CRITICAL CARE NURSING:

Devices used in ICU

Prof. Dr. Ram Sharan Mehta, MSND, CON, BPKIHS 1

DEVICES USED IN ICU &
MONITORING

Prof. Dr. RS Mehta, BPKIHS 2

INTRODUCTION

Intensive care unit (ICU) equipment

includes patient monitoring, respiratory
and cardiac support, pain management,
emergency resuscitation devices, and
other life support equipment .

Prof. Dr. RS Mehta, BPKIHS 3

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.

Prof. Dr. RS Mehta, BPKIHS 4

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.
Prof. Dr. RS Mehta, BPKIHS 5
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.

Prof. Dr. RS Mehta, BPKIHS 6

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.
Prof. Dr. RS Mehta, BPKIHS 7
Prof. Dr. RS Mehta, BPKIHS 8
TYPES OF DEVICES

Intensive care unit equipment includes

 Patient monitoring devices
 Life support and emergency resuscitation
devices, and
 Diagnostic devices.

Prof. Dr. RS Mehta, BPKIHS 9

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 Prof. Dr. RS Mehta, BPKIHS 10
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
Prof. Dr. RS Mehta, BPKIHS 11
DIAGNOSTIC EQUIPMENT

 Mobile x-ray units

 portable clinical laboratory devices,
 Bronchoscope
 Colonoscope
 Endoscope
 Gastroscope
Prof. Dr. RS Mehta, BPKIHS 12
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)
Prof. Dr. RS Mehta, BPKIHS 13
Hemodynamic
Monitoring

Prof. Dr. RS Mehta, BPKIHS 14

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
Prof. Dr. RS Mehta, BPKIHS 16
 Why monitor BP?

 Alterations inherent
 Provides data for interpretation/therapeutic
decisions
 Important for determining organ perfusion
(MAP most important, except with the heart)

Prof. Dr. RS Mehta, BPKIHS 17

Noninvasive Hemodynamic
Monitoring

 Noninvasive BP
 Skin Temperature

 Heart Rate,
pulses  Capillary Refill

 Mental Status  Urine Output

Prof. Dr. RS Mehta, BPKIHS 18

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

Prof. Dr. RS Mehta, BPKIHS 19

Supplies to Gather
 Arterial Catheter  Pressure Bag
 Pressure Tubing  Flush – 500cc NS
 Pressure Cable  Suture (silk 2.0)
 Sterile Gown  Chlorhexidine Swabs
 Mask
 Sterile Towels
 Sterile Gloves

Prof. Dr. RS Mehta, BPKIHS 20

Potential Complications
Associated With Arterial Lines

 Hemorrhage

 Air Emboli

 Infection

 Altered Skin Integrity

 Impaired Circulation
Prof. Dr. RS Mehta, BPKIHS 21
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.

Prof. Dr. RS Mehta, BPKIHS 22

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.
Prof. Dr. RS Mehta, BPKIHS 23
 Arterial lines may be useful in patients
with very high or low blood pressures.
The arterial line also provides access for
frequent blood sampling.

Prof. Dr. RS Mehta, BPKIHS 24

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.

Prof. Dr. RS Mehta, BPKIHS 25

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.
Prof. Dr. RS Mehta, BPKIHS 26
BEDSIDE MONITOR
 A bedside monitor is
a display of major
body functions on a
device that looks like
a television screen or
computer monitor.

Prof. Dr. RS Mehta, BPKIHS 27

 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.

Prof. Dr. RS Mehta, BPKIHS 28

 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.

Prof. Dr. RS Mehta, BPKIHS 29

 Each patient bed in an ICU has a
physiologic monitor that measure
these body activities. All monitors are
networked to a central nurses' station.

Prof. Dr. RS Mehta, BPKIHS 30

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.

Prof. Dr. RS Mehta, BPKIHS 31

 The bedside monitor has alarms that
signal the nurse if a body function
needs attention.

Prof. Dr. RS Mehta, BPKIHS 32

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.

Prof. Dr. RS Mehta, BPKIHS 33

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)
Prof. Dr. RS Mehta, BPKIHS 34
Prof. Dr. RS Mehta, BPKIHS 35
Common1 sites for central
venous catheter insertion

Prof. Dr. RS Mehta, BPKIHS

PROCEDURE
 The most
common
used method
is seldinger
technique.

Prof. Dr. RS Mehta, BPKIHS

 In some patients, a central
venous catheter may be inserted
into the elbow vein (anticubital
vein) and advanced into the
subclavian vein.

Prof. Dr. RS Mehta, BPKIHS 38

Prof. Dr. RS Mehta, BPKIHS 39
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 Prof. Dr. RS Mehta, BPKIHS 40
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.

Prof. Dr. RS Mehta, BPKIHS 41

 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
Prof. Dr. RS Mehta, BPKIHS 42
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.

Prof. Dr. RS Mehta, BPKIHS 43

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.

Prof. Dr. RS Mehta, BPKIHS 44

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.

Prof. Dr. RS Mehta, BPKIHS 45

 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.

Prof. Dr. RS Mehta, BPKIHS 46

 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.

Prof. Dr. RS Mehta, BPKIHS 47

complication
 Potential complications associated with
ICP monitoring include infection and
brain hemorrhage, which are very
infrequent.

Prof. Dr. RS Mehta, BPKIHS 48

Nurses role

 Optimizing cerebral tissue perfusion.

 Preventing infection.
 Maintaining patient airway.
 Maintaining negative fluid balance.
 Prevent infection( dressing)

Prof. Dr. RS Mehta, BPKIHS 49

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.
Prof. Dr. RS Mehta, BPKIHS 50
 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.

Prof. Dr. RS Mehta, BPKIHS 51

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.
Prof. Dr. RS Mehta, BPKIHS 52
 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.

Prof. Dr. RS Mehta, BPKIHS 53

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.
Prof. Dr. RS Mehta, BPKIHS 54
 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.

Prof. Dr. RS Mehta, BPKIHS 55

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

Prof. Dr. RS Mehta, BPKIHS 56

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
Prof. Dr. RS Mehta, BPKIHS 57
b. Suction periodically as per need
c. Change the mode setup as adviced.
d. Give sedatives as adviced.

Prof. Dr. RS Mehta, BPKIHS 58

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.

Prof. Dr. RS Mehta, BPKIHS 59

PURPOSE
 Under some circumstances, the rate at
which IV fluids and/or IV medications
are given needs to be closely
controlled.

Prof. Dr. RS Mehta, BPKIHS 60

 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.

Prof. Dr. RS Mehta, BPKIHS 61

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.
Prof. Dr. RS Mehta, BPKIHS 62
Resuscitation Cart (Crash
Cart)
 The resuscitation
cart contains all of
the equipment and
medications needed
for advanced life
support and CPR
(cardiopulmonary
resuscitation).

Prof. Dr. RS Mehta, BPKIHS 63

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.

Prof. Dr. RS Mehta, BPKIHS 64

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.

Prof. Dr. RS Mehta, BPKIHS 65

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.

Prof. Dr. RS Mehta, BPKIHS 66

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.

Prof. Dr. RS Mehta, BPKIHS 67

 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).

Prof. Dr. RS Mehta, BPKIHS 68

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.

Prof. Dr. RS Mehta, BPKIHS 69

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.
Prof. Dr. RS Mehta, BPKIHS 70
 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. Prof. Dr. RS Mehta, BPKIHS 71
 Report and record the procedure and
clean the paddle area with spirit swab.
 Keep the difibrilator on continue
electrical charging.

Prof. Dr. RS Mehta, BPKIHS 72

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.

Prof. Dr. RS Mehta, BPKIHS 73

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.
Prof. Dr. RS Mehta, BPKIHS 74
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.

Prof. Dr. RS Mehta, BPKIHS 75

 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.

Prof. Dr. RS Mehta, BPKIHS 76

Thank you

Prof. Dr. RS Mehta, BPKIHS 77

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

Prof. Dr. RS Mehta, BPKIHS 78

METHODS
 Percussive
pacing
 Transcutaneous
 Epicardial
 Transvenous
 Permanent
pacing

Prof. Dr. RS Mehta, BPKIHS 79

 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

Prof. Dr. RS Mehta, BPKIHS 80

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 Dr.
Prof. arterial oxygen
RS Mehta, saturation.
BPKIHS 81
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,
Prof. Dr. RS Mehta, BPKIHS 82
near continuous value for cardiac output
Prof. Dr. RS Mehta, BPKIHS 83
PULMONARY ARTERY
CATHETER

Prof. Dr. RS Mehta, BPKIHS 84

Components of a Pulmonary
Artery
Catheter

Prof. Dr. RS Mehta, BPKIHS 85

Prof. Dr. RS Mehta, BPKIHS 86
 POSITION OF PATIENT

Fluid
Bag

manometer
3-way tap

Central
Venous
Access

Patient in supine position

Prof. Dr. RS Mehta, BPKIHS 87

Prof. Dr. RS Mehta, BPKIHS 88
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)
Prof. Dr. RS Mehta, BPKIHS 89
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
Prof. Dr. RS Mehta, BPKIHS 90
Prof. Dr. RS Mehta, BPKIHS 91
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).
Prof. Dr. RS Mehta, BPKIHS 92
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.
Prof. Dr. RS Mehta, BPKIHS 93
MONITORING

 Oxygenation
 Ventilation
 Circulation
 Temperature
 Monitoring patients on ventilator
 Monitoring patients with raised ICP

Prof. Dr. RS Mehta, BPKIHS 94

MONITORING
CIRCULATION
 Clinical parameters

 Pulse- Rate,  Capillary Refill

Rhythm, Volume,  Urine Output
Character  Peripheral
 NIBP Temperature
 Pulse Oximeter-  JVP
Plethysomograph  Pedal Edema
y
 Basal Rales
 Cyanosis
 Temperature
Prof. Dr. RS Mehta, BPKIHS 95