The intensive care unit is one of the most unnerving areas in a hospital, and it is quite normal to be anxious and worried about your visit.
The machines in the ICU make a variety of sounds, such as bleeps and alarms. Some sounds make staff aware of slight changes to a patient’s condition, or alert them when something needs attention. A few alarms need the nurse’s immediate attention but most just or show standard monitoring. Some of the main ICU machines and what they do are described below:
Ventilators and breathing tubes
Some patients in the ICU need help breathing. To help them they sometimes need to be sedated and use a breathing tube attached to a machine called a ventilator.
Modern ventilators use complex computers to allow patients to breath as much as they can for themselves with variable amounts of help from the machine.
Sometimes when a patient is using a ventilator they wear a tight fitting mask over their nose and mouth to help them breath. This is called non-invasive ventilation. This looks uncomfortable, but most patients get used to them very quickly. This means they do not need to be so deeply sedated or need a tube putting in their windpipe.
If a patient needs more help breathing they can have a tube placed in their windpipe. This is usually through their mouth although very occasionally it can be put through the nose. This is uncomfortable so the patient will be sedated to make this less invasive
Sometimes, if a patient needs to be on a ventilator for more than a few days, they may have a small operation called a tracheostomy. This is where the tube is put directly into their windpipe (trachea) through a small incision in the front of the neck. This is more comfortable, means the patient does not need to be so heavily sedated and makes chest infections less likely.
The tracheostomy is performed by a doctor who is skilled in anaesthesia or critical care. The procedure is always done under general anaesthetic.
In rare situations the patient may need to have a surgical tracheostomy, which is done in an operating theatre.
If your relative requires a tracheostomy, the doctors will discuss the procedure with you.
Sometimes patient’s kidneys stop working properly due to their illness. The kidney works to filter the blood and remove waste products, which are passed out of the body as urine. If this fails, a machine called a dialysis machine can take over this job. To do this a large tube is put into one of the bigger veins in the leg or neck.
Patients in intensive care are constantly monitored to track their condition and alert staff to changes. Monitors that are used to keep track of the patient’s condition often measure:
- Heart rate and heart electrical tracing (ECG)
- Oxygen levels in the blood
- Blood pressure
- Pressure in the veins (CVP)
- Urine output
- All the fluids, food and drugs the patient takes
The monitors track even tiny changes in the patient’s condition and will inform ICU staff.
Monitors often make a lot of noises, this does not necessarily mean something dangerous has happened. Often alarms are just to let the staff know the patient’s condition.
These are plastic tubes sometimes referred to as “drips”. These are inserted into the patient’s blood vessels. The lines help to give fluids or medication and to help monitor blood pressure or take blood samples for regular testing.
Common lines include:
This is a very thin tube that is inserted into one of the patient’s arteries, usually in the arm. This allows ICU staff to measure patient’s blood pressure and concentration of oxygen and carbon dioxide in the blood.
This is a thin tube that is inserted into a larger vein, normally in the neck, shoulder or groin. This is to measure blood pressure, take samples or to give the patient concentrated medication or fluids.
Dialysis line or Vascath
These lines are inserted into a big vein like the central line, although these tubes are bigger and are attached to a kidney machine in order to perform the job of the kidneys.
These lines are inserted into one of the veins in the upper arm and are long enough to reach the bigger veins close to the heart. These lines are useful as they have a lower chance of infection, so can be used to help the patient for longer.
How lines are inserted
Lines are inserted by a doctor or nurse who is experienced in the procedure and lines are inserted under local anaesthetic to make the patient more comfortable.
Feeding in ICU
Patients in ICU are at risk of malnutrition because of their illness. It is therefore important to ensure the patient gets the nutrition and calories they need to fight their illness and help their recovery.
A nasogastric tube is the most common type of feeding tube used in the ICU. These are long, thin tubes that are inserted by a doctor or nurse. The tube goes down the patient’s nose, down the oesophagus until it reaches the stomach.
These tubes can then be used to feed patients who cannot eat and drink for themselves, as well as empty the patient’s stomach content.
The position of the feeding tube is checked by x-ray or by pH test to make sure it is in the right position.
If a patient has problems absorbing nutrients through their stomach, an intravenous line can be used to put nutrients directly into their blood stream.
If there is a problem with feeding via a nasogastric tube, a nasojujunal tube might be used instead. This tube goes though the patient’s nose like the nasogastric tube, but instead of going to the stomach it takes the nutrients directly to the small intestine instead. X-rays or other scanners are used to make sure the tube is positioned correctly.
A PEG (Percutaneous Endoscopic Gastrostomy) tube is inserted through the skin in the abdomen leading directly to the stomach. These tubes are inserted if the patient needs long term feeding or if there is a risk they might inhale the nutrients into the lungs. This is a more complicated procedure and is carried out by a surgeon.
A urinary catheter is a flexible tube that is inserted into the bladder to drain urine. This is essential whilst the patient can’t use the toilet normally. It is also important to check the amount of urine the patient produces to check that their kidneys are functioning properly.
The tube is inserted by a doctor or nurse via the urethra until it reaches the bladder. Once in the bladder, a balloon on the end of the tube is inflated to keep the tube in place.
Your relative may need to have further testing carried out whilst they are staying in ICU. Some of these test can be carried out on the unit, whilst others need specialist machinery and equipment.
CT and MRI
Computerised tomography scans (CT or CAT scans) and Magnetic Resonance Imaging (MRI) can be used to get a clearer picture of what is going on inside a patient than can be seen with an x-ray. To have these scans, the patient will need to be taken to the x-ray department, as the machines that are used are very large. Whilst they are being transferred and scanned, they will be escorted and monitored by a specially trained doctor or nurse who can give any treatment they require.
Ultrasound is a commonly used device in the ICU. It is used to help doctors when they are inserting lines, as well as being an easy to use and safe scanning tool. The scanner is portable and can be used at your relative’s bedside.
The scanner works by emitting a very high frequency sound, which is too high pitch for people to hear. The machine then detects the echos of that sound from things inside the body, which is then turned into a picture by the computer. This is completely safe and is very useful to check what’s going on inside a patient without having to have specialist scans.