• Arterial Line Insertion Open or Close

    arteriallineAn arterial line is a special plastic tube that is inserted in to a patient's artery to enable continuous monitoring of the blood pressure.

    • Why does a patient need an arterial line?

    Critically ill or injured patients frequently have profound abnormalities in their blood pressure. The arterial line provides a way to constantly measure a patient's blood pressure and may be essential to the stabilization of the patient. Arterial lines may be useful in patients with very high or low blood pressures. The arterial line also provides access for frequent blood sampling. Blood can be withdrawn from the patient through the arterial line tubing without having to use a needle.

    • How is an arterial line inserted?

    Arterial lines may be inserted in the wrist (radial artery), armpit (axillary artery), groin (femoral artery), or foot (pedal artery). The arterial line is inserted into the artery by the same technique used to insert a regular peripheral IV. The arterial line is usually sutured (sewed) to the overlying skin to assure that it remains in the artery. An arterial line insertion causes the similar discomfort to that associated with the insertion of a regular peripheral IV. The arterial line tubing is connected to the bedside monitor, where the patient's blood pressure is constantly displayed. 

    • How long is an arterial line used?

    Typically, an arterial line is required for a short period of time. If the information from the arterial line is required for more than five to seven days, a new arterial line may be required. 

    • Are there any potential complications associated with use of an arterial line?

    The major complications associated with the arterial line are bleeding, infection, and rarely, a lack of blood flow to the tissue supplied by the artery.

     

  • Central Venous Pressure Catheter Insertion Open or Close

    cvpCentral Venous Pressure (CVP) describes the pressure of blood in the vena cava, one of the central veins near the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Normal CVP is 2-6 mm Hg. 

    A CVP catheter is a special IV line is inserted into a large vein in the body. Several veins are used for central venous catheters including those located in the shoulder (subclavian vein), neck (jugular vein), and groin (femoral vein). In some patients, a central venous catheter may be inserted into the elbow vein (anticubital vein) and advanced into the subclavian vein. These special IVs are also used when the patient either does not have adequate veins in the arms or needs special medications and/or nutrition that cannot be given through the smaller arm veins. It also allows for serial venous blood assessment.

    • Do central venous catheters hurt?

    Yes, when they are inserted. The doctor numbs the area with an anaesthetic before placing the catheter. Once it is in place, it usually does not hurt. Central venous catheters in the shoulder or neck veins can occasionally cause the lung to collapse. After a neck, shoulder or elbow central venous catheter is put in, the doctor gets a chest x-ray to make sure that the catheter is in the proper place and that the patient's lung is still inflated.

    • How long is a central venous catheter used?

    The amount of time that a central venous catheter remains in a patient varies and may depend upon the patient's condition. The ICU staff monitors the catheter closely and removes it when it is no longer needed. Occasionally, the catheter may need to be replaced.

    • Are there any potential complicatons associated with central venous catheters?

    Bleeding and infection are complications associated with IV catheters. As previously mentioned, collapse of a lung is a rare complication of central venous catheters. If this occurs, a chest tube (chest drain) may be required to re-expand the lung.

     

  • Chest and Abdominal Drainage Open or Close

    Surgical drains of various types have been used, with the best intentions, in different operations for many years. It is often open to question whether they achieve their intended purpose despite many years of surgery. There is a paucity of evidence for the benefit of many types of surgical drainage and many surgeons still 'follow their usual practice'. With better evidence, management of surgical patients should improve and surgeons should be able to practise based upon sound scientific principles rather than simply 'doing what I always do'. Lack of definitive evidence has not helped the resolution of some controversial issues surrounding the use of surgical drainage.

  • Endotracheal Tube Insertion Open or Close

    endotrachealtube1A breathing (endotracheal) tube is a plastic tube used during artificial respiration, a procedure to assist a patient in breathing. One end of the breathing tube is placed into the windpipe (trachea) through the mouth or nose. The other end of the tube is connected to a breathing machine (mechanical ventilator) or breathing bag (manual resuscitator). The breathing tube provides an airway so that air and oxygen from the breathing machine or breathing bag can be provided to the lungs.

    • How is the breathing tube held in place?

    The breathing tube is held in place with tape or a plastic device. The nurses and respiratory therapists secure the tube with tape. The tape extends around the neck to form a circle of tape holding the tube in place.

    • Can the patient talk with the breathing tube in place?

    No. The breathing tube goes through the vocal cords and prevents them from moving. This means the patient cannot make sounds.

    • How long is a breathing tube used?

    Normally, breathing tubes are used only for a short time until patients can breath on their own. If the patient needs a breathing tube for more than a few days, the doctor may want to put a temporary tracheostomy tube in the patient's neck. The tracheostomy tube is usually more comfortable than an endotracheal tube.

    • Does a breathing tube hurt?

    Initially, most patients complain about the breathing tube feeling uncomfortable. It often makes patients cough or gag. Over time the patients get used to the tube and the initial discomfort fades.

    • Are there any complications associated with use of a breathing tube?

    Breathing tubes can become displaced and may require reinsertion. This most commonly happens if the patient is agitated and vigorously moving. Some patients attempt to remove the tubes themselves. This is one of the reasons that patient's hands are gently restrained and mild sedation is used.

     

  • Epidural Open or Close

    Epidural anaesthesia, often referred to as "an epidural", is an injection in the back that numbs the nerves and stops you feeling pain.

    Areas that can be numbed by an epidural include the:

    Chest

    Abdomen

    Pelvic area

    Legs

    The doctor will identify the correct location of the epidural space and can choose either to give a single (bolus) injection or to place a thin plastic tube (catheter) to enable a series of injections or a conitnuous infusion of drug to be administered. Drugs routinely used are either pain killers (e.g. morphine, fentanyl), local anaesthetics (e.g. bupivacaine, chirocaine), or a combination of both. The catheter can be left in place for several days and is a particularly effective way of managing pain.

    Patients who are receiving an epidural infusion require special monitoring to observe the effect.. The nurse will thus be doing frequent observations of the patient's ability to move, their pulse and blood pressure and the degree of pain relief produced.

    Removal of the catheter is a simple procedure that has minimal side effects.

  • Tracheostomy Open or Close

    Tracheostomy is an operative procedure that creates a surgical airway in the trachea (windpipe). It is most often performed in patients who have had difficulty weaning off a ventilator, followed by those who have suffered trauma or a catastrophic neurologic insult.

    The procedure is most commonly performed in the ICU with the patient is heavily sedated. A team of people will carry out the procedure that usually takes about an hour from the initial setup until the patient is settled back on their ventilator (breating machine).

    Many patients require a small increase in their oxygen requirement in the hours following a tracheostomy but this settles within 24 hours and the patient will be considerably more comfortable and require less sedation. Weaning off the ventilator is thus much hastened and special devices can be used to faciltate dialogue between the patient, carers and their relatives.