patients who received care in these units had improved outcomes.  ​**Early​ Cardiac​ Surgical​ Critical​ Care​ Unit​ circa​ 1967, ​** **called​ the​ Cardiac​ Constant​ Care​ Unit** In 1969, the American Association of Critical-Care Nurses (AACN) was founded, marking the formal recognition of critical care nursing as a specialty. Critical Care Nursing continued to evolve as a specialty in the 1970s with the development of general intensive care units. Since that time, critical care nursing has become increasingly specialized. Certification programs for critical care nursing were established in the 1970s, to validate the knowledge and expertise of nurses working in ICUs. In Nigeria, the history of critical care nursing can be traced back to the establishment of the first ICU at the University of Nigeria Teaching Hospital (UNTH), Enugu, in 1973, following the successful management of cardiac surgery patients there. Subsequently, other Federal Universities/tertiary care centers developed their own ICUs. Critical care nursing training was introduced in Nigeria in 1982 by the Department of Anesthesia of the Jos University Teaching Hospital (JUTH), Nigeria. Currently, there are three Schools/hospitals that train critical care nurses in Nigeria. They are: - School of Post Basic Critical Care Nursing, Jos University Teaching Hospital, Jos. - School of Post Basic Critical Care Nursing, University of Abuja Teaching Hospital, Abuja. - School of Post Basic Critical Care Nursing, University of Maiduguri Teaching Hospital, Maiduguri. Today, critical care nursing remains a dynamic and essential field within healthcare. These nurses are highly trained and skilled in providing specialized care to patients facing life-threatening medical conditions and continue to contribute significantly to patient outcomes and advancements in critical care. **Philosophy of Critical Care Nursing** The philosophy of critical care nursing encompasses the fundamental beliefs that guide the practice of critical care nursing. This philosophy is rooted in the core values of nursing and the unique challenges and responsibilities associated with caring for critically ill patients. i. Critical Care Nursing reflects a holistic approach in caring of patients. Critical care nurses embrace a holistic approach to patient care, considering not only the physical aspects of illness but also the emotional, psychological, and spiritual well-being of the patient. This approach recognizes that patients in the ICU often face not only complex medical issues but also significant emotional distress. It helps maintain the individual patient's identity and dignity. ii. The focus of caring includes preventive care, risk factor modification and education to decrease future patient admissions to acute care facilities. iii. In the Critical Care Units, each patient is viewed as a unique individual with dignity and worth. The critically ill patient should receive comfort and provided privacy in a highly technological environment. iv. Critical care nurses views health care as the rights of every individual regardless of financial political, geographical, racial and religious consideration. This right includes the right to choose or decline care, including the right to accept or refuse treatment or nourishment; informed consent; confidentiality and dignity, including the right to die with dignity. **THE INTENSIVE CARE UNIT** **What is the Intensive Care Unit?** The Intensive Care Unit (ICU), also known as the Critical Care Unit, is a specialized Unit within a hospital that provides advanced and highly specialized care to patients who are critically ill or facing life-threatening medical conditions. It is a separate, self-contained area within a medical facility, equipped with high-tech specialized facilities designed for close monitoring, rapid intervention and often extended treatment of patients with acute organ dysfunction. It provides aggressive therapy, using state-of-the-art technology and both invasive and noninvasive monitoring for critically ill and high-risk patients. Although an ICU is based in a defined geographic area of a hospital, its activities often extend beyond the walls of the physical space to include the emergency department, hospital ward, and follow-up clinic.  **An ICU** **Categories/Types of Intensive Care Unit** The Intensive Care Unit can be categorized according to patients' age group or medical specialties. A. **General (interdisciplinary) ICU:** This is the commonest type of ICU especially in Nigeria of today. It provides service for patients of various specialties. It embraces all clients who can benefit from their care irrespective of age, sex, or diagnosis. The clients may therefore include a teenager with, multiple injuries, middle aged man with respiratory failure, a child with severe head injury and others with totally different diagnosis. The common factor is their need for specialized care. B. **Age Group** 1. **Neonatal Intensive Care Unit:** A Neonatal Intensive Care Unit (NICU) provides intensive medical care to neonates (newborn infants), particularly those who are premature, critically ill, or have complex medical conditions. The NICU is staffed by a team of healthcare professionals with expertise in neonatology and neonatal nursing. **NICU** 2. **Paediatric** **Intensive Care Unit:** A Pediatric Intensive Care Unit (PICU) provides intensive medical care to infants, children, and adolescents (up to 18 years of age) who are critically ill or have complex medical conditions. The PICU is staffed by a team of healthcare professionals with expertise in pediatric medicine and pediatric nursing. 3. **Adult** **Intensive Care Unit:** An Adult ICU provides intensive medical care to adult patients who are critically ill. It is staffed by a team of healthcare professionals with expertise in critical care medicine and critical care nursing. C. **Specialty** 1. **Medical-Surgical** **ICU**: This cares for adult patients who have a wide range of complex medical and surgical conditions including post-operative complications, diabetic/insulin coma, sepsis, multi-organ failure, gastrointestinal disorders, etc. 2. **Trauma ICU:** This provides critical care to patients who have suffered severe traumatic injuries resulting from accidents, falls, violence, or other traumatic events. Injuries commonly treated in the Trauma ICU include traumatic brain injuries, spinal cord injuries, multiple fractures, internal organ injuries, severe burns, and gunshot wounds. 3. **Neuro ICU**: Neuro ICU primarily cares for patients with a wide range of neurological conditions, disorders, or injuries including traumatic brain injuries (TBI), stroke, brain tumors, Guillian barer syndrome, epilepsy, neurovascular disorders (e.g., aneurysms), spinal cord injuries, and neurological infections. 4. **Cardio-Pulmonary ICU**: This takes care of any life threatening conditions of the respiratory and circulatory systems, e.g. respiratory failure, acute pericarditis, prolonged cardiac operations e.g. heart transplant etc. 5. **Obstetric** **ICU:** This provides intensive care to pregnant or recently postpartum women who have complex medical conditions or complications related to pregnancy, labor, or childbirth. Conditions requiring OB ICU care may include severe preeclampsia, eclampsia, HELLP syndrome, placental abruption, sepsis, respiratory distress, cardiac issues, and hemorrhage, among others. **Levels of Intensive Care Unit** There are three different level of intensive care unit. They are as follows: A. **Level -- 1 ICU:** Level 1 ICU provides immediate resuscitation for the critically ill and short term cardio-respiratory support because the patients are at risk of deterioration. This can be referred as High Dependency Unit (HDU) where close monitoring, resuscitation, observation and short term ventilation (less than 24 hours) is performed. A level 1 ICU is capable of providing oxygen, noninvasive monitoring, and more intensive nursing care than on a ward. B. **Level -- 2 ICU:** This level provide high quality of care to the critically ill patient. It provides a high standard of general critical care for patients who are stepping down from higher levels of care or requiring single organ support/support post-operatively. It is capable of providing sustainable support for mechanical ventilation, renal replacement therapy, invasive hemodynamic monitoring and equipment for critically ill patients of various specialties such as medicine, surgery, trauma, neurosurgery, vascular surgery. It has a designated medical doctor with appropriate intensive care qualification and a duty specialist available exclusively to the unit at all times. The nurse in-charge and a significant number of nursing staff in the unit have critical care certification. The nurse: patient ratio is 1:2, but 1:1 for all critically ill patients. C. **Level -- 3 ICU:** This covers all aspects of intensive care and provides a full spectrum of monitoring and life support technologies, serves as a regional resource for the care of critically ill patients, and may play an active role in developing the specialty of intensive care through research and education. It is a tertiary referral unit, capable of managing all aspects of critical care medicine (this does not only include the management of patients requiring advanced respiratory support but also patients with multi-organ failure). It has a medical doctor with specialist critical/intensive care qualification and a duty specialist available exclusively to the unit and medical staff with an appropriate level of experience present in the unit at all times. The nurse in-charge and the majority of nursing staff have intensive care certification. The nurse: patient ratio is at least 1:1 for all patients at all times. **The Critical Care (ICU) Team** The ICU team is a multidisciplinary group of healthcare professionals who work together to provide specialized care to critically ill patients. The composition of the ICU team may vary depending on the type of ICU (e.g., medical, surgical, cardiac, pediatric, or neonatal ICU) and the specific needs of the patients. It includes the following: 1. **Intensivists (Critical Care Physicians):** The intensivist is a medical doctor with specialized training in critical care medicine. They lead the ICU team, make clinical decisions, and manage complex medical conditions. Intensivists may be pulmonologists, anesthesiologists, internists, or other specialists with additional critical care training. 2. **Critical Care Nurses:** Critical care nurses are specially trained to care for critically ill patients. They monitor patients closely, administer medications, perform procedures, and provide direct patient care. 3. **Clinical Pharmacists:** Pharmacists in the ICU play a crucial role in medication management. They review medication orders, ensure proper dosing, and provide guidance on drug interactions and potential side effects. 4. **Physiotherapists:** Physiotherapist help patients regain mobility and function. They develop rehabilitation plans, assist with early mobilization, and provide exercises and activities to improve strength and function. They also assist in managing patients\' respiratory needs and perform techniques and interventions to help improve lung function, clear airway secretions, and assist patients with various respiratory conditions. 5. **Dieticians**: Dietitians assess patients\' nutritional needs and create specialized diet plans. They monitor and adjust feeding regimens, especially in patients who are unable to eat normally. 6. **Clinical Psychologists**: Clinical psychologists assess and screen ICU patients for psychological distress, anxiety, depression, post-traumatic stress disorder (PTSD), and other emotional issues. They offer support, psychoeducation, and counseling to help the families of ICU patients, who often experience high levels of stress and uncertainty, understand and cope with their loved one\'s condition. **Roles of the Critical Care Nurse** In response to the changes and expansions within and outside the healthcare environment, critical care nurses have broadened their roles management / leadership and research. A. **Practitioner Role** Critical care nurses execute their practice roles 24-hours a day to provide high quality direct care and indirect care (care of the family) to the critically ill patient. The critical care nurse: 1. Detects and interprets indicators that signify the varying conditions of the critically ill with the assistance of advanced technology and knowledge. 2. Plans and initiates nursing process to its full capacity in a need driven and proactive manner. 3. Acts promptly and judiciously to prevent or halt deterioration of patients' condition when conditions warrant. 4. Co-ordinates with other healthcare providers in the provision of optimal care to achieve the best possible outcomes. 5. Understands family needs and provide information to allay fears and anxieties. 6. Assists family to cope with the life-threatening situation and/or patient's impending death. 7. Provides health education to patient and family to promote understanding and acceptance of the disease process thus facilitate recovery. 8. Participates in the training and coaching of novice healthcare team members to achieve cohesiveness in the delivery of patient care. 9. Acts in the best interests of the patient, as patient advocate. 10. Ensures patient safety by monitoring and safeguarding the quality of care which the patient receives. B. **Management and Leadership Role** The critical care nurse in her management and leadership role will be able to assume the following responsibilities: 1. Performance of management and leadership skills in providing safe and quality care. 2. Delivery of effective health programs and services to critically-ill patients in the acute setting. 3. Management of the critical care nursing unit or acute care setting. 4. Taking the lead and supervision of nursing support staff. 5. Utilization of appropriate mechanism for collaboration, networking, linkage --building and referrals. C. **Role in Research** The critical care nurse's role in research will entail the following responsibilities: 1. Engage self in nursing or other health -- related research with or under the supervision of an experienced researcher. 2. Utilization of  guidelines in the evaluation of research study or report. Application of the research process in improving patient care infusing concepts of quality improvement in partnership with other team-players. **PRINCIPLES AND PRACTICE OF CRITICAL CARE NURSING** **Principles of Critical Care Nursing** Critical care nursing is guided by a set of principles and best practices that ensure the provision of high-quality care to critically ill patients. These principles guide critical care nurses in delivering high-quality care and encompass various aspects of nursing care in the ICU or other critical care settings. The principles include: 1. ***Patient-Centered Care***: The primary focus of critical care nursing is the patient. Nurses assess and address the physical, emotional, and psychological needs of the patient and their family. Patient preferences and values are respected, and care is individualized to meet each patient\'s unique needs and circumstances. 2. ***Comprehensive Assessment***: Thorough and ongoing assessment is essential. Nurses continually monitor vital signs, organ function, and other parameters to detect changes in the patient\'s condition promptly. Assessment includes not only physical aspects but also psychological and emotional well-being. 3. ***Timely Intervention*: Critical care nurses are trained to recognize subtle changes in a patient\'s condition and respond quickly to prevent deterioration. Timely interventions may include administering medications, adjusting ventilator settings, or initiating life-saving measures.** 4. ***Effective Communication:*** Communication is crucial within the healthcare team, including nurses, physicians, respiratory therapists, and other specialists. Nurses convey important information, collaborate on care plans, and advocate for the patient\'s needs. 5. ***Family-Centered Care:*** Families play an integral role in the care of critically ill patients. Critical care nurses support and involve families in decision-making and care planning. Communication with families is transparent, compassionate, and respectful. 6. ***Evidence-Based Practice:*** Critical care nursing is based on the best available evidence and research. Nurses stay current with the latest advancements in critical care medicine and incorporate evidence-based practices into patient care. 7. ***Cultural Competence:*** Nurses recognize and respect cultural diversity and its impact on healthcare decisions and preferences. Culturally competent care ensures that patients\' cultural beliefs and practices are considered in their care plans. 8. ***Patient Safety:*** Ensuring patient safety is a top priority. Critical care nurses follow strict protocols to prevent medical errors, infections, and complications. Double-checking medications, maintaining a sterile environment, and practicing proper hand hygiene are essential safety measures. 9. ***Ethical Practice:*** Ethical considerations are paramount in critical care nursing. Nurses must navigate complex ethical dilemmas, such as end-of-life decisions and organ donation, while upholding patient autonomy and dignity. 10. ***Continual Education and Professional Growth:*** Critical care nurses are committed to ongoing education and professional development. They pursue certifications and training in critical care nursing to enhance their knowledge and skills. 11. ***Interdisciplinary Collaboration:*** Critical care is a team effort, and nurses collaborate closely with other healthcare professionals to provide comprehensive care. Team members, including physicians, respiratory therapists, dietitians, and physical therapists, work together to achieve the best outcomes for the patient. 12. ***Compassion and Empathy:*** Critical care nurses provide care with compassion and empathy, recognizing the stress and vulnerability of both patients and families in critical situations. **EQUIPMENT USED IN THE ITENSIVE CARE UNIT** The equipment used in ICUs is crucial for the assessment, treatment, and support of patients with serious medical conditions. ICU equipment plays a vital role in the care of critically ill patients, and its proper use and maintenance are essential to ensure patient safety and optimal outcomes. They include: 1. Patient monitoring equipment 2. Life support and emergency resuscitative equipment 3. Diagnostic equipment 4. Tubes & Catheters **1. Patient Monitoring Equipment** Patient monitoring equipment includes the following: a. ***Cardiac Monitors: ***These are specialized monitors used to monitor the electrical activity of the heart, including electrocardiogram (ECG) and arrhythmia detection. Cardiac monitors continuously measures and displays data on vital signs, such as heart rate, blood pressure, cardiac output, and blood oxygen levels.  **Cardiac Monitor** **Cardiac Monitor Screen**  **Cardiac Monitor Interpretation** b. ***Pulse Oximeter: ***This device measure oxygen saturation levels in the blood, providing critical information about a patient\'s respiratory status.  **Pulse oximeters** c. ***Swan-Ganz Catheter:*** Swan-Ganz catheter, also known as ***pulmonary artery catheter,*** is used to measure the amount of fluid filling the heart as well as to determine how the heart is functioning. It is used to measure pressures within the heart and pulmonary artery, as well as to obtain various cardiac and hemodynamic parameters. It is typically inserted through a large vein, such as the jugular or subclavian vein, and advanced into the right side of the heart and pulmonary artery.  Swan-Ganz catheters are used to monitor hemodynamic parameters in critically ill patients. They provide valuable information about cardiac output, central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and systemic vascular resistance (SVR). These parameters help assess cardiac function and guide treatment in patients with heart and lung conditions. **The proximal injectate port (blue)** is also called the right atrial lumen. This port can monitor RA pressures (RAP/ CVP) and receive the injectate for cardiac output studies. Can also be used to give fluids and drugs. **Thermistor port** is the red/white connector. It has a temperature-sensitive wire, called ***thermistor*** that terminates 4 cm proximal to tip of the catheter. The thermistor is used to monitor the temperature of blood as it flows through the pulmonary artery, providing important information about cardiac output and intravascular volume. **The proximal infusion port** (white) is used for infusing fluids, medications, or other solutions directly into the central circulation. **The distal port** (yellow) measure pressures within the pulmonary artery. This includes pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and other relevant hemodynamic parameters and measurement of mixed venous SO~2~. Caustic or hyperosmotic solutions must not be infused through this lumen.../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_qE4gyT/Screen%20Shot%202023-10  **Swan-Ganz catheter in a patient** d. ***Intracranial Pressure Monitor***: Measures the pressure of fluid in the brain (CSF) in patients with head trauma or other conditions affecting the brain (such as tumors, edema, or hemorrhaging). Normal ICP in adults is usually between **5 to 15 mmHg**. When ICP exceeds the normal range or becomes pathologically high (Intracranial hypertension ICP \> 20 mmHg), it can lead to decreased cerebral perfusion, brain damage, and other complications. Monitoring intracranial pressure is crucial in the management of patients with various neurological conditions, traumatic brain injuries, brain tumors, and other conditions that can affect brain function and cerebral perfusion.  e. ***Apnea monitor:*** Also known as an apnea alarm or apnea detection device, is designed to monitor a patient\'s breathing patterns, especially during sleep or in neonatal and pediatric care settings. It continuously monitors breathing to detect cessation in infants and adults at risk of respiratory failure. The primary purpose of an apnea monitor is to detect and alert caregivers or medical professionals when a patient experiences episodes of apnea, which is the temporary cessation of breathing. ../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_OR9ZbB/Screen%20Shot%202023-10 **Apnea Monitor** f. ***Arterial Line: ***Also referred to as ***an arterial catheter*** or ***art line***, is used to monitor and measure a patient\'s blood pressure continuously and in real-time. A very thin tube (catheter) is inserted into one of the patient\'s major arteries, usually the radial artery in the wrist (although other arteries such as the femoral or brachial arteries can also be used), to allow direct measurement of the blood pressure and to measure the concentration of oxygen and carbon dioxide in the blood (SaO~2~). The arterial line is attached to a monitor. ../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_zRbGBP/Screen%20Shot%202023-10  **Arterial line connection**  **2. Life Support and Emergency Resuscitative Equipment** ICU equipment for life support and emergency resuscitation include the following: a. ***Intra-aortic Balloon Pump (IABP) Machine: ***It is a mechanical circulatory support device used to assist the heart in pumping blood. It is used to temporarily support the heart in patients with certain cardiac conditions, particularly those with heart failure, cardiogenic shock, or after certain cardiac surgeries. The IABP is designed to assist the heart by increasing coronary artery perfusion and reducing the workload of the heart, ultimately improving cardiac output and oxygen delivery to vital organs. These actions combine to decrease myocardial oxygen demand and increase myocardial oxygen supply. ../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_hiIMpT/Screen%20Shot%202023-10 **Intra-aortic Balloon Pump Machine\ ** The IABP consists of a ***balloon catheter*** (a flexible catheter with an inflatable balloon at its tip). This catheter is typically inserted into the patient\'s aorta, the large artery that carries oxygenated blood from the heart to the rest of the body, typically through a femoral artery in the leg. The balloon is positioned within the aorta, just below the left subclavian artery.  **A Balloon Catheter** The IABP machine inflates the balloon during diastole, the resting phase of the cardiac cycle when the heart fills with blood. By inflating the balloon in the aorta during diastole, the IABP increases aortic pressure, which effectively reduces systemic vascular resistance, making it easier for the heart to pump blood into the aorta during systole. This reduction in afterload can lead to an increase in stroke volume (the amount of blood ejected with each heartbeat) and improved cardiac output. The balloon deflates just before systole, when the heart contracts, to allow blood to be ejected from the left ventricle.  b. ***Ventilator:*** Also called a respirator, assists with or controls pulmonary ventilation in patients who cannot breathe on their own.   **Patient on a Ventilator** c. ***Defibrillator:*** A defibrillator is used to \"shock\" the heart from an abnormal rhythm pattern back into a normal rhythm.  **Manual Defibrillator** **Automated External Defibrillator (AED)** d. ***Infusion pump***: An electronic device used to control the administration of intravenous fluids in very small amounts and at a carefully regulated rate over long periods. It is a device that delivers fluids intravenously or epidurally, including continuous anaesthesia, drugs, and blood infusions. ../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_nr5jgk/Screen%20Shot%202023-10 ../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_W9idF1/Screen%20Shot%202023-10  **Infusion Pumps** e. ***Syringe Pump:*** Syringe pumps, also known as a syringe drivers, are designed to deliver medications or fluids in small, precise volumes using syringes as the fluid source. They are often used for high-alert medications that require exact dosing, and are commonly used for infusing critical care medications such as vasoactive drugs (e.g., epinephrine, norepinephrine), sedatives, and other intravenous medications in intensive care units.../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_4kuWsM/Screen%20Shot%202023-10  **Syringe Pumps** f. ***Crash Cart:*** A crash cart, also known as a code cart or emergency cart, is a mobile and standardized cart or trolley that is equipped with essential medical supplies and equipment to respond rapidly to medical emergencies. It contains emergency resuscitation equipment for patients who are \"coding\" (that is, their vital signs are in a dangerous range), including a defibrillator, airway intubation devices, resuscitation bag/mask, and medication box. Crash carts are designed to provide immediate access to lifesaving interventions and medications during critical situations when a patient\'s condition deteriorates suddenly.  **Crash Carts** g. ***Suction Machine:*** Used to remove secretions, fluids, and foreign materials from a patient\'s airways or body cavities. Suction machines help to maintain airway patency and hygiene by removing unwanted substances. ../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_xAAn31/Screen%20Shot%202023-10../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_zyQVnQ/Screen%20Shot%202023-10 **Suction Machines** **3. Diagnostic Equipment** The use of diagnostic equipment is also required in the ICU. A. ***Mobile X-ray Units: ***Are portable medical imaging devices designed to provide prompt diagnostic imaging services (particularly of the chest) for critically ill patients. These mobile units offer flexibility in providing diagnostic imaging services at the patient\'s bedside in the intensive care units.  OBILETT Elara Max - Siemens Healthineers Finland  **Mobile X-ray Machines** B. ***Portable clinical laboratory devices***: Also called ***point-of-care analyzers***, are used for blood analysis at the bedside to provide results much faster than if samples were sent to the central laboratory.../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_Abzsj2/Screen%20Shot%202023-10- **Mobile Lab Unit** **4. Tubes and Other Catheters** A. ***Central Venous Catheter (CVC):*** is a soft, pliable tube that is inserted into a large vessel (vein) in the neck (internal jugular vein), in the upper chest (subclavian vein), or in the groin area (femoral vein) to facilitate the administration of medications, fluids, blood products, and other treatments. Central venous catheters provide healthcare professionals with a direct and secure access route to the central venous system, which includes the superior vena cava and the right atrium of the heart. It is also known as a ***central line***.  B. ***Intravenous (IV) set: ***is a plastic catheter (tube) that is inserted into the peripheral veins for fluids, medications, nutrition preparations, and blood products.  C. ***Chest tubes: ***Chest tubes are also known as ***thoracostomy*** ***tubes*** or ***chest drainage catheters***. They are inserted into the pleural space (the space between the lung and the chest wall) to remove air, blood, or other fluids and gases. They are used in the management of various thoracic conditions, including pneumothorax (accumulation of air in the pleural space), pleural effusion (accumulation of fluid in the pleural space), and haemothorax (accumulation of blood in the pleural space). ../../../../../../var/folders/vv/2bf41q416qld8pz0\_f46y\_qh0000gn/T/TemporaryItems/NSIRD\_screencaptureui\_8ATTuJ/Screen%20Shot%202023-10-  **Chest tube drainage** Other tubes and catheters used in the ICU include: - Gastrostomy tube (G-Tube) - is placed directly into the stomach to give direct access for supplemental feeding, hydration or medicine. - Nasogastric Tube (NG Tube) - Urinary catheter - Endotracheal tubes, etc. **VENTILATORY SUPPORT (MECHANICAL VENTILATION)**