ICU Procedures

Arterial Line

Usually inserted by the doctor, it is a thin plastic tube into an artery in the wrist or placed at the elbow, groin or foot.

An arterial line monitors blood pressure regularly and continuously. It also helps the nurses to take blood samples when required.

These lines may stay in place for a long time until the patient is in ICU and is changed periodically.

Arterial lines are generally safe although they may occasionally require multiple attempts for insertion.

Central Venous Catheter

Central Venous Catheter (CVC), is a thin plastic tube inserted into large veins in the neck beneath the collar bone or groin.

It helps to deliver large volumes of fluids, and medications such as antibiotics, life-saving medications etc.

The CVC may stay in place for several days and changed regularly when required for a more extended period.

These are done with proper techniques to prevent infections. These line insertions may sometimes require several attempts. Infection may be a significant complication. Coated tubes and sterile dressings are used to reduce the chance of infection

During insertion, there may be a risk of damage to other arteries and nerves or a risk of puncturing the lung during insertion in the neck.

Chest X-rays are routinely done to check the position of central lines.

The pulmonary artery (PAC) is also known as the Swan Ganz Catheter.

Similar to the central line, it is a plastic tube inserted into large veins in the neck beneath the collarbone. The tube is inserted into the right side of the heart into the main blood vessel in the lungs called the pulmonary artery. Measurements are recorded continuously to monitor pressures within the heart and lungs. It is also used to deliver medications to support blood pressure and heart function.

PAC insertion may have all complications as in the central line. During insertion of PAC, there may be some irregularity of the heart rhythm.

Chest X-rays are routinely done to check the position of PAC.

Communication

Intubation is the insertion of a breathing tube, also called an endotracheal or ET tube into the windpipe (trachea).

The breathing tube is usually connected to the ventilator or breathing machine. Often, it remains for 2-3 days in patients who had any surgery or may be prolonged in certain situations.

The breathing tube may be accidentally dislodged or may be malpositioned in the oesophagus. There is a risk of infection while the patient has the breathing tube in.

A ventilator is a life-saving machine that allows patients to breathe through the endotracheal tube.

It has large tubings coming out of the machine, as shown in the picture. The ventilator connects to the breathing tube. The patient is usually sedated when connected to this machine.

A patient may be connected to the ventilator for a few days to several weeks, depending on the patient's severity of illness. The patient is gradually weaned off the ventilator as the patient can breathe or is allowed to breathe on his or her own.

In situations where prolonged ventilator support is required, a tracheostomy is usually performed.

Tracheostomy

When a patient is on a ventilator for a prolonged period, a tracheostomy is usually performed. This procedure involves inserting a plastic tube directly into the windpipe through the front of the neck.

Having a tracheostomy is more comfortable than breathing through a breathing tube. It also helps to wean the patient from the ventilator. A patient can speak and even swallow while the tracheostomy tube is on.

ECMO

Also known as Extra Corporeal Membrane Oxygenation.

ECMO is a complicated and very high-risk procedure. Patients on ECMO are very sick; when their heart and or lungs do not respond to conventional treatment.

The ECMO machine puts the patient's heart and lungs to rest while the patient is in intensive management with life-saving medications.

The procedure is performed by a trained team of doctors and nurses. It involves the insertion of plastic tubes in the neck or the groin. Blood is drawn out of the body through these tubes into the ECMO machine. Oxygen is added to the blood in the machine and returned to the body, keeping the patient alive while the heart and the lungs recover.

Patients are monitored continuously for any complications and deterioration. There is a risk of bleeding when the plastic tubes are inserted at the start of the procedure. The patient is put on blood thinner medications to minimise the risk of clotting while on ECMO. This may cause an increased risk of bleeding from other sites.

Intra aortic Balloon Pump

Also known as Intra-Aortic-Balloon-Pump (IABP). This procedure is performed in patients requiring support to maintain their blood pressure, which is needed to supply blood to our bodies adequately.

It is mostly done in patients who may present to the hospital with a severe heart attack and require angioplasty or surgery.

It is a long inflatable large bore tube with a large balloon at the tip. It is inserted through an artery in the groin and positioned in the aorta, the main blood vessel which runs out of the heart.

The tube is attached to a console that sits at the bed end. It beats in time with the heart and helps in the pumping of blood to the rest of the body

There may be a risk of impaired blood supply to legs and intestines. There is also a small risk to form blood clots. Patients are monitored continuously for any complications while on balloon pump.

Disclaimer

This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about ICU services or procedures does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.