The following procedures are commonly performed in the critical care to monitor and treat the patients.
Our team is dedicated in ensuring that you are informed about the procedures being carried out on patients. The team will be happy to discuss or answer any questions or concerns you have on any procedure or device.
Arctic sun
This is a cooling or warming device that targets temperature management. It is often used in patients following a cardiac arrest to control their temperature. The Arctic Sun has gel pads that stick to a patient’s body. The device circulates water through the pads at a temperature between 4-42 °C.
Arterial line
An arterial line is a thin plastic tube inserted into an artery to continuously measure blood pressure. It is normally inserted into the wrist or the groin. Regular blood tests can be taken from it. Arterial lines are generally very safe, although they may occasionally require multiple attempts for insertion.
Blood culture
This procedure consists of obtaining blood from a peripheral or central vein, to test for bacteria or fungal growth in a laboratory.
Bronchoscopy
A doctor performs a bronchoscopy by passing a flexible scope into the patient’s mouth and down the trachea to check the lungs’ condition. This may be needed when a patient has pneumonia when there is a blocked airway, or to aid the placement of other tubes (such as a tracheostomy) into the trachea. In the ICU, a bronchoscopy is usually performed through a breathing tube (endotracheal (ET) tube or tracheostomy). Sedation is given during the procedure.
Chest drain
The chest drain is a tube that is inserted through the chest wall into the chest space outside the lung to remove air (pneumothorax – “air leaks”) or fluid (pleural effusion – “fluid outside the lung”). This is an ultrasound-guided procedure. Chest X-rays are done after insertion to ensure they are in an appropriate position. The patient with a chest drain is constantly monitored for complications. It is removed when they are no longer necessary.
Non-invasive ventilation (NIV)
When patients cannot breathe adequately on their own, this means of ventilation may provide additional oxygen and assistance with breathing. This may reduce the need to insert an ET tube (intubate). It is usually delivered by a tight-fitting mask to the face or nose.
Central venous catheter (CVC)
A CVC is a thin plastic tube inserted into a large vein for the administration of intravenous medications and for monitoring pressures within the body. That can be inserted into either the neck, beneath the collar bone, or through the groin. During insertion, there is a low risk of needle damaging other structures such as arteries, nerves, or the lung.
Haemofiltration / filter / dialysis
Patients often require a dialysis (filter) machine when there is kidney failure or abnormal levels of toxins in the blood. It is also occasionally used to treat some drug overdoses. A doctor inserts a VasCath, like a CVC, into a large vein in the neck or groin which will serve an access for the dialysis machine. Blood circulates through the dialysis machine, toxins are removed, and the filtered blood then returns to the body. A patient’s blood pressure may drop temporarily when dialysis is started. When the kidneys recover their function, the machine can be stopped.
Intravenous cannula
An intravenous cannula is a small, soft piece of hollow tubing which is inserted into a vein, usually in the back of the hand or the arm, which is then used to administer intravenous medications and fluids.
Intubation
If a patient is unconscious or has severe breathing difficulty, an Endotracheal Tube (ETT) is placed into the mouth down the trachea. This is then connected to a ventilator. The ventilator assists with breathing and providing additional oxygen. Sedation is usually given for comfort while the ETT is in place. We have clear intubation protocols and guidelines, the latest equipment, and regular training to minimise risks. An ETT may stay in place for several weeks and occasionally longer. If a patient requires ventilator support for an extended period, we usually perform a tracheostomy (see tracheostomy).
Lumbar puncture (LP)
A lumbar puncture is performed to collect sample fluid from around the spinal cord and brain. Under sterile conditions, a doctor inserts a small needle through the lower part of the back and draws off a small amount of spinal fluid. An LP is done to measure the pressure inside the spine and brain or to check for conditions such as meningitis. Occasionally, an LP may cause a headache after the procedure.
Nasogastric feed (NG feed)
NG feed is a liquid form of nutrition passed into a patient’s stomach via a plastic tube inserted through the nose (NG tube) or mouth (OG tube). Patients attached to ventilators are not able to eat food normally, hence are fed in this way. NG feeding rarely causes problems.
Proning
Prone positioning, or “proning”, is a form of treatment performed to support mechanically ventilated patients with lung disease requiring high oxygen concentrations. To initiate prone positioning, the medical staff should turn a patient face down from their back (supine position). Patients can be put on prone position between 12 and 24 hours depending on their response to treatment. We aim to minimise the risks associated with proning as much as possible.
Total Parenteral Nutrition (TPN)
TPN involves introducing nutrition directly into a patient’s vein. It is usually given via a CVC. It is used when it is not possible to feed a patient via the stomach and gut. As the patient’s condition improves, it is often possible to switch back to normal feeding via the gut. TPN is regularly assessed by nursing, medical, and nutrition staff.
Tracheostomy
This plastic tube is placed directly into the trachea through the front of the neck. It is more comfortable than a breathing tube through the mouth, and often allows better weaning from the ventilator. Speech and swallowing are sometimes possible when a patient has had a tracheostomy for some time. The tracheostomy is removed when the patient has recovered, leaving a small scar. There is a small risk of bleeding during the procedure. Rarely, the patient may need to go to the operating theatre if the bleeding cannot be stopped.
Transfusion
Blood transfusions are required to correct low blood counts (low haemoglobin, anaemia) or replace blood loss due to bleeding. Other blood products, such as platelets and cryoprecipitates, are used to correct abnormal or low levels of clotting factors (if a patient is bleeding or is at risk of bleeding during a procedure). Severe reactions against transfusions are fortunately rare. However, all transfusions carry a small risk of infection.
Urinary catheter A urinary catheter is a soft tube inserted into the bladder through the urethra. It continuously drains urine from the bladder temporarily removing the need for a patient to empty the bladder as usual. A small balloon at the tip of the catheter holds it in place within the bladder. A urinary catheter is essential for patients who are heavily sedated, have an epidural catheter in place, or have limited mobility and are unable to walk to the toilet. It is also used to record urine output closely.
