SUMMARY
INTRODUCTION: Intensive care units (ICUs) are specialist hospital wards. They provide intensive care (treatment and monitoring) for people in a critically ill or unstable condition. ICUs are also sometimes known as critical care units or intensive therapy departments. A person in an ICU needs constant medical attention and support to keep their body functioning. They may be unable to breathe on their own and have multiple organ failure. Medical equipment will take the place of these functions while the person recovers. There are several circumstances where a person may be admitted to an ICU. These include after surgery, or following an accident or severe illness. The Special Hospital for Surgical Diseases”Filip Vtori” was established on 01.03.2000 and from the very beginning of its existence, it represents a new and original concept in medicine based on modern medical technology, prime education of staff, intensive work and uncompromising dedication and humanity for patients. The Intensive Care Unit in SHSD “Filip Vtori” is a 15-bed unit that provides care to patients requiring pre- and post-operative care for cardiac surgical conditions. Care in this unit is provided on a continuous 24-hour basis and is available for critically ill patients requiring intensive care as well as patients requiring intermediate care (IMC). A critical care intensivist rounds daily with other care providers.
Invasive procedures conducted in our ICU are:
Central venous catheter – CVK is a catheter placed into a large vein in the neck (internal jugular vein), chest (subclavian vein or axillary vein) or groin (femoral vein).
Position of CVK
Indications
Hemodynamic monitoring
Administration of drugs likely to induce phlebitis
Temporary cardiac pacemaker
Hemodialysis
Lack of peripheral venous access
Use of Vigileo
Arterial catheter – is a thin catheter inserted into an artery. It is most commonly used in intensive care medicine and anesthesia to monitor the blood pressure real-time (rather than by intermittent measurement), and to obtain samples for arterial blood gas measurements.
Insertion of arterial catheter
Indications
Continuous direct blood pressure(BP) monitoring
Inability to use indirect BP monitoring
Frequent blood sampling
Intraaortic ballon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing cardiac output. Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery. It consists of a cylindrical polyethylene balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery and counterpulsates. That is, it actively deflates in systole, increasing forward blood flow by reducing afterload through a vacuum effect. It actively inflates in diastole, increasing blood flow to the coronary arteries via retrograde flow. These actions combine to decrease myocardial oxygen demand and increase myocardial oxygen supply.
Placement and use of IABP
Indications
Cardiogenic shock
Non stabile angina
Acute myocardial infarction with hemodynamic instability
Acute left heart failure
Chronic left heart failure
High left main stenosis with hemodynamic non stability
IABP pre-op. 2781(81.2%) pts.
IABP post op. 644(18.8%) pts.
IABP total 3425 (23,9%) of 14 589 operated patients
A Tracheotomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube.
Tracheostomy tube with “nose” and on ventilator
Indications
To facilitate weaning from positive pressure ventilation in acute respiratory failure or prolonged ventilation.
To secure and clear an airway in the upper respiratory tract where obstruction is a risk.
To facilitate the removal of respiratory secretions.
To protect/minimise risk of aspiration in the patient with poor or absent cough reflex.
To obtain an airway in patients with injuries or surgery to the head and neck area.
In certain circumstances the tracheostomy may facilitate:
Improved oral hygiene for the intubated patient
Decreased requirement for sedation in the intubated patient
Oral movement for communication, nutrition and hydration (with manipulation)
Reduction in damage to the larynx, mouth or nose from prolonged endotracheal intubation
Vocalisation (with manipulation)
Improved patient comfort
Renal Replacement Therapy – (RRT); Continuous veno- venous hemofiltration (CVVH) The goal of any continuous renal replacement therapy (CRRT) is to replace, as best as possible, the lost function of kidneys. CRRT provides slow and balanced fluid removal that even unstable patients – those with shock or severe fluid overload – can more easily tolerate.
Patient on IABP and CRRT
Indications
Normal water balance
Electrolyte control
Coagulation control
Decreasing of serum urea and creatinine level
Good patient comfort- without muscle cramps, hypoglycemia, parenthesis and vomiting
Continuous veno-venous hemofiltration (CVVH) in progress
Percutaneus endoscopy gastrostomy – PEG is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient’s stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate (for example, because of dysphagia or sedation).
Set for percutaneous endoscopic gastrostomy
Indications
Neurologically unsafe swallowing:
Acute ischaemic or haemorrhagic stroke:
Chronic progressive neuromuscular disease.
Failure of feeding:
Dementia
Cystic fibrosis
Peritoneal dialysis
Percutaneus chest tube is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum. It is also known as a Bülau drain or an intercostal catheter.
Placement phases of percutaneous chest tube
Indications
to remove air (pneumothorax)
or fluid (pleural effusion, blood, chyle),
or pus (empyema) from the intrathoracic space
Discussion
These invasive procedures are done on patient’s bedside by our intensivist mostly in life treating situations, saving patient’s lives. The planned procedures are convenient to the patients as well as for staff members because they are shortening the time to getting adequate treatment, are performed in patient’s familiar settings by familiar faces and the time to get results are much faster considering transport related time spending. Prompt and timely diagnostics based on modern imaging techniques provides right diagnosis at the right time for every patient. That is why performing these procedures on patients bed most of the times is life saving.
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