What to expect when you visit ICU - The Equipment
The equipment in a critical care area can seem frightening at first. It may help to understand what the various pieces of equipment are for and what the readings they display mean.
It is common for patients to be connected to a number of different machines or devices whilst in the ICU. These include:
Breathing machine or ventilator, which needs a tube in the mouth or nose into the windpipe or sometimes through the neck, "tracheostomy" or "trachy".
Infusion pumps giving drugs and fluids to patients through "drips" in the veins or a large "central line" in the main veins in the neck.
A tube in the nose going into the stomach, "nasogastric tube" for feeding.
A tube or "catheter" in the bladder draining the urine.
A kidney filtration or dialysis machine
A ventilator is a machine that helps the patient to breathe. A tube may be inserted into the windpipe via the nose, mouth or via the windpipe itself, which is a tracheostomy, or face mask may be worn by the patient. A tracheostomy is usually performed if ventilation is needed for more than a few days. The advantage of a tracheostomy is that a patient does not need to receive sedatives but it may not be suitable for all patients. As a patient's condition improves he or she can be weaned off the ventilator.
If the patient's kidneys are not working normally, he or she will need to be attached to an artificial kidney machine. This works in a similar way to a dialysis machine, which removes waste from the blood and manages fluid levels. Blood circulates from the body through the dialysis machine, where it is filtered and then returned. If the kidneys are working normally, patients may have a urinary catheter so that urine samples can be taken to check the condition of the kidneys.
You may see a number of tubes and drips attached to the patient. These are used for a variety of purposes, including taking blood samples, providing water and liquid food, giving drugs and draining waste.
Most commonly, a feeding tube is inserted into the stomach via the nasal passage or through the wall of the abdomen into the small intestine.
Sometimes a patient is unable to tolerate tube feeding so they will be fed intravenously whereby nutrients are injected directly into their blood stream. Similar to tube feedings the intraveneous feeding ensures the patient receives the right amount of protein, carbohydrate, fat, vitamins, and minerals.
A monitor by the patient's bedside records heart rate, blood pressure and oxygen levels in the blood. The patient will be connected to this via a number of leads. Monitors bleep if levels are falling or rising outside normal ranges. But don't be too alarmed if you hear the monitor making a different sound. On most occasions, the monitor is simply drawing the attention of a nurse to check the patient's condition.
Many patients need help with breathing and to do this they usually need to be sedated and have a tube put into their airway, "Endotracheal tube" or ETT. Initially this tube goes through the mouth and into the windpipe. Sometimes a tube is put through the nose and into the windpipe.
If patients are likely to need the tube for a long time or if there are likely to be difficulties waking the patient up and removing the tube then a procedure is performed to put the tube directly into the windpipe throught a small hole in the front of their neck. This is called a tracheostomy or tracheotomy ("trachy"). Patients usually cannot tolerate having a tube through their mouth into their windpipe if they are awake, but can tolerate it through a tracheostomy, so it enables us to use much smaller doses of sedative drugs.
Patients still can't talk as all the air goes in and out through the tube and not through their voice box (which is above the tracheostomy tube). As patients start to recover special tracheostomy tubes that allow some air through the voice box (larynx) and this enables some patients to talk even with a tracheostomy in place.
This is the machine that helps the patient to breath. At its simplest the machine blows air into the patient through a tube in their windpipe and then lets it back out again. A massive amount of research goes into working out the best way to do this to cause as little harm as possible and to best help patients. Modern ventilators use complex computers to enable patients to breath as much as possible for themselves with variable amounts of help from the machine. These machines cost tens of thousands of pounds each.
More and more commonly patients are provided help with breathing by using "non-invasive" ventilators. These machines use a tight fitting facemask, nasal mask or even a helmet to give support to each breath. They look uncomfortable at first but many patients get used to them very quickly and this means they don't need to be put to sleep and don't need a tube putting into their windpipe. This protects the patient from a lot of the complications of being on a ventilator, particularly the risk of getting secondary pneumonia (chest infection). There are some conditions that respond very well to this treatment, but there are still many circumstances when this treatment cannot be used and a "normal" ventilator and tube is used.
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 machines take over this job. If this isn't done the patient's blood becomes more and more acid and the potassium builds up and this would eventually stop their heart working. If patients are well then the kidney doctors can put them on a dialysis machine two or three times a week for a few hours and quickly remove the waste products that have built up. Patients who are very unwell however can't cope with this rapid removal of waste material and fluid and on intensive care a more gentle process called "haemofiltration" is normally used which slowly filters the blood. To do this a special large tube is put into one of the big veins in the leg or neck.
What the machines do and what the numbers mean
Patients in intensive care are constantly monitored to track their condition and alert staff of changes. This monitoring routinely includes measurement of:
Heart rate and heart electrical tracing, "ECG"
Oxygen levels in the blood, "sats"
Pressure in the veins, "CVP"
All the fluids, food and drugs given to patients
Where appropriate staff may also monitor: