What is an Intensive Care Unit?
An Intensive Care Unit (ICU), also known as a Critical Care Unit (CCU), Intensive Therapy Unit or Intensive Treatment Unit (ITU) is a special department of a hospital that provides Intensive-Care Medicine and Intensive Care Nursing.
Intensive Care Units cater to Patients with the most serious injuries and illnesses, most of which are life-threatening and need constant, close monitoring and support from specialist equipment and medication in order to maintain normal bodily functions. They are staffed by highly trained doctors and critical care nurses who specialise in caring for the most severely ill patients. Both, Nurses and Doctors go through years of specialised training and studying in order to be proficient and highly skilled in their respective professions.
Patients may be transferred to an Intensive Care Unit from a ward, from an Emergency department/ Emergency Room, from another Hospital if they require constant monitoring, or immediately after surgery form the operating theatre/ operating room if the surgery is invasive or the Patient is at risk of complications.
For you as a Family member of a loved one that has been admitted to an intensive care unit, it means that he or she is suffering from an actual or potential life threatening condition. Although most Patients admitted to Intensive Care are suffering from a serious or life threatening condition and are considered a ‘high acuity’ admission, some Patients are admitted as a precautionary measure and are considered ‘low acuity’ admission. The Intensive Care Unit (ICU) of a hospital fulfils different functions depending on the size and the services the hospital itself delivers. Today the role of the ICU has evolved to the point, where many units are now admitting high dependency(lower acuity) Patients, as well as Critically Ill(high acuity) Patients. The admission procedure remains more or less the same in all Critical care Units, as usually one nurse or in severe cases a team of nurses is allocated to admit your loved one into the ICU. Depending on the severity of the admission, one doctor or a team of doctors is involved in the admission as well. What will be different between Patients are length of time and the complexity of the admission procedures.
- Getting a bed
- When a patient first arrives
- Plan of Care
- When can Visitors come in?
Getting an intensive care bed
Intensive Care or Critical Care beds are an expensive and scarce resource and the numbers of those beds are usually limited, even in the big metropolitan teaching hospitals.
Under most circumstances a doctor will identify the need for the Patient be admitted to the ICU and will ring the intensive care staff asking them to review the Patient. If the intensive care doctors agree that the Patient needs to be in Intensive Care and there is a bed available the Patient will normally be transferred to the ICU. Furthermore, often an ICU bed is pre-aranged, especially for elective surgery that requires critical care admission.
In some instances, ICU admissions are not pre- planned and often happen in a blink of an eye, especially if a Patient suffers a Cardiac or respiratory arrest in the hospital or sometimes Patients are deteriorating and a nurse or a doctor is calling a “met call” or for a medical emergency. It’s the same with accidents. It’s unexpected and severe accidents often require ICU admission.
When your loved one first arrives in Intensive Care:
- Your loved one will be connected to a number of technical equipment such as Bedside Monitors
- You can expect your loved one to have frequent Chest X-rays and blood tests(Blood& Pathology tests in Intensive Care) especially arterial blood gases (ABGs)
- Oxygen and respiratory support might be commenced via an oxygen mask or via Non- Invasive Ventilation(NIV) or BIPAP ventilation
- Full ventilation using a Ventilators(Breathing Machine) and a Breathing Tube (endotracheal tube) may be required to improve and maintain the oxygen delivery
- Your loved one will be thoroughly assessed by the doctors and the nurses to identify their condition and other problems. This will include a physical examination as well as blood tests and x-rays. It may be necessary for the staff to interview the next of kin for further information.
- Once your loved one has been assessed and stabilised, the intensive care staff will develop a care plan and implements the care plan. The care plan is often subject to how stable or unstable your loved one is and in severe cases it might take a while to adhere to an optimum care plan if your loved one is very unstable.
- Once your loved one has been stabilised, you and your Family should be able to visit and see your loved one. Do not hesitate to ask questions and usually the doctors and nurses are there to give you as much information as possible
- Patients who are critical and unstable may require immediate resuscitation and management
- The time frame and the length of the admission process may vary from sometimes less than half an hour to many hours, depending on the acuity and the severity of the illness. Immediate treatment required to stabilise your loved one takes priority and different treatments may have to be commenced at the same time and this can be a fairly lengthy process
Plan of care
Over the next few hours the plan of care will be implemented.
This will include a combination of:
- Establishing monitoring of vital functions
- Invasive procedures such as Line insertions, I.e. Arterial Line(Arterial Catheter), CVC(Central Venous Lines), PiCCO or Pulmonary Artery Catheters
- Further investigations and diagnostics such as Chest X-rays and blood tests(Blood& Pathology tests in Intensive Care and ECG. However more complex tests such as CT scans or MRI may be required.
- Treatment to support major organs:
- Lungs – Oxygen therapy, Non- Invasive Ventilation(NIV) or BIPAP or Intubation(insertion of a Breathing Tube or Endotracheal Tube) and mechanical ventilationVentilators (Breathing Machines).
- Heart – medications for shock, such as Inotropes or insertion of an Intra-Aortic Balloon Pump (IABP).
- Kidneys – commencing dialysis or Renal Replacement Therapy, where your loved one requires a Dialysis Catheter to commence Dialysis on a Dialysis Machines.
- Procedures or surgery
- Such as the insertion of chest drains(Under Water Seal Drain & Chest Tube) or surgery to stop bleeding or relieve pressure on the brain
The plan of care will be amended as the Patient’s condition changes and new information is received
When can Visitors come in?
Visitors are generally admitted at the earliest opportunity however on occasion this may be several hours. Whilst communicating with the visitors is seen as important the medical priority is stabilising the Patient’s condition. Social worker services and/or pastoral care workers are available at a number of hospitals, including after-hours in some of the larger hospitals. Social workers can act as a liaison between ICU staff and provide visitors with updated information on the condition of the Patient. Social workers are trained to assist people in crisis and can provide information on issues such as accommodation and where to eat. They may also be able to assist with legal and financial issues. Reversal of social worker assistance early on does not mean that these important services cannot be accessed at a later time. Please refer to the visiting policy in your Intensive care for further explanations). Social worker support after hours may be difficult to arrange, but is usually available during business hours Monday- Friday. Most major metropolitan ICU’s have support services such as Social work and pastoral care workers are available on weekends as well.
Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.
All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
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