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 .


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

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


Prof. Dr. RS Mehta, BPKIHS

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 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.


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)


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

Health & Medicine