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Intensive Care Unit

Intensive Care Unit. Sanjay Arya S.Vivek Adhish. Introduction. A nursing unit staffed & equipped to care critically ill patients with potentially reversible lesions. Patient are unable to communicate their needs. Patient require intense monitoring, life support & mechanical ventillation.

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Intensive Care Unit

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  1. Intensive Care Unit Sanjay AryaS.VivekAdhish

  2. Introduction • A nursing unit staffed & equipped to care critically ill patients with potentially reversible lesions. • Patient are unable to communicate their needs. • Patient require intense monitoring, life support & mechanical ventillation.

  3. Objectives • To give life support i.e. prevent threat to life. • Treat the underlying cause. Patient is admitted by need not choice.

  4. Key Planning Considerations • Source of patients. • Admission & discharge criteria. • Expected occupancy rate. • Availability of resources: Money, Technical staff & equipment.

  5. Levels of ICU Care Level 1: Provides monitoring, observation & short term ventilation. Level 2: Monitoring, observation & long term ventilation with resident doctor. Level 3: All above with invasive haemo-dynamic monitoring & dialysis.

  6. Designing An ICU Team should include: • Medical director • Nurse administrator • Architect • Hospital Administrator • Engineering staff

  7. Location • Different geographical area to have control over access. • With in direct elevator travel to Emergency, OT complex, & Radiology services

  8. Planning An ICU… • No of beds in a unit: 8-12 • Isolation rooms: • Open ward like or cubicle type layout. • Controlled access.

  9. Fire Exit Layout-Cubicle Type

  10. Planning An ICU… • Visualization: This is the most important consideration in lay out. All patient should be directly or indirectly visible from central nursing station. Area requirement for patient module: • 225sq ft /bed, if ward type layout. • 250 sq. ft. /bed if room type outlay

  11. Different Areas In ICU • Central Station • X ray view area • Special Procedure area • Medication Room: At least 50 sq. ft. • Alcoves for crash carts, portable monitor & defibrillator. • Ante Room: 20 sq ft For hand wash, gowning & storage.

  12. Different Areas In ICU… • Staff Rooms • Secretarial area • Conference room • Equipment storage area • Clean & Dirty utility rooms. • Nourishment preparation area • Visitor’s room: 1.5-2 seat per bed • Supply & service corridor: 8ft wide at least

  13. Planning ICU • Natural light & view • Emergency call button • Electric power, oxygen, compressed air & vacuum outlets, in Head panel or in Utility column, free standing or roof mounted & positioned to allow free access to patient’s head.

  14. Electrical Power • Separate panel for ICU. • Easy access to panel in emergency. • Alternative source of power in panel. • 16 outlet per bed • On head wall, points should be 3ft above ground level. • On side walls or foot end, close to floor.

  15. Other Outlets • Oxygen point : 2 • Compressed Air : 2 • Vacuum : 3 (At least 290 mm of Hg) • For medical gases alarm panel should be there & facility for manual shut down. • Alarms should be for leaks, abnormal pressures.

  16. Lighting • Normal working daytime : 30 fc • Night reading : 6.5 fc • For procedure : 150fc shadow free • Provision of dimmer to modulate intensity of light at different point in a day

  17. Environment Control • Air conditioning with 6 air changes/ hr • Mix of fresh air with 2 air change of fresh air • Exhausts in toilet : 75 cf /min

  18. Noise in ICU Acceptable levels • 45 db in daytime • 40 db in evening • 20 db at night

  19. Noise in ICU • Choose building material which absorbs sound. • Doorways should be offset: Two door should not be opposite to each other. • Special ceiling. • Flooring.

  20. Monitoring Capabilities in ICU • ECG : 1 or more leads • Three fluid pressures • Arterial oxygen saturation • Display should be both digital as well as analogue • Visual wave form as well as numeric display • Alarms : Visual as well as audio

  21. Monitoring Capabilities in ICU • Pulse oxymetry. • Transcutaneous pO2 • End Tidal CO2 • Transcutaneous pCO2 • Respiratory rate monitoring • Cardiac output & derived variables

  22. Others… • Computerized monitoring & charting • Voice Intercommunication system • Satellite laboratory • Administrative Office

  23. Manpower • Nurses • Residents • Consultants • Physiotherapist • Technicians • On call consultant

  24. Policies • Admission & discharge policy • Asepsis policy • Manpower rotation • Emergency preparedness • Evacuation plan • Protocols for all activities

  25. Thank You

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