Topik 4. Reading Intensive Care Unit

Equipment, devices
and procedures
in the Intensive Care Unit
Information for relatives, friends and carers

Welcome
Reading Comprehension Assignment
Answer the questions from the text above!
1. What is Intensive care unit for?
2. What staffs are provided in ICU?
3. what is the function of breathing machines or ventilators?
4. what is the function of kidney machines?
5. what does monitor measure in ICU?
6. what is the function of arterial line?
7. what is the function of central line?
8. how is line is inserted to patients' body?
9. What is the function of tracheostomy?
10. What is the benefit of tracheostomy?
11. What are the differences between nasogastric tube and intravenous feeding?
12. what is the function of urinary catheter?
13. What is the function of MRI and city scan?
14.What is the function of ultrasound?
15. What is the function of echocardiography?
2
Contents
Staff and patient comfort 3

Noises and alarms 3
Equipment 4
Lines 6
Breathing tubes 7
Feeding in intensive care 9
Urinary catheter 11
Scans: CT and MRI 12
Ultrasound 13
Echocardiogram 14
Facilities for relatives and friends 15
3
Staff in Intensive care
Intensive care units in the United Kingdom are run and staffed
by specialists trained in intensive care. Once a patient is
admitted to the unit the intensive care team will manage the
care of the patient in consultation with the original team that
admitted the patient to the hospital and any other specialists
that they think can help to aid the patient’s recovery. The
intensive care doctors and nurses will give the best overview
and general update on the patient, but they may refer relatives
to the specialist teams for discussion of certain aspects of care.
Patient comfort
Patients need to be sedated to tolerate the help they need with
their breathing. This level of sedation is much less than is needed
for an operation and patients are often partially awake. The nurses
and doctors will keep reassuring the patient and make sure that
they have plenty of pain relief to minimise any uncomfortable
procedures that need to be done.
Relatives often want to know if they can talk to the patient

or touch them and this is usually encouraged. Reassuring voices
and contact can really help patients.
Noises and alarms

Noise levels are likely to be higher than on a general hospital ward
largely because of the operation of the equipment, often beeping
or sounding an alarm. If you do hear an alarm it doesn’t necessarily
mean something’s wrong, just that there’s something the staff
need to be aware of. Staff will be able to explain the equipment
and noises to you should you have concerns about the alarms.
Equipment
It is common for patients to be connected to a number of different
machines or devices whilst in the ICU.
Breathing machines or ventilators

Many patients need help with breathing and to do this they
usually need to be sedated and have a breathing tube put
into their windpipe or through the neck. Such tubes are
attached
to a breathing machine known as ventilator. Modern ventilators
use complex computers to enable patients to breath as much
as possible for themselves with variable amounts of help from
the machine. Sometimes, patients’ breathing might be
supported with tight fitting masks which look uncomfortable at
first, but many patients get used to them very quickly and this
means they don’t need to be deeply sedated and don’t need a
tube putting into their windpipe.
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.
Monitors
Patients in intensive care are constantly monitored to track their
condition and alert staff to changes. This monitoring routinely
includes measurement of:
 Heart rate and heart electrical tracing (ECG)

 Oxygen levels in the blood
 Blood pressure
 Pressure in the veins (CVP)
 Urine output
 Temperature
 All the fluids, food and drugs.
Lines
These are plastic catheters or tubes sometimes referred to as
‘drips’ or ‘lines’ and are inserted by the doctors and nurses into
the patient’s blood vessels. These lines help to give fluids and
medications, are used in monitoring blood pressure, and for taking
blood samples for regular investigations. Common lines inserted in
ICU are:
Arterial line
A very thin tube is inserted into one of the patient’s arteries
(usually in the arm) to allow direct measurement of the blood
pressure and to measure the concentration of oxygen and carbon
dioxide in the blood.
Central line
A thin tube is inserted into a big vein usually in the neck,
shoulder or groin to measure the pressure, take blood samples
and to give concentrated medications and fluids.
Dialysis line or Vascath

These line are similar to central lines and are inserted into a
big vein. However there are bigger in diameter enabling to
attach to a kidney machine in order to perform the job of the
kidneys.
PICC lines
These lines are inserted in one of the veins in the upper arm
and are long enough to reach the big veins close to the heart.
They have the advantage of having less chance of infection,
thereby could be used for long duration of time.
How are lines inserted?
All lines inserted are done by doctors or nurses experienced in
doing the procedure. Local anaesthetic will be injected into the
site to numb the area before performing the procedure to ensure
patient comfort. Sometimes a strong painkiller might be given
through a venous line. All lines are inserted in the safest manner.
Complications do occur although these are rare. The common one
are bleeding, bruising and infection.
Breathing tubes
Some of the patients in the intensive care will need support with
their breathing. This is achieved by passing a plastic breathing tube
into the windpipe. There are two types of breathing tubes:
Endotracheal (ET) tube

This is a plastic tube placed through the patient’s mouth or rarely
through the nose into the windpipe (trachea). Most patients will
need sedation to keep them comfortable while this breathing tube
is in place.
Tracheostomy
This is a plastic tube placed into the patient’s windpipe through
a small incision in the front of the patient’s neck. Tracheostomy
is usually performed where there is a need for breathing support
for a prolonged period of time.
Breathing tubes are placed by doctors skilled in anaesthesia

or critical care and are always done using a general anaesthetic.
Rarely, the patient may need a surgical tracheostomy, which
is done in the operating theatre – more information will be given
if this operation is needed.
Benefits of tracheostomy
Tracheostomy is far more comfortable than a breathing tube
passing through the mouth/nose. Patients need less or no
sedation after a tracheostomy which means that they are more
awake
and this will help in the process of reducing the breathing support
needed by the patient. Most of the tracheostomies performed
in the intensive care are safe. Complications include bleeding,
bruising, infection and rarely a collapsed lung (pneumothroax).
Feeding in the intensive care
Patients in the intensive care unit are at risk of malnutrition
because of their illness. It is essential to maintain an
adequate nutrition and calorie intake in order to fight the
infection and aid recovery after prolonged illness.
Nasogastric tube
A nasogastric tube is the most common type of feeding tube used
in the critical care. These are long thin tubes which are inserted
by the nurse or the doctor, which goes into the nose, down the
oesophagus (food pipe) until it reaches the stomach. Nasogastric
tubes are used to feed the patients in the intensive care who are
unable to eat or drink. In addition to this, these tube could be
used to drain the stomach contents. Complications with nasogastric
tube are rare. Common ones include bleeding from the nose,
inflammation of the sinuses and occasionally these tube might
go into the lungs instead of the stomach. The position of the tube
is checked either by x-ray or by pH test in order to ensure that
it is in the right position.
Intravenous feeding
If there are problems with absorption of the feed through
the stomach, nutrition is provided through a central line
into the veins. This route is usually not the first choice for
feeding
as it poses the risk of infection and feeding through the stomach
is more physiological.
Other types of tube used for feeding include:
Nasojejunal tube
If there are problems with the nasogastric tube due to
absorption of the feed, a nasojejunal tube might be inserted.
These are similar to nasogastric tube but tip of the tube is
positioned in the small intestine (jejunum) instead of being in
the stomach. Special x-rays or other imaging may be needing to
ensure the adequate positioning of the tube.
PEG tube
A PEG (Percutaneous Endoscopic Gastrostomy) tube is inserted
through the skin on the abdomen leading into the stomach.
These tubes are inserted if the patient need long standing feeding,
or they are a high risk of aspirated food contents into the lung.
The procedure is technically challenging and the surgeon
performing the procedure will update you with further information.
Urinary catheter
A urinary catheter is a flexible tube that is inserted into the
bladder to drain urine. This is essential to drain the bladder of
urine while the patient is unable to use the toilet normally. In
addition to this, it is essential to check the amount of urine
produced by the patient to ensure that the kidneys are
functioning alright.
The tube is inserted by a doctor or a nurse via the urethra

until it reaches the bladder and a balloon is inflated to keep
the tube within the bladder. Urinary catheter carry a risk of
urinary tract
infection (UTI) in the urethra, bladder or the kidneys. Care will be
taken to prevent such infections, however this might need treating
with antibiotics.
Scans: CT and MRI
Patients in the intensive care unit may need further
investigation in terms of a computerised tomography scan (CT
or CAT scan)
or an MRI (Magnetic Resonance Imaging) of their head, chest or
abdomen. These investigations give detailed radiological
pictures which are not possible with a plain x-ray film. The
patient needs to be taken to the x-ray department in order to
get these investigations. This will be done by a doctor and a
nurse who are trained to manage the patient during the process
of the transfer.
A doctor and a nurse will escort the patient to ensure continuous

monitoring, and to give essential treatment during the entire
process. Occasionally, tubes may become disconnected or a
medical problem may occur during the process of the transfer. The
doctor and the nurse are trained to handle such situations and will
deal the patient based on the necessity.
Ultrasound
Ultrasound is a commonly used device in ICU. It is used to assist
the doctor in inserting lines, and also forms an easy and safe
investigative tool. Most of the ultrasound machines used in the
intensive care are portable and could be used at the bedside.
The ultrasound machine has a probe attached to a monitor
screen, and high frequency sounds are emitted from the probe.
The probe is placed on the part of the body to be examined and
images are obtained based on the density of the organ such as
bone, muscle or a blood vessel. It is totally safe and does not
cause any pain to the patient. However, it has limitations with
regards to the type and quality of images that can be obtained.
Ultrasound is commonly used to scan the lung for any fluid,

examine the abdomen and the organs within, such as the liver
and kidneys, and also to aid insertion of lines into central vein.
Echocardiography
This is a scan of the heart to look how it is functioning, identify
leaky valves, looks for any clots in the heart, and to guide
treatment plans for the patient.
Echocardiography uses the same principle as any other

ultrasound device. A probe is placed on the patient’s chest to
obtain images of the heart. Most of the echocardiograms done in
the intensive care unit are painless with no risk to the patient.
Sometimes, more detailed images need to be acquired which
can’t be done by
a probe placed on the patient’s chest. In such circumstances, the
probe has to be introduced into the patients oesophagus (food
pipe). This procedure is called as Transoesophageal Echocardiogram
and will be done under sedation or under general anaesthesia.
The procedure is usually safe. Occasionally there is a risk of an
injury or tear in the oesophagus and an operation might be needed
to fix this.
Facilities for relatives and friends
The intensive care team aim to regularly update relatives, friends
and carers on the patient’s condition. These updates might be
done at the patient’s bedside or in a quiet place outside the unit
were we can sit down and talk (sometimes referred to as the quiet
room).
Occasionally while procedures are being performed and in between
visiting times, the staff might ask you to wait outside the intensive
care. Please be patient if this is the situation. To make your wait a
bit easier there is a visitors waiting area outside the intensive care.
Final comments
We hope you find this information leaflet helpful in explaining
some of the equipment, people and procedures you might come
across during your visit to the intensive care unit.
We appreciate your feedback and will from time to time collect

feedback with a questionnaire. If you have any further
questions, please contact the intensive care team on the
numbers provided on the front of this leaflet.
Contact
The Royal Sussex County
Hospital Eastern Road, Brighton
BN2 5BE Phone 01273 696955
The Princess Royal Hospital

Lewes Road, Haywards Heath RH16 4EX
Phone 01444 441881
www.bsuh.nhs.uk
© Brighton and Sussex University Hospitals NHS Trust
Disclaimer
The information in this leaflet is for guidance purposes
only and is in no way intended to replace professional
clinical advice by a qualified practitioner.
Ref number: 611.1

Publication Date: January 2018
Review Date: January 2020

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Equipment, devices

Information for relatives, friends and carers

Reading Comprehension Assignment

Answer the questions from the text above!

1. What is Intensive care unit for?

2. What staffs are provided in ICU?

3. what is the function of breathing machines or ventilators?

4. what is the function of kidney machines?

5. what does monitor measure in ICU?

6. what is the function of arterial line?

7. what is the function of central line?

8. how is line is inserted to patients' body?

9. What is the function of tracheostomy?

10. What is the benefit of tracheostomy?

12. what is the function of urinary catheter?

13. What is the function of MRI and city scan?

14.What is the function of ultrasound?

15. What is the function of echocardiography?

Staff and patient comfort 3

Relatives often want to know if they can talk to the patient

Noises and alarms

Breathing machines or ventilators

 Heart rate and heart electrical tracing (ECG)

Dialysis line or Vascath

Endotracheal (ET) tube

Breathing tubes are placed by doctors skilled in anaesthesia

The tube is inserted by a doctor or a nurse via the urethra

A doctor and a nurse will escort the patient to ensure continuous

Ultrasound is commonly used to scan the lung for any fluid,

Echocardiography uses the same principle as any other

We appreciate your feedback and will from time to time collect

The Princess Royal Hospital

© Brighton and Sussex University Hospitals NHS Trust

Ref number: 611.1

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