Critical Care Nursing Procedures



DESCRIPTION

This is the process of building a therapeutic relationship/environment with the patient/client and family who visits the hospital. It makes the patient/client and family feel at ease to discuss his/her needs with the nurse. This action is performed by the nurse immediately he/she comes into contact with a patient/client and family.

AIMS

  1. Develop mutual trust between patient/client and the nurse
  2. Reduce anxiety
  3. Maintain the dignity of patient/client
  4. Promote effective communication

TYPES

  1. N/A

DESCRIPTION

It is the act of describing a procedure, an action or task that will be carried out for a patient/client and or the family during the delivery of care.

AIMS

  1. Seek patient/client and family’s co-operation and consent
  2. Provide clear understanding of the action or task
  3. Allay fear and anxiety
  4. Indicate the purpose of the procedure
  5. Aid in patient/client and family’s compliance to treatment

TYPES

  1. N/A

DESCRIPTION

This is the process whereby a central venous catheter is inserted aseptically into a major vein of a critically ill patient. This procedure is done by the intensivist/Anaesthesiologist with the assistance of the Critical Care nurse.

AIMS

  1. Massive transfusion of fluids (intravenous infusions, blood and blood products)
  2. Administration of medications
  3. Parenteral feeding
  4. Blood sampling
  5. Central venous pressure monitoring

TYPES

  1. Peripherally Inserted Central Catheter (PICCs)
  2. Non tunneled catheter
  3. Tunneled catheter
  4. Implanted ports

DESCRIPTION

This is an airway clearance technique to expand the lungs using an incentive spirometer after a major surgery or diseases of the lungs.

AIMS

  1. Open the alveoli for adequate gaseous exchange
  2. Mobilize mucus and other fluids from the lungs
  3. Strengthen the lungs
  4. Facilitate slow deep breath

TYPES

  1. N/A

DESCRIPTION

This is the act of ensuring and providing a stable cervical immobilization to facilitate adequate ventilation in the event of cervical injury.

AIMS

  1. Maintain adequate ventilation in patient with cervical spine injury
  2. Maintain patent airway

TYPES

  1. N/A

DESCRIPTION

This is the process of taking blood from an artery primarily to determine Arterial Blood Gases (ABGs).

AIMS

  1. Analyse, interpret and intervene abnormal values of ABGs
  2. Correct electrolyte imbalances
  3. Ensure adequate hydration (lactate levels)

TYPES

  1. N/A

DESCRIPTION

This is the process by which a catheter is placed in the radial artery for continuous blood pressure monitoring and blood sampling in the critically ill patient/client.

AIMS

  1. Real-time monitoring of blood pressure
  2. Arterial blood gases
  3. Other Diagnostic testing

TYPES

  1. N/A

DESCRIPTION

This is the process of administering prescribed dopamine at a controlled rate via a syringe pump.

AIMS

  1. For inotropic support
  2. To treat symptomatic Bradycardia
  3. Manage post cardiac arrest

TYPES

  1. N/A

DESCRIPTION

This is the process of administering prescribed adrenaline/epinephrine at a prescribed and controlled rate.

AIMS

  1. Maintain blood pressure control in severe life-threating hypotensive situations
  2. Treat the symptoms of cardiac arrest
  3. Treat symptomatic bradycardia
  4. Strengthen cardiac contractility
  5. Open up the bronchioles in the lungs
  6. Treat severe allergic reaction (Analphylaxis)

TYPES

  1. N/A

DESCRIPTION

This is the process of administering prescribed Noradrenaline/Norephinephrine via syringe pump at a controlled or regulated rate.

AIMS

  1. Treat severe cardiogenic shock with hypotension and low total peripheral resistance
  2. Treat Ischemic heart diseases

TYPES

  1. N/A

DESCRIPTION

This is the process of replacing depleted electrolyte at a prescribed and controlled rate.

AIMS

  1. Treat and prevent low serum potassium
  2. Prevent cardiac failure
  3. Prevent arrhythmias

TYPES

  1. N/A

DESCRIPTION

This is the process of administering prescribed Nitroglycerin via infusion at a regulated or controlled rate.

AIMS

  1. Treat and prevent chest pain (anti-angina for ischemic pain)
  2. Treat heart failure, high blood pressure

TYPES

N/A

DESCRIPTION

This is the process of administering sedative which works by slowing activity in the brain to induce relaxation and sleep at a controlled rate.

AIMS

  1. Treat symptoms of status epilepticus
  2. Provide sedation
  3. For anaesthesia purposes

TYPES

  1. N/A

DESCRIPTION

This is the process of replacing depleted electrolyte at a prescribed and controlled rate as well as treating some medical conditions.

AIMS

  1. Treat and prevent low serum magnesium
  2. Prevent and control of seizures in pre-eclampsia and eclampsia
  3. Acute nephritis in children
  4. Treat severe Asthma exacerbation

TYPES

  1. N/A

DESCRIPTION

This is the process of administering injection morphine (narcotic analgesia) which acts on the central nervous system to relieve pain at a controlled rate.

AIMS

  1. Management and relive of pain
  2. For anaesthesia purposes

TYPES

  1. N/A

DESCRIPTION

This is the process of administering prescribed heparin infusion (anticoagulant) to decrease the clotting ability of the blood and help prevent clots from forming in blood vessels.

AIMS

  1. Treat and prevent DVT, PE, and Atrial fibrillation
  2. Prevent blood clotting during open heart Surgery, Bypass surgery and Dialysis
  3. Treat unstable angina
  4. Anticoagulation of post mechanical valve replacement

TYPES

  1. N/A

DESCRIPTION

This is the process of setting up a transducer for monitoring the pressure in the right atrium and vena cava (CVP) of the critically ill patient. The transducer is a device that converts electrical energy into electronic figures.

AIMS

  1. Assess patient/client volume status
  2. Assess cardiac preload
  3. Guide fluid resuscitation
  4. Aid in the diagnosis of right-sided heart failure

TYPES

  1. N/A

DESCRIPTION

This is an emergency life-saving intervention performed in the absence of spontaneous heartbeat and respiration. It is a combination of chest compression and giving of rescue breaths.

AIMS

  1. Support life by means of haemodynamic, through chain of activities
  2. Prevent irreversible cerebral damage from anoxia
  3. Save the life of the patient
  4. Restore cardiopulmonary function

TYPES

  1. N/A

DESCRIPTION

Cardiopulmonary Resuscitation (CPR) is a fundamental life support technique aimed at providing oxygen to the brain and the heart until appropriate definitive medical treatment can reinstate regular heart ventilatory function.

AIMS

  1. Maintain an open and clear airway
  2. Maintain vital blood flow
  3. Ensure continuous oxygenation to the brain
  4. Sustain adequate oxygen supply to the heart
  5. Preserve life until definitive medical treatment
  6. Support life by means of haemodynamics, through chain of activities
  7. Prevent irreversible cerebral damage from anoxia
  8. Save the life of the patient
  9. Restore cardiopulmonary function

TYPES

  1. N/A

DESCRIPTION

A series of life-saving interventions performed after unsuccessful Basic Life Support. This may involve invasive procedures such as intubation, IV medication administration (epinephrine) and ends with post cardiac arrest care.

AIMS

  1. Optimize patient/client’s chances of survival
  2. Restore cardiopulmonary function
  3. Prevent severe vital organ damage
  4. Identify and treat reversible causes of cardiac arrest

TYPES

  1. N/A

DESCRIPTION

This is the process of administering prescribed insulin infusion via infusion pump at a controlled and regulated rate.

AIMS

  1. Control patient blood sugar level
  2. Adjunct for correction of electrolyte imbalance

TYPES

  1. N/A

DESCRIPTION

This is an airway clearance technique using the chest vibrator, coupled with chest percussion and is applied during therapy to help patient clear mucus from the airway.

AIMS

  1. Open the alveoli for adequate gaseous exchange
  2. Mobilize mucus and other fluids from the lungs
  3. Strengthen the lungs

TYPES

  1. N/A

DESCRIPTION

This is the process of administering oxygen as a medical treatment. It is also known as supplemental oxygen.

AIMS

  1. To treat hypoxia
  2. Used in cardiac arrest and respiratory arrest
  3. Used in Systemic hypotension
  4. Low cardiac out state and metabolic acidosis
  5. Respiratory distress
  6. During and after anesthesia

TYPES

  1. N/A

DESCRIPTION

This is the process of assembling the accessories of the mechanical ventilator and checking for its functions for patients’ use.

AIMS

  1. Set up and provide mechanical ventilatory support for critically ill patients who has compromised airway or an organ failure.

TYPES

  1. Adult setting
  2. Paediatric setting

DESCRIPTION

A 12-lead ECG is a procedure done to record the electrical activities in the heart to check for different cardiac conditions. The data generated is displayed as wave forms known as electrocardiograph.

AIMS

  1. Identify myocardial ischemia and infarction
  2. Detect rhythm and conduction disturbances
  3. Determine chamber enlargement
  4. Determine electrolyte imbalances and drug toxicity

TYPES

  1. N/A

DESCRIPTION

The is the act of administering medication directly by inhalation, with the help of a nebulizer that converts liquid medicine into mist. This is then given to the patient with the help of a breathing mask.

AIMS

  1. Prevent and treat airway and lungs disorders
  2. Loosen lung secretions

TYPES

  1. Jet type (Oxygen or compressed air driven type)
  2. Ultrasonic type

DESCRIPTION

This is the process of administering medication directly by inhalation, using a T-piece attached to a nebulising chamber that converts liquid medicine into mist. This is then given to the patient with an artificial airway in-situ. (ET tube or Tracheotomy tube).

AIMS

  1. Prevent and treat airway and lungs disorders
  2. Loosen lung secretions

TYPES

  1. N/A

DESCRIPTION

This is the process of administering mucolytic agents and bronchodilators into the lungs via the mechanical ventilator. The strategy is aimed at the prevention of sputum plugging, atelectasis, and pneumonia in intubated and ventilated patients in the Intensive Care Unit (ICU).

AIMS

  1. Prevent and treat airway and lungs disorders
  2. Loosen lung secretions

TYPES

  1. N/A

DESCRIPTION

This is the procedure of removing pulmonary secretions from a patient through a multi-use suction catheter which is inserted into an artificial airway.

AIMS

  1. Ensure patent airway
  2. Improve gas exchange

TYPES

  1. N/A

DESCRIPTION

This is the procedure whereby a single-use suction catheter is inserted into the artificial airway of a patient for the purpose of removing pulmonary secretions.

AIMS

  1. Ensure patent airway
  2. Improve gas exchange

TYPES

  1. N/A

DESCRIPTION

This procedure provides a comprehensive and systematic approach of examining an unconscious patient using different skills, scales and tools.

AIMS

  1. Provide physiological stability and make a diagnosis
  2. Optimize patient outcomes

TYPES

  1. N/A

DESCRIPTION

The procedure describes the appropriate process for taking a blood sample from a critically ill patient’s vein or artery in the ICU (intensive care unit).

AIMS

  1. For diagnostic purposes such as abnormalities of blood chemistry, including kidney failure and dehydration
  2. Determine treatment outcomes of critically ill patients

TYPES

  1. N/A

DESCRIPTION

This is a comprehensive process for receiving potentially severe and physiologically unstable patient into the acute care unit.

AIMS

  1. To initiate immediate expert care
  2. To provide continuous monitoring
  3. To provide advanced life support

TYPES

  1. Planned admission
  2. Emergency admission

DESCRIPTION

This is the act of moving the critically ill patient from the intensive care unit to another unit/facility for investigations or continuity of care.

AIMS

  1. Carry out investigations such as radiology and endoscopy
  2. For further management

TYPES

  1. N/A

DESCRIPTION

It is the process of checking capillary blood glucose in a patient. The blood sample could be obtained from any digit of the upper and lower limbs, earlobe and heel unless contraindicated.

AIMS

  1. Monitor patient’s blood glucose levels for prompt intervention
  2. To guide clinical decision on treatment options
  3. For diagnosis of certain conditions e.g. hypoglycaemia for prompt resuscitation

TYPES

  1. Fasting blood sugar (FBS)
  2. Random blood sugar (RBS)

DESCRIPTION

This procedure outlines how to administer nutrition safely by bypassing the digestive system to a critically ill patient. Feeding is therefore delivered via intravenous route usually through a central vein such as the superior vena cava.

AIMS

  1. Meet patient’s nutritional requirement when oral or enteral nutrition is contraindicated
  2. Provide sufficient calories, nutrients and amino acids to match energy expenditure
  3. Need to avoid using the digestive system for a while so it can heal

TYPES

  1. N/A

DESCRIPTION

This outlines the systematic daily care of the central venous catheter by the nurse. It involves assessment and sterile dressing of the catheter. The catheter insertion site is oobserved at least 3 times per day.

AIMS

  1. Prevent catheter based skin site and related blood stream infection, central line thrombosis and mechanical complications

TYPES

  1. N/A

DESCRIPTION

This procedure outlines the technique involve in removing Central Venous Catheter (CVC). It involves an aseptic non touch technique way of removal. Central Venous Catheter should be removed as soon as they are no longer required and their necessity should be reviewed on a daily basis by the ‘on-call’ Anesthetist or Physician. Care should be taken to prevent air embolism.

AIMS

  1. Prevent the risk of central venous catheter colonization

TYPES

  1. N/A

DESCRIPTION

Cardioversion is a medical procedure that uses quick, low-energy shocks to restore a regular heart rhythm. The process is use to convert certain irregular heartbeats back to sinus rhythm.

AIMS

  1. Based on ACLS (Advanced cardiac life support) guidelines, it is used to treat:

TYPES

  1. Electrical cardioversion
  2. Chemical cardioversion

Preparation prior to the procedure

  1. Synchronous cardioversion preparation involves:
  2. Obtaining a 12 Lead electrocardiogram that gives details of the heart's electrical activity
  3. If this is a planned procedure:
    1. Sedation will likely be used. Therefore, an anaesthesia team member will evaluate the patient and prepare sedation
    2. Instruct patient not to drink for a least eight hours prior to the procedure
    3. Blood thinning medicines may be given with planned electrical cardioversion to prevent clots from moving to the heart
    4. Instruct patient to take their regular medications the morning of the procedure unless otherwise advise by their physician
    5. Stop digoxin 48hrs prior to the procedure
    6. Tell patient to come along with the list of all their medications

  4. Do not apply any lotions or ointment to chest or back as this may interferes with the adhesiveness of the defibrillator shocking pad

DESCRIPTION

Defibrillation is the act of administering a transthoracic electrical current to a person experiencing one of the two lethal ventricular arrhythmia.

AIMS

  1. Treat Pulseless ventricular tachycardia
  2. Treat ventricular fibrillation

TYPES

  1. N/A

DESCRIPTION

This process describes the removal of an endotracheal tube from the trachea. Early extubation obviates ventilator dependence and preserves respiratory muscle function. The timing of extubation (day, evening, night) depends on the institution and individual ICU, but the most critical factor to consider is the availability of adequately experienced personnel.

AIMS

  1. Prevent complications associated with prolonged intubation such as vocal cord paralysis and tracheomalacia
  2. Allow the patient to regain his/her ability to eat, drink and talk
  3. Following caseation of anaesthesia

TYPES

  1. N/A

Criteria for Extubation

  1. Patient should be awake and able to follow commands
  2. GCS should be > 8/15
  3. Must be off sedation
  4. Maintain an open airway
  5. Adequate oxygenation (i.e. PO2 >60mmHg on FIO2 of 0.5, PEEP <=5cmH20, P/F ratio >150 and Spo2>90%)
  6. Acceptable ventilator parameters
  7. Tidal volume > 5ml/kg
  8. Vital capacity > 10mls/kg
  9. Patient must be afebrile (Temp < 38*C)
  10. Patient must be stable medically
  11. No significant acidosis
  12. Stable metabolic status and acceptable electrolyte values
  13. After a successful weaning trial

DESCRIPTION

This is the process of maintaining oral hygiene in a patient who has been intubated in order to maintain the integrity of the mucous membranes, teeth, gums and lips.

AIMS

  1. Decrease tooth decay
  2. Prevent halitosis
  3. Prevent Ventilator Associated Pneumonia

TYPES

  1. N/A

DESCRIPTION

Central venous pressure (CVP) is the measurement of the filling pressure in the thoracic vena cava near the right atrium. CVP represents the driving force for filling the right atrium and ventricle. It is measured by using a central venous catheter advanced via the internal jugular/subclavian/femoral vein and placed in the superior vena cava near the right atrium with a pressure manometer or a transducer. A normal central venous pressure reading is between 8 to 12 mmHg. However, normal a pressure of 0-6mmHg in a spontaneously breathing non-ventilated patient is considered normal.

AIMS

  1. Used to estimate a patient's fluid volume status
  2. Assess cardiac function
  3. Assess how well the right ventricle of the heart is functioning

TYPES

  1. Electronic using a transducer
  2. Manual using a manometer rule

USING A TRANSDUCER

DESCRIPTION

Central venous pressure (CVP) is the measurement of the filling pressure in the thoracic vena cava near the right atrium. CVP represents the driving force for filling the right atrium and ventricle. It is measured by using a central venous catheter advanced via the internal jugular/subclavian/femoral vein and placed in the superior vena cava near the right atrium with a pressure manometer or a transducer. A normal central venous pressure reading is between 8 to 12 mmHg. However, normal a pressure of 0-6mmHg in a spontaneously breathing non-ventilated patient is considered normal.

AIMS

  1. Used to estimate a patient's fluid volume status
  2. Assess cardiac function
  3. Assess how well the right ventricle of the heart is functioning

TYPES

  1. Electronic using a transducer
  2. Manual using a manometer rule

USING A MANOMETER

DESCRIPTION

This is the process of cleaning arterial lines aseptically to prevent catheter associated infections.

AIMS

  1. Prevent catheter associated infection
  2. Prevent complications

TYPES

  1. N/A

DESCRIPTION

The is a procedure done for patients with new or recent tracheostomy. The care includes suctioning, keeping the flange, dressing, ties or straps and surrounding area clean.

AIMS

  1. Maintain patent airway
  2. Prevent infection of tracheostomy site
  3. Promote comfort
  4. Promote healing and prevent skin excoriations around the trachy site
  5. Prevent tube dislodgment

TYPES

  1. N/A

DESCRIPTION

Tracheal intubation is the placement of a flexible plastic tube into the trachea to maintain an open airway or to serve as a conduit through which certain drugs are administered via the oro-tracheal or the naso-tracheal route.

AIMS

  1. Keep the airway open in order to give anaesthesia, medicine or oxygen
  2. Support respiration in certain conditions such as Respiratory failures (type 1&2) ARDS, Status asthmaticus, COPD, Aspiration pneumonitis
  3. Remove blockages from the airway especially in Neuromuscular disorders such as Myasthenia Gravis, Guillain Barre syndrome (GBS)
  4. Allow a better view of the airway Peri arrest and Cardiac arrest
  5. Prevent aspiration in patients who are unable to protect their airways E.g. Acute Decreased Level of Consciousness i.e. GCS >3 in less than 4hours and CVA

TYPES

  1. Direct laryngoscopy via oro or naso route
  2. Video laryngoscopy