Protocols equipments and supplies pp.pptx

A presentation to provide a brief knowledge regarding ICU protocols used to treat critically ill patients

1. Intensive care unit

2. Protocols, equipment & supplies Of Critical/Intensive care unit Submitted to ~ Ms. SAKSHI KANWAR [lecturer medical surgical nursing] Submitted by ~ Ms. Isha B.Sc. ( N ) 3 rd year Roll no. ~45 Submitted on~ 21/08/2023

3. Introduction •Intensive care units (ICUs) are specialist hospital wards that provide treatment and monitoring for people who are very ill. They’re staffed with specially trained healthcare professionals and contain sophisticated monitoring equipment. It is an organized system for the provision of care to the critically ill patients that provides intensive & specialized medical &nursing care

4. Protocols of Icu/ccu The most common meaning of protocols is the correct conduct & procedures followed in formal situations. “A set of rules & guidelines for communicating data.” “A detailed plan for a medical experiment, treatment or procedure.” According to Alan Morris ~ Precise & detailed plans for the study of a medical or biomedical problem or for a regimen of therapy.

5. What is the need For Protocols ?

6. Proper use of protocols helps physician more frequently treat the similar patients. Protocols have potential to minimize medical errors and increases patient’s safety. It improves patients outcomes. It minimizes inconsistencies in the care of similar patients. It can prove useful when applied in a judicious & thoughtful fashion It reduces variations in the treatment of patients. It may facilitate the teaching of appropriate clinical management for selected disease. Need for the protocols

7. Protocols used in ccu/icu Basic life support (bls) protocol Advanced cardiac life support(acls) protocol Stress Related ulcer prevention protocol Deep vein thrombosis protocol Sedation interruption protocol Weaning protocol Oral hygiene protocol

8. Basic life support (BLS) Protocol Basic Life Support (BLS) defines Sequences of procedures performed to restore the circulation of oxygenated blood after a sudden pulmonary or cardiac arrest until they can be given full medical care at a hospital.
BLS does not include the use of drugs or invasive skills.

9. Acls (advanced cardiac life support) Protocol Advanced cardiac life support, advanced cardiovascular life support (ACLS) refers to a set of clinical guidelines for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, using advanced medical procedures, medications, and techniques.
ACLS is designed for healthcare professionals who either direct or participate in the management of cardiopulmonary arrest and other cardiovascular emergencies.

10. Drugs used in acls protocol Epinephrine Vasopressin Adenosine Atropine Amiodarone Lidocaine Procainamide Sotalol

11. Stress ulcer prevention protocol

12. Stress ulcer prophylaxis Haemorrhage from stress ulceration is secondary GI bleeding (nosocomial GI bleeding), which is distinct from primary GI bleeding (GI bleeding that results in hospitalization) Prophylaxis ~ >250mg hydrocortisone /day Ppis (omeprazole, esmeprazole ,40mg, bd) Ranitidine (50mg, tds, iv) (150mg, bd, orally)

13. Deep vein thrombosis protocol Hospitalized patients are at increased risk of developing DVT (approximately 50%), increasing the risk of Pulmonary Embolism. Pulmonary Embolism is one of the most common but preventable causes of death in hospitalized patients.

14. Thromboprophylaxis

15. Sedation interruption protocol A daily interruption of sedation is a strategy designed to: reduce exposure to sedative agents. allow assessment of neurological status. assess readiness for extubation, and. reduce duration of mechanical ventilation Propofol and dexmedetomidine should be used as first line agents for sedation over benzodiazepines in critically ill, mechanically ventilated adult patients.

16. Benefits of daily sedation interruption Lowers the mortality rate Decreases dependency on mechanical ventilator Prevents over sedation Helps in neurological assessment Helps To avoid drug accumulation

17. Weaning protocol A weaning plan starts with assessing the ability of the patient for spontaneous breathing. Weaning is the process of decreasing the degree of ventilator support and allowing the patient to assume a greater proportion of their own ventilation

18. Three main strategies are used by clinicians to perform Spontaneous breathing trials ~ Simv (synchronized intermittent mandatory ventilation ) Psv (pressure support ventilation) T-piece trial

19. Oral hygiene protocol

20. Oral Hygiene Oral hygiene cleaning the teeth and the oral cavity of the patient. It includes the measures to prevent the spread of disease from mouth and increase the comfort of the patient ARTICLES- Articles needed for un conscious patients- A tray containing the following articles- Face towel Mackintosh with draw sheet Artery forceps Dissecting forceps Tongue depressor Mouth gag Potassium permanganate (1gm:5000ml) Gauze piece Emollients( Boroglycerine, Vaseline ) Cotton applicator

21. Rationale for good oral hygiene Oral care protocols (usually included in VAP bundles) show decrease in incidence of VAP
Oral care reflects preventive measures aimed at reducing pathogenic organisms, and promoting holistic patient care
Patient comfort
Prevention of halitosis

22. Advantages & disadvantages of protocols

23. Advantages Disadvantages Reducing unnecessary variability in care. Quick adoption of new information to the bed side Streamlining of care. Educational aids Improved communication Cost containment Decreases errors & improve patient safety Use in inappropriate patient. Loss of individualization of care. Potential to be obsolete if not kept current. Maybe Designed around Low quality evidence. Maybe oversimplified

24. Equipments & supplies Of Ccu/icu

25. Equipments & supplies Medical Equipment and Supplies means items used for therapeutic or diagnostic purposes essential for patient care. Equipment numbers & types are decided based on the existing standards of the country and the services provided. There should be a functional system in place to ensure the safe and accurate functioning of the machines and equipment. Periodically, the monitors have to be calibrated.

26. Basic equipments needed to organize a level iii icu/ccu is as follows : Ventilator Multi channel monitor Defibrillator and pacemaker Infusion/syringe pumps Fluid & bed warmer Portable transfer monitor Specialized beds Bedside trolley, drug cart, & emergency cart Patient lifting device Bedside ultrasound & echo machine Iabp or ventricular assist device Bedside bronchoscopy

27. For every patient, the following monitors should be available: Ecg monitor Pressure monitor Temperature monitor End-tidal co ² monitor Pulse oximeter Non invasive arterial pressure monitoring Ecmo (extracorporeal membrane oxygenation)

28. Ventilator A medical ventilator (or simply ventilator in context) is a machine designed to provide mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. At least one per bed.

29. Ventilator

30. Monitor Monitors in intensive care units (ICUs) provide information related to vital parameters in numerical and waveform formats

31. Emergency cart A crash cart is a set of trays/drawers/shelves on wheels used in hospitals for transportation and dispensing of emergency medication/equipment at site of medical/surgical emergency for life support protocols (ACLS/ALS) to potentially save someone’s life.

32. Infusion pump An infusion pump is a device that delivers fluids into a patient’s body in a controlled manner.
It is used to deliver nutrients or medications such as hormones, antibiotics, chemotherapy drugs, and pain relievers.

33. Defibrillator Defibrillation is a treatment for life- threatening cardiac dysrhythmias, specifically ventricular fibrillation and non- perfusing ventricular tachycardia. A defibrillator delivers a dose of electric current (often called a counter-shock) to the heart.
This process depolarizes a large amount of the heart muscle, ending the dysrhythmia. Subsequently, the body’s natural pacemaker in the sinoatrial node of the heart is able to re-establish normal sinus rhythm.

34. Defibrillator

35. Pressure monitor Blood pressure measurement is integral to the intensive care patient’s vital signs and is used to screen for hypertension, estimate cardiovascular risk, and diagnose, manage, and treat acute and chronic medical condition.
The blood pressure device most commonly used in the ICU is the sphygmomanometer.

36. Bed side ultrasound A bedside ultrasound examination is a very specific ultrasound scan that is performed whilst you are in your bed in the Emergency Department.

37. Echocardiogram Echocardiogram is a tool that support diagnosis, monitoring, management and clinical progress of critically-ill patients, in addition it works as therapeutic interventions.

38. Intra-aortic balloon pump [Iabp] The intra-aortic balloon pump is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through after load reduction.
It consists of a cylindrical polyurethane balloon that sits in the aorta, approximately 2 centimeters from the left sub clavian artery.

39. Extracorporeal membrane oxygenation [Ecmo] Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation.

40. Modified Heart- lung machine This machine is also called a cardiopulmonary bypass machine. It pumps blood while your heart is stopped and adds oxygen to the blood before it is pumped throughout the body. Use of Modified Heart-Lung Machine Life Support System is a Life-Saving measure for some Patients. The ECLS system uses a modified heart-lung machine to provide continuous circulation of blood to provide gas exchange and perfusion.

41. Heart-lung machine

42. References: Brunner & suddarth’s, “textbook of medical surgical nursing," volume-ii, south Asian edition; published by wolters kulver, page no:2146- 2147. https://www.slideshare.net/kuldeepvyas370/icu-equipment-232228257 https://cpr.heart.org/en/courses/basic-life-support-course-options