A an atraumatic guidewire that will be introduced in a central vein: Port a cath Implantable Venous Access System kit. It can be used for chemotherapy administration, high doses of diuretics in terminal heart failure patients, parenteral nutrition, and blood sampling.

Introductory Chapter: Bedside Procedures in Critical Care Unit

A Syringe, B atraumatic metallic catheter that will be introduced through the cephalic, jugular or subclavian vein, C the chamber for therapy injection, D dilator used to access the central vein, E needle for venous puncture, F polyethylene catheter tubing that will be inserted at the junction between the right atrium and superior vena cava, and G degree winged infusion set. Before deciding to perform a procedure at the bedside of the patient in ICU, we should limit visitors to enter in the immediate surrounding of the patient or even in the entire unit during the performance of the procedure.

This ensures a sterile field and also provides measures of privacy.


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On the other hand, we should separate the procedure and the patient from the rest of the ICU to minimize distractions and disruptions. This can be done by curtains or temporary partitions or by changing the room of the performance.

Common Bedside Procedures

Nurses should be present during the procedure, and they should be familiar with the technique of the procedure. Most of the time adequate sedation is necessary with midazolam, propofol and pethidine. Doses for analgesia and sedation should be prescribed by the doctor, but the volume of the vial and dilution should be known by the nurse.

Prior to assisting in a new procedure, nurses, residents, students and other staff members should receive adequate training with a prior period of observation when there is no anterior experience [ 3 ].

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For the safety of the procedure, adequate preparation is mandatory, with prior sedation, intravenous access, initial preparation of the kit and suitable monitoring. Specific sites for venous access are preferred in the function of the bedside procedure being performed. Advanced airway equipment should be available, especially when the bedside procedure is performed in an unstable patient.

Whenever possible, informed consent should be obtained from the patient before the beginning of the procedure, and in case of unstable patients, consent should be obtained from a family member or tutor of the patient.

Surgical procedures in the intensive care unit: a critical review

All the staff members should be aware of the nosocomial infection risk. This risk can be reduced by proper hand hygiene, the use of antiseptic skin agents, selecting a good puncture site, and the use of sterile drapes for an aseptic technique [ 4 ]. Proper hand hygiene, appropriate site selection, use of appropriate skin preparation agents, and an aseptic technique with a full body drape during device insertion have been shown to reduce the rate of nosocomial device-related infections. In urban non-academic, rural and community hospitals, intensivists are more likely to perform bedside procedures as compared to their urban academic counterparts.

This is likely because of a lack in interventional radiology departments and performance of the procedure at the bed of the patient may be particularly important [ 5 ]. We are of the strong belief that hospitalization costs can be reduced by doing the procedures at the bedside of the patient rather than referring them to the surgery department or interventional radiology.


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    Surgical procedures in the intensive care unit: A critical theranchhands.com Critical Care

    This handbook is a guide to best practice in interventions commonly encountered in the ICU. The information is easily accessible providing practical advice and essential background for every member of the multi-disciplinary team caring for critically ill patients. It will serve the senior consultant who has not performed a procedure for some time as well as the junior doctor in need of an aide memoire. Chapter 2 Airway Management and Intubation.

    Chapter 4 Percutaneous Dilatational Tracheostomy. Chapter 5 Arterial and Venous Catheter Insertion. Chapter 7 Temporary Cardiac Pacing. Chapter 8 DC Cardioversion.