1. Dr.Anjalatchi Muthukumaran
Vice principal Cum Nursing Supt.
ELMCH, ECON Era University
Intensive /critical care unit
ideal set up
training for health care professional
2. CRITICAL word denote that
Crucial
Crisis
Emergency
Serious
Requiring immediate action
Thorough and constant observation
Total dependent (Oxford Dictionary)
3. Critical care meaning
Critical Care Is A Term Used To Describe As The
Care Of Patients Who Are Extremely Ill And
Whose Clinical Condition Is Unstable Or
Potentially Unstable.
4. Critical care Unit
It Is Defined As The Unit In Which
Comprehensive Care Of A Critically Ill Patient
Which Is Deemed To Recoverable Stage Is
Carried Out.
5. Critical care Nursing meaning
It Refers To Those Comprehensive, Specialized
And Individualized Nursing Care Services Which
Are Rendered To Patients With Life Threatening
Conditions And Their Families.
6. Critical care technology means
Continues cardiac monitoring of patients
ECG monitoring
Arterial Lines in site
Oxygen Saturation support
Ventilation support
Intracranial Pressure Monitoring support
Temperature monitoring
Pulmonary Artery Catheter pressure monitoring
IABP
Extensive use of pharmaceuticals
10. Types of ICU
General
Medical Intensive Care Unit(MICU)
Surgical Intensive Care Unit
Medical Surgical Intensive Care Unit(MSICU)
Specialized
Neonatal Intensive Care Unit(NICU)
Special Care Nursery(SCN)
Paediatric Intensive Care Unit(PICU)
Coronary Care Unit(CCU)
Cardiac Surgery Intensive Care Unit(CSICU)
Neuro Surgery Intensive Care Unit(NSICU)
Burn Intensive Care Unit(BICU)
Trauma Intensive Care Unit
11. Multidisciplinary & Collaborative
approach to ICU care
Medical & nursing directors : co-responsibility for ICU
management
A team approach : doctors, nurses, R/T, pharmacist
Use of standard, protocol, guideline consistent
approach to all issues
Dedication to coordination and communication for all
aspects of ICU management
Emphasis on research, education, ethical issues,
patient advocacy
12. CLASSIFICATION OF CRITICAL
CARE PATIENTS
Level O : normal ward care
Level 1: at risk of deteriorating , support from
critical care team
Level 2 : more observation or intervention, single
failing organ or post operative care
Level 3; advanced respiratory support or basic
respiratory support ,multiorgan failure
13. ORGANIZATION OF ICU
DESIGN OF ICU :
1. Should be at a geographically distinct area within the hospital, with
controlled access.
2. There should be a single entry and exit. However, it is required to
have emergency exit points in case of emergency and disaster.
3. There should not be any through traffic of goods or hospital staff.
Supply and professional traffic should be separated from public/visitor
traffic.
4. Safe, easy, fast transport of a critically sick pt should be a priority in
planning its location. Therefore, the ICU should be located in close
proximity or ER, OT, trauma ward etc.
5. Corridors, lifts and ramps should be spacious enough to provide easy
movement of bed/trolley of a critically sick patient. 6. Close, easy
proximity is also desirable to diagnostic facilities, blood bank, pharmacy
etc.
14. BED STRENGTH
1. It is recommended that total bed strength in
ICU should be between 8-12 and not less than 6
or not more than 24 in any case.
2. 3-5 beds per 100 hospital beds for a Level III
ICU or 2 to 20% of the total no of hospital beds.
3. 1 isolation bed for every ICU beds.
15. BED AND ITS SPACE
1. 150-200 sq.ft per open bed with 8 ft in
between beds.
2. 225-250 sq.ft per bed if in a single room.
3. Beds should be adjustable, no head board,
with side rails and wheels.
4. Keep bed 2 ft away from head wall.
16. ACCESSORIES
1. 3 O2 outlets, 3 suction outlets (gastric, tracheal and underwater seal),
2 compressed air outlets and 16 power outlets per bed.
2. Storage by each bedside.
3. Hand rinse solution by each bedside.
4. Equipment shelf at the head end.
5. Hooks and devices to hang infusions/ blood bags, extended from the
ceiling with a sliding rail to position.
6. Infusion pumps to be mounted on stand or poles.
7. Level II ICUs may require multi channel invasive monitors.
8. ventilators, infusion pumps, portable X ray unit, fluid and bed
warmers, portable light, defibrillators, anaesthesia machines and difficult
airway management equipments are necessary.
17. Staffing pattern/manpower
STAFFING :
1. Medical Staff – the best senior medical staff to be
appointed as an Intensive Care Director or Intensivist.
Less preferred are other specialists from anaesthesia
/ medicine who has clinical commitment elsewhere.
Junior staff are intensive care trainers and trainees on
deputation from other disciplines.
2. Nursing staff – The major teaching tertiary care
ICU requires trained nurses in critical care
18. The no of nurses ideally required for such unit is 1:1 ratio,
however it might not be possible to have such members in
our set up.
So 1 nurse for 2 patients is acceptable.
The no of trained nurses should also be worked out by the
type of ICU, the workload and work statistics and type of
patient load.
3.Allied Services – Respiratory services, Nutritionist,
Physiotherapist, Biomedical engineer, technicians,
computer programmer, clinical pharmacist, social worker /
counsellor and other support staff, guards and grade IV
workers
19. Design of icu summary
For critically ill: unstable patients
Level: I II III
Bed strength: ideal 8-14
Each pt. > 100 sq. ft. ( 125-150 desirable)
Additional space = 100%
10% isolation bed
At least 2 barriers to enter ICU
20. Maintenance plan for ICU
Only one entry and exit, emergency exit
Proper fire extinguisher
At least 2 ft. away from head wall
Central nursing station: all pt.
visible Environment requirements: Heating, ventilation, air-conditioning
system in ICU (HVAC system)
Fully air-conditioned : 6 cycle/hr, 2 cycle outside air
Temperature = 16-25 oC Prof. Dr. R S Mehta, BPKIHS 25
Light: high illumination, 150 foot candle (fc), overhead light = 20fc, floor light
at night = 10fc
Noise control: Under 45 dBA in day, <40 in evening, <20 in night. (watch
tick= 20 & normal conversation at 55)
Furniture: solid, non-porous, stain resistant.
Floor: easy to clean and non-slippery
Wall= 4-5 ft. finished with tiles
Ceiling: paint with soft color, no wire lines
21. Core Competencies
Patient Care
Medical Knowledge
Professionalism & Ethics
Interpersonal Communication Skills
Practice-based Learning and Improvement
Systems-based Practice
Staff stressors: Nurses role is to decrease stress:
examining feeling about death, listen attentively to needs,
use touch therapy as applicable, family care, maintain
privacy, allow cultural practices as possible.