Common Equipment and Systems in ICU
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The most basic monitors
show your heart rate,
blood pressure, and body
temperature. More
advanced
models show respiratory
rate and how much carbon
dioxide you're breathing
out.
H
R
The hearts of healthy adults typically beat 60 to 100 times
a minute. People who are more active can have
slower heart rates
What are the causes of an increased heart rate?
R
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R
a
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(
R
R
)
Respiratory Rate (RR): Look for the patient's respiratory rate under “RR” on
the patient monitor. It is reported in breaths per minute, with normal
values between 12 and 20. However, this number isn't very accurate,
especially as the patient's breathing goes faster or slower.
What are the causes of an increased RR?
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This is a measure of the force on your arteries when your heart is beating
(known as systolic pressure) and when it’s at rest (diastolic pressure). The
first number (systolic) should be between 100 and 130, and the second
number (diastolic) should be between 60 and 80.
O
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This number measures how much oxygen is in your blood, on
a scale up to 100. The number is normally 95 or higher, and
anything below 90 means your body may not be getting
enough oxygen.
If one of your vital signs rises or falls outside healthy levels, the monitor
will sound a warning. This usually involves a beeping noise and a
flashing color. Many will highlight the problem reading in some way
If one or more vital signs spikes or drops sharply, the alarm may get
louder, faster, or change in pitch. This is designed to let a caregiver
know to check on you, so the alarm may also show up on a monitor in
another room.
But one of the most common reasons an alarm goes off is because a
sensor isn’t getting any information. This might happen if one comes
loose when you move or isn’t working the way it should.
E
T
C
O
2
The capnogram is a direct monitor of the inhaled and exhaled
concentration or partial pressure of CO2, and an indirect monitor of
the CO2 partial pressure in the arterial blood. In healthy individuals, the
difference between arterial blood and expired gas CO2, partial pressures is
very small. the difference between arterial blood and expired gas can exceed
7 mmHg in some disease
Capnography directly reflects the elimination of CO2 by the lungs to the
anesthesia device. Indirectly, it reflects the production of CO2 by tissues
and the circulatory trans
Carbon dioxide is produced continuously as the body's cells respire, and
this CO
2
will accumulate rapidly if the lungs do not adequately expel it
through alveolar ventilation. Alveolar hypoventilation thus leads to an
increased
PaCO2
(a condition called hypercapnia). The increase
in
Pa
CO
2
in turn decrease the pH.
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Suction machines create a vacuum effect to remove obstructions such as
blood, saliva, mucus, vomit, or other liquids from the respiratory tract.
Suction of the endotracheal tube (ETT) is routine and common
procedure in intensive care unit to clear secretions and to keep the
airway patent so that oxygenation and ventilation in an intubated patient
can be optimized. ETT suction can cause hypoxia due to
oxygen suction from the lung and alveoli collapse.
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:
Saw tooth pattern on flow-volume loop on ventilator monitor
Coarse crackles auscultated over trachea
Increased peak inspiratory pressure during volume control
ventilation
Decreased tidal volume during pressure-controlled ventilation
Deterioration in oxygen saturation and/or arterial blood gas values
Visible secretions in airway
Patient’s inability to generate an effective cough
Acute respiratory distress
Suspected aspiration of gastric or upper airway secretions
p
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hyperoxygenate the patient by giving them a few breaths with 100%
oxygen
Insert the catheter through the nose, tracheostomy tube or
endotracheal tube. Do not be aggressive when inserting the tube
through the nose.
Once the catheter has been inserted to the appropriate depth, apply
intermittent suction and slowly withdraw the catheter
If suctioning more than once, allow the patient time to recover
between suctioning attempts
During the procedure, monitor oxygen levels and heart rate to make
sure the patient is tolerating the procedure well. Suctioning attempts
should be limited to 10 seconds
T
i
p
s
Apply suction for no longer than 10 seconds. Applying suction for longer periods of ti
me can cause injury, hypoxia and bradycardia.
Do not apply suction while inserting the catheter. This can increase the chances of in
juring the mucus membranes.
Use a clean
suction
catheter when
suctioning
the patient. Whenever the
suction
c
atheter is to be reused, place the catheter in a container of distilled/sterile water and
apply
suction
for approximately 30 seconds to clear secretions from the inside.
Reoxygenate between attempts.
Maximum number
of attempts should be 2
suctio
n passes
/episode.
Suction
catheter size should be
no
more than 1/2 (one-half) the i
nternal diameter of the artificial airway (ETT) to avoid greater negative pressure in t
he airway and potentially minimize the PaO2.
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p
u
m
p
A syringe pump is a small infusion device that is used to gradually
administer specific amounts of fluids for use in chemical and
biomedical research.
A syringe pump is also known as Micro Infusion Pump
The main purpose of the equipment is to supplement volumetric
infusion pump in micro-administration
It is more accurate than a typical volumetric infusion pump while
administering small doses
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P
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•
Majority of the patients in ICU need these pumps. These are pumps
that you will see beside the patient and they control the amount of
medication or fluid that a patient receives and how fast or slow it can
be given.
•
used for
•
Chemotherapy
•
parenteral nutrition
•
Anaesthesia/sedation
•
Drugs like (dopamine, epinephrine, dobutamine, …)
Majority of the patients in ICU need these pumps. These are pumps that
you will see beside the patient and they control the amount of medication
or fluid that a patient receives and how fast or slow it can be given.
A
d
v
a
n
t
a
g
e
s
Infusion pumps provide a high level of control, accuracy, and precision in drug
delivery, thereby reducing medication errors and contributing to improvements in
patient care. At the same time, infusion pumps have been associated
with persistent safety problems that can result in over- or under-infusion, and
missed or delayed therapy.
Infusion pump used an unit ml/hour or mcg/hour
You can determine the drug and dose
You can determine the duration of administration
An alarm for any obstruction to access and when the amount of medicine in the
vial or container is running out
C
V
l
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e
(
c
e
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t
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)
C
V
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e
(
c
e
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t
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r
v
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e
)
A central venous catheter (CVC), also known as a central line, central
venous line, or central venous access catheter, is a catheter placed into a
large vein. It is a form of venous access. Placement of larger catheters in
more centrally located veins is often needed in critically ill patients, or in
those requiring prolonged intravenous therapies, for more reliable vascular
access. These catheters are commonly placed in veins in the neck (internal
jugular vein), chest (subclavian vein or axillary vein), groin (femoral vein),
or through veins in the arms.
E
C
G
The electrocardiogram (ECG ) is a diagnostic tool that is
routinely used to assess the electrical and muscular
functions of the heart. it gives the full information about the
heart beats consists of 12 leads for acquistion and a rhythm
lead as an optional. it is used to analyse the heart rate and
rhythm of the heart.
E
n
d
o
t
r
a
c
h
e
a
l
t
u
b
e
(
E
T
T
)
It is used in the ICU for
patients who are having
difficulty breathing
because of a lung
problem, or for patients
who are not awake
enough to breathe for
themselves.
T
r
a
c
h
e
o
s
t
o
m
y
A tracheostomy is
sometimes and option
to patients who require
long term ventilation,
difficult weaning from
the ventilator, and
patients with copious
secretions . When a
patient no longer
requires ventilator
support and only needs
oxygen therapy, oxygen
tube can be connected
to the tracheostomy.
A
r
t
e
r
i
a
l
l
i
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e
It allows the nurse
to see the blood
pressure
continuously and
also allows the
staff to take bloods
when required
D
i
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c
t
c
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r
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t
(
D
C
)
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Defibrillation is a common treatment for life-threatening cardiac
dysrhythmias, ventricular fibrillation and pulseless ventricular
tachycardia. Defibrillation consists of delivering a therapeutic dose of
electrical energy to the heart with a device called a defibrillator The
purpose of defibrillator is to give electrical stimulation for cardiac arrest
patients
A
E
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(
'
A
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a
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s
'
)
The majority of our patients will be lying on an air mattress. This mattress
is used to prevent pressure injuries or 'bed sores'
The air mattress is constantly distributing air and alternating the pressure
under the body.
In addition to the use of an air mattress we should also turn the patients in
the bed frequently
A
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A
i
r
m
a
t
t
r
e
s
s
(
A
i
r
b
e
d
)
Nasogastric Tube (NG)
This tube goes through a
patients nose and down into
their stomach. It allows us to
feed them when they are too
unwell to eat and drink as
they normally would or when
their appetite is reduced due
to illness. We can also give
them medication
U
r
i
n
a
r
y
C
a
t
h
e
t
e
r
In the ICU, a patient
may have a urinary
catheter put in place
to monitor an hourly
output. This allows us
to calculate how much
fluid is going in,
versus how much is
coming out
K
i
d
n
e
y
m
a
c
h
i
n
e
s
Some patients kidneys stop working due to their illness. The kidneys work
to filter the blood and remove waste products (and in doing so produce
urine) so if they fail, it is important that the machines take over this job. To
do this a special large tube is put into one of the big veins in the leg or neck.
B
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Common equipment in an ICU includes mechanical ventilators, cardiac monitors, monitoring equipment for bodily functions, and a variety of tubes, lines, and pumps. Drugs like analgesics are used to reduce pain and prevent infections. Monitors track heart rate, blood pressure, and temperature, while tools like respiratory rate monitor and blood pressure cuff help in patient care.
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L 2 Dr_ Dr_Zainab Zainab Al M. M.B. B.Ch. Ch.B B / /FICMS. Al Youseif Youseif FICMS.A& A&IC IC
Equipment and systems Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tube or a tracheostomy tube; cardiac monitors for monitoring Cardiac condition; equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction, drains, and catheters, syringe pumps; and a wide array of drugs to treat the primary condition(s) of hospitalization. analgesics, and induced sedation are common ICU tools needed and used to reduce pain and prevent secondary infections.
The most basic monitors showyour heart rate, blood pressure, and body temperature. More advanced modelsshow respiratory rate and how much carbon dioxide you're breathing out.
HR The hearts of healthy adults typically beat 60 to 100 times a minute. People who are more active can have slower heart rates What are the causes of an increased heart rate?
Respiratory Rate (RR) Respiratory Rate (RR): Look for the patient's respiratory rate under RR on the patient monitor. It is reported in breaths per minute, with normal values between 12 and 20. However, this number isn't very accurate, especially as the patient's breathing goes faster or slower. What are the causes of an increased RR?
Blood pressure This is a measure of the force on your arteries when your heart is beating (known as systolic pressure) and when it s at rest (diastolic pressure). The first number (systolic) should be between 100 and 130, and the second number (diastolic) should be between 60 and 80.
Oxygen saturation This number measures how much oxygen is in your blood, on a scale up to 100. The number is normally 95 or higher, and anything below 90 means your body may not be getting enough oxygen.
If one of your vital signs rises or falls outside healthy levels, the monitor will sound a warning. This usually involves a beeping noise and a flashing color. Many will highlight the problem reading in some way If one or more vital signs spikes or drops sharply, the alarm may get louder, faster, or change in pitch. This is designed to let a caregiver know to check on you, so the alarm may also show up on a monitor in another room. But one of the most common reasons an alarm goes off is because a sensor isn t getting any information. This might happen if one comes loose when you move or isn t working the way it should.
ETCO2 The capnogram is a direct monitor of the inhaled and exhaled concentration or partial pressure of CO2, and an indirect monitor of the CO2 partial pressure in the arterial blood. In healthy individuals, the difference between arterial blood and expired gas CO2, partial pressures is very small. the difference between arterial blood and expired gas can exceed 7 mmHg in some disease
Capnography directly reflects the elimination of CO2 by the lungs to the anesthesia device. Indirectly, it reflects the production of CO2 by tissues and the circulatory trans Carbon dioxide is produced continuously as the body's cells respire, and this CO2will accumulate rapidly if the lungs do not adequately expel it through alveolarventilation. Alveolar hypoventilation thus leads to an increased PaCO2(a condition called hypercapnia). The increase in PaCO2in turn decrease the pH.
DC shock used for patients with VT, VF, SVT .
suction machine Suction machines create a vacuum effect to remove obstructions such as blood, saliva, mucus, vomit, or other liquids from the respiratory tract. Suctionof the endotracheal tube (ETT) is routine and common procedure in intensive care unit to clear secretions and to keep the airway patent so that oxygenation and ventilation in an intubated patient can be optimized. ETT suction can cause hypoxia due to oxygen suction from the lung and alveoli collapse.
The following are recommendations for endotracheal suctioning from the American Association of Respiratory Care: Saw tooth pattern on flow-volume loop on ventilator monitor Coarse crackles auscultated over trachea Increased peak inspiratory pressure during volume control ventilation Decreased tidal volume during pressure-controlled ventilation Deterioration in oxygen saturation and/or arterial blood gas values Visible secretions in airway Patient s inability to generate an effective cough Acute respiratory distress Suspected aspiration of gastric or upper airway secretions
procedure hyperoxygenate the patient by giving them a few breaths with 100% oxygen Insert the catheter through the nose, tracheostomy tube or endotracheal tube. Do not be aggressive when inserting the tube through the nose. Once the catheter has been inserted to the appropriate depth, apply intermittent suction and slowly withdraw the catheter If suctioning more than once, allow the patient time to recover between suctioning attempts During the procedure, monitor oxygen levels and heart rate to make sure the patient is tolerating the procedure well. Suctioning attempts should be limited to 10 seconds
Tips Apply suction for no longer than 10 seconds. Applying suction for longer periods of ti me can cause injury, hypoxia and bradycardia. Do not apply suction while inserting the catheter. This can increase the chances of in juring the mucus membranes. Use a clean suction catheter when suctioning the patient. Whenever the suction c atheter is to be reused, place the catheter in a container of distilled/sterile water and apply suction for approximately 30 seconds to clear secretions from the inside. Reoxygenate between attempts. Maximum number of attempts should be 2 suctio n passes/episode. Suction catheter size should be no more than 1/2 (one-half) the i nternal diameter of the artificial airway (ETT) to avoid greater negative pressure in t he airway and potentially minimize the PaO2.
syringe pump used to given bolus dose ( not for infusion) like 10 mg midazolam in every 6 hours
syringe pump A syringe pump is a small infusiondevice that is used togradually administer specific amounts of fluids for use in chemical and biomedical research. A syringe pump is also known as Micro Infusion Pump The main purpose of the equipment is to supplement volumetric infusion pump in micro-administration It is more accurate than a typical volumetric infusion pump while administering small doses
Pump infusion used for infusion doses drugs like dopamine 10 mcg/kg/min (not for bolus dose)
Pump infusion Majority of the patients in ICU need these pumps. These are pumps that you will see beside the patient and they control the amount of medication or fluid that a patient receives and how fast or slow it can be given. used for Chemotherapy parenteral nutrition Anaesthesia/sedation Drugs like (dopamine, epinephrine, dobutamine, )
Majority of the patients in ICU need these pumps. These are pumps that you will see beside the patient and they control the amount of medication or fluid that a patient receives and how fast or slow it can be given.
Advantages Infusion pumps provide a high level of control, accuracy, and precision in drug delivery, thereby reducing medication errors and contributing to improvements in patient care. At the same time, infusion pumps have been associated with persistent safety problems that can result in over- or under-infusion, and missed ordelayed therapy. Infusion pump used an unit ml/houror mcg/hour You can determine thedrug and dose You can determine theduration of administration An alarm for any obstruction to access and when the amount of medicine in the vial orcontainer is running out
CV line (center venous line) A central venous catheter (CVC), also known as a central line, central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous therapies, for more reliable vascular access. These catheters are commonly placed in veins in the neck (internal jugular vein), chest (subclavianvein or axillary vein), groin (femoral vein), or through veins in the arms.
ECG The electrocardiogram (ECG ) is a diagnostic tool that is routinely used to assess the electrical and muscular functions of the heart. it gives the full information about the heart beats consists of 12 leads for acquistionand a rhythm lead as an optional. it is used to analyse the heart rate and rhythm of the heart.
Endotracheal tube (ETT) It is used in the ICU for patients who are having difficulty breathing because of a lung problem, or for patients who are not awake enough to breathe for themselves.
Tracheostomy A tracheostomy is sometimes and option to patients who require long term ventilation, difficult weaning from the ventilator, and patients with copious secretions . When a patient no longer requires ventilator support and only needs oxygen therapy, oxygen tube can be connected to the tracheostomy.
Arterial line It allows the nurse to see the blood pressure continuously and also allows the staff to take bloods when required
Direct current (DC) cardioversion or defibrillation Defibrillation is a common treatment for life-threatening cardiac dysrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the heart with a device called a defibrillator The purpose of defibrillator is to give electrical stimulation for cardiac arrest patients
Pressure Relieving Mattress ('Air mattress') The majority of our patients will be lying on an air mattress. This mattress is used to prevent pressure injuries or 'bed sores' The air mattress is constantly distributing air and alternating the pressure under the body. In addition to the use of an air mattress we should also turn the patients in the bed frequently
Nasogastric Tube (NG) This tube goes through a patients nose and down into their stomach. It allows us to feed them when they are too unwell to eat and drink as they normally would or when their appetite is reduced due to illness. We can also give them medication
Urinary Catheter In the ICU, a patient may have a urinary catheter put in place to monitor an hourly output. This allows us to calculate how much fluid is going in, versus how much is coming out
Kidney machines Some patients kidneys stop working due to their illness. The kidneys work to filter the blood and remove waste products (and in doing so produce urine) so if they fail, it is important that the machines take over this job. To do this a special large tube is put into one of the big veins in the leg or neck.
