Intensive care unit (ICU)

The Intensive Care Unit is run and staffed by specialists trained in intensive care. Once a patient is admitted onto the unit, the intensive care team will manage the care of the patient, whilst consulting with the original team who admitted them into hospital and any other specialists they think will help the patient’s recovery.

The ICU doctors and nurses will give the best overview and general update on the patient’s condition, but relatives may be referred to other specialist teams to discuss certain aspects of care.

There are many people you may see when visiting the ICU:

Consultants

Consultants are the most senior members of the team who will be assisted by other doctors, nurses and specialists.

The Intensive Care consultants are in overall charge of the ICU on a day to day basis. They are responsible for the care of the patients.

The consultants have doctors working for them, one of whom is based in the ICU at all times.

Nurses

A sister/charge nurse or senior staff nurse is responsible for coordinating the nurses on each shift. Each nurse looks after one or two patients in the unit depending on if the patient requires intensive care or high dependency care.

If you are visiting a friend or relative in the ICU, the nurses will be the members of staff you will see most often.

Physiotherapists

Physiotherapists help with treating patient’s chests to ensure there is no build up of fluids that can increase the chance of infection. The physiotherapist also helps with patients who are recovering by helping them to exercise, mobilise and help them transfer from a bed to a chair.

Pharmacists

Pharmacists are involved in monitoring the patient’s medication. They review the patient’s drug chart and make sure doses are correct and that any problems with any medications are identified. The pharmacist also makes sure the unit is stocked with enough medication.

Speech and language therapists

Speech and language therapists, sometimes known as SALT work with patients who have trouble swallowing or chewing, or are having difficulties communicating. They can offer expert advice on these problems as well as supporting the patient’s recovery.

Dietitians

Dietitians ensure the patients in the ICU are receiving the correct nutrients. This is particularly important if patients are being tube fed or are receiving nutrients directly into a vein.

Healthcare assistants

Healthcare assistants are employed to help the nurses. They assist the nurses with caring for the patients as well as stocking equipment and laundry.

ICU technologists

ICU Technologists make sure that the equipment used in the ICU is safe and effective. They are responsible for maintaining and repairing the equipment.

Ward clerks

Ward clerks take care of the medical records in the ICU, as well as performing other administrative duties.

The machines in the ICU make a variety of sounds, such as bleeps and alarms. Some sounds make staff aware of slight changes to a patient’s condition, or alert them when something needs attention. A few alarms require the nurse’s immediate attention but most just indicate standard monitoring.

Some of the main ICU machines and what they do are described below:

Ventilators and breathing tubes

Some patients in the ICU need help breathing. To help them they sometimes need to be sedated and use a breathing tube attached to a machine called a ventilator.

Modern ventilators use complex computers to allow patients to breath as much as they can for themselves with variable amounts of help from the machine.

Breathing tubes

Sometimes when a patient is using a ventilator they wear a tight fitting mask over their nose and mouth to help them breath. This is called non-invasive ventilation. This looks uncomfortable, but most patients get used to them very quickly. This means they do not need to be so deeply sedated or need a tube putting in their windpipe.

Endotracheal (ET) Tube

If a patient needs more help breathing they can have a tube placed in their windpipe. This is usually through their mouth although very occasionally it can be put through the nose. This is uncomfortable so the patient will be sedated to make this less invasive.

Tracheostomy

Sometimes, if a patient needs to be on a ventilator for more than a few days, they may have a small operation called a tracheostomy. This is where the tube is put directly into their windpipe (trachea) through a small incision in the front of the neck. This is more comfortable, means the patient does not need to be so heavily sedated and makes chest infections less likely.

The tracheostomy is performed by a doctor who is skilled in anaesthesia or critical care. The procedure is always done under general anaesthetic.

In rare situations the patient may need to have a surgical tracheostomy, which is done in an operating theatre.

If your relative requires a tracheostomy, the doctors will discuss the procedure with you.

Kidney machines

Sometimes patient’s kidneys stop working properly due to their illness. The kidney works to filter the blood and remove waste products, which are passed out of the body as urine. If this fails, a machine called a dialysis machine can take over this job. To do this a large tube is put into one of the bigger veins in the leg or neck.

Monitors

Patients in intensive care are constantly monitored to track their condition and alert staff to changes. Monitors that are used to keep track of the patient’s condition often measure:

• Heart rate and heart electrical tracing (ECG)
• Oxygen levels in the blood
• Blood pressure
• Pressure in the veins (CVP)
• Urine output
• Temperature
• All the fluids, food and drugs the patient takes

The monitors track even tiny changes in the patient’s condition and will inform ICU staff.

Monitors often make a lot of noises, this does not necessarily mean something dangerous has happened. Often alarms are just to let the staff know the patient’s condition.

Lines (drips)

These are plastic tubes sometimes referred to as “drips”. These are inserted into the patient’s blood vessels. The lines help to give fluids or medication and to help monitor blood pressure or take blood samples for regular testing.

Common lines include:

Arterial line

This is a very thin tube that is inserted into one of the patient’s arteries, usually in the arm. This allows ICU staff to measure patient’s blood pressure and concentration of oxygen and carbon dioxide in the blood.

Central line

This is a thin tube that is inserted into a larger vein, normally in the neck, shoulder or groin. This is to measure blood pressure, take samples or to give the patient concentrated medication or fluids.

Dialysis line or Vascath

These lines are inserted into a big vein like the central line, although these tubes are bigger and are attached to a kidney machine in order to perform the job of the kidneys.

PICC line

These lines are inserted into one of the veins in the upper arm and are long enough to reach the bigger veins close to the heart. These lines are useful as they have a lower chance of infection, so can be used to help the patient for longer.

How lines are inserted

Lines are inserted by a doctor or nurse who is experienced in the procedure and lines are inserted under local anaesthetic to make the patient more comfortable.

Feeding in ICU

Patients in ICU are at risk of malnutrition because of their illness. It is therefore important to ensure the patient gets the nutrition and calories they need to fight their illness and help their recovery.

Nasogastric tubes

A nasogastric tube is the most common type of feeding tube used in the ICU. These are long, thin tubes that are inserted by a doctor or nurse. The tube goes down the patient’s nose, down the oesophagus until it reaches the stomach.

These tubes can then be used to feed patients who cannot eat and drink for themselves, as well as empty the patient’s stomach content.

The position of the feeding tube is checked by x-ray or by pH test to make sure it is in the right position.

Intravenous feeding

If a patient has problems absorbing nutrients through their stomach, an intravenous line can be used to put nutrients directly into their blood stream.

Nasojejunal tubes

If there is a problem with feeding via a nasogastric tube, a nasojujunal tube might be used instead. This tube goes though the patient’s nose like the nasogastric tube, but instead of going to the stomach it takes the nutrients directly to the small intestine instead. X-rays or other scanners are used to make sure the tube is positioned correctly.

PEG tube

A PEG (Percutaneous Endoscopic Gastrostomy) tube is inserted through the skin in the abdomen leading directly to the stomach. These tubes are inserted if the patient needs long term feeding or if there is a risk they might inhale the nutrients into the lungs. This is a more complicated procedure and is carried out by a surgeon.

Urinary Catheter

A urinary catheter is a flexible tube that is inserted into the bladder to drain urine. This is essential whilst the patient can’t use the toilet normally. It is also important to check the amount of urine the patient produces to check that their kidneys are functioning properly.

The tube is inserted by a doctor or nurse via the urethra until it reaches the bladder. Once in the bladder, a balloon on the end of the tube is inflated to keep the tube in place.

Scanning

Your relative may need to have further testing carried out whilst they are staying in ICU. Some of these test can be carried out on the unit, whilst others need specialist machinery and equipment.

CT and MRI

Computerised tomography scans (CT or CAT scans) and Magnetic Resonance Imaging (MRI) can be used to get a clearer picture of what is going on inside a patient than can be seen with an x-ray.  To have these scans, the patient will need to be taken to the x-ray department, as the machines that are used are very large. Whilst they are being transferred and scanned, they will be escorted and monitored by a specially trained doctor or nurse who can give any treatment they require.

Ultrasound

Ultrasound is a commonly used device in the ICU. It is used to help doctors when they are inserting lines, as well as being an easy to use and safe scanning tool. The scanner is portable and can be used at your relative’s bedside.

The scanner works by emitting a very high frequency sound, which is too high pitch for people to hear. The machine then detects the echos of that sound from things inside the body, which is then turned into a picture by the computer. This is completely safe and is very useful to check what’s going on inside a patient without having to have specialist scans.

Visiting a relative in the ICU can be a tiring and upsetting experience. It is understandable to be worried about your loved one, but it is important to take care of yourself. Try to rest as often as you can and try to sleep at night rather than in the day. Remember to eat sensibly as well. You will need your strength.

It is important to remember that it is OK to be distressed by having a relative in Intensive Care. Having a loved one in Intensive Care is one of the most traumatic experiences that many people will go through. It is very common for relatives of patients to suffer from depression or post-traumatic stress. There are a range of things you can do and services you can use that can help you get through this difficult experience.

Keeping a diary

Keeping a diary of your relative’s time in ICU can be helpful for both yourself and your relative after they have recovered. For more, see the ‘keeping a diary’ section below.

GP services

If you are having any difficulty coping either during or after your relative’s time in ICU, your GP should be able to offer you help. NHS direct can also offer you help and guidance with coping with depression, anxiety or any other difficulty you are experiencing.

Support groups

Being able to talk to people who have gone through a similar experience can really help you cope with what you’re going through. ICUSteps is a charity set up for patients and relatives recovering after they or a relative have been in Intensive Care. There is an ICUSteps Brighton support group as well as other groups around the country.

Chaplaincy

The hospital chaplains can offer religious and spiritual support for a variety of faiths. A chaplain is available 24 hours a day, 7 days a week. They are happy to talk to patients and their families both about specific religious matters as well as more general spiritual concerns.

Patients in the ICU often don’t remember a lot of their stay in Intensive Care as they are usually sedated. This can cause psychological problems later in their recovery. Patients can struggle with the “lost” time they missed or fail to realise quite how ill they were. This can make them feel like they aren’t recovering quickly enough.

As a relative visiting a loved one in Intensive Care, it can also be hard to notice signs of improvement as patients in the ICU often get better gradually and it is hard to see the changes day by day.

This is where keeping a diary of your relative’s time in the unit can often help. By keeping a diary, you can see the improvements as they get better. This has been found to make it easier for you to cope and recover from the trauma you and your family will have been through.

It can also be difficult to keep track of all of the treatments your loved one has received during their stay in ICU, particularly in such a stressful situation. Keeping a diary can help you keep track of that information.

A diary can also help your relative realise how ill they were, and how much they have progressed whilst they are recovering afterwards.

Studies have shown that keeping a diary can cut the rate of depression and post-traumatic stress in relatives and patients during their recovery after ICU by as much as 50%.

The ICU staff will help you with your diary, they can fill in the medical information and you can put in anything else you want to keep track of.

As your relative starts to get better, they will need fewer machines to help them with normal body functions and they won’t need to be monitored so closely.

Your relative will probably be very weak and find moving around difficult and very tiring at first, so a physiotherapist will probably give them exercises to do to start getting their strength back.

When they are well enough, your loved one will be moved onto a general ward. This can be a difficult time for them as they will not be getting the one on one nursing they were getting in Intensive Care. They may have to learn how to do basic things again, such as walking, eating, drinking or even breathing for themselves. They will still be looked after by nurses and doctors, but the care will not be as personal as before. However they will be visited by a member of Critical Care Outreach Team on a daily basis who will ease their transition to the ward and monitor them closely.

When you move onto a general ward, there will be a written plan for your care. This will include:

• a record of your treatment in ICU
• a monitoring plan to make sure you keep getting better
• a plan for your ongoing treatment
• details of your physical and psychological recovery needs

Visiting times on a general ward will not be as flexible as they were in ICU which can be distressing for you and your loved one at first. It may take a while to get back into a normal sleep pattern after ICU, but this will return in time.

You may want to bring your relative a personal music player with headphones to help them relax and keep them occupied while they carry on recovering.