Definition

There are several different types of Units in hospitals that

offer care to those patients that are seriously ill. You will
hear terms such as 'Intensive Care Units', 'Coronary Care
Units', High Dependency Units' and even 'Specialised
Intensive Care Units'. Indeed some units combine these
functions.

WHAT IS AN INTENSIVE CARE UNIT?

Each year in New South Wales, thousands of patients are
admitted into Intensive Care Units (ICUs). These units are
designed to deliver the highest of medical and nursing
care to the sickest of patients. Some smaller rural and
urban hospitals do not have intensive care units while
larger metropolitan hospitals may have a number of
.specialised intensive care units

History
During the 1960s and early 1970s doctors recognised the
life-saving potential of placing patients into specialised
areas called Intensive Care Units. The purpose of the units
was to provide more intensive management for patients
.following major injury, illness or after major surgery

First Impressions of an Intensive

Care Unit
Physically, most ICUs are large areas with a concentration
of specialised, technical equipment and monitors needed
to care for the critically ill. Access to the unit is often
limited, not only to families but also to other non-ICU staff
members. The ICU has a larger ratio of doctors and nurses
.to patients than found in other areas of the hospital
Every patient in ICU has a monitor (a television-like
screen) that can monitor the patient's heart rate and
rhythm, blood pressure, temperature, breathing and many
other things. Most patients will have powerful drugs given
to them continuously through intravenous infusions (I.V
or drip). Patients may also be assisted in their breathing
by a machine (ventilator). They are attached to the
machine by a tube (ETT) inserted into the trachea
.(windpipe)
For most families of ICU patients there is no previous
knowledge of intensive care equipment and procedures.
The visitor can be confronted by a lot of activity and noise
which can make the environment alien and frightening.
One of the most concerning aspects of being in the ICU
are the alarms as they seem to go off regularly and come
from all around. Almost all ICU equipment uses alarms.
However, it is important to remember that most alarms do
not signal an emergency, but rather, they assist staff in

providing better care by letting the staff know that the

.patient needs closer attention

Visiting Family in the Intensive Care

Unit
Visiting in most units is restricted in the interests of both
patient and family safety and to allow staff to continue the
high intensity care required. Children of the patient may
be allowed to visit. We recommend discussion with a
senior registered nurse or a social worker as to how this
visit may affect your child. Visiting hours are usually
during the daytime with some units having a quiet-time
(no visitors) during the middle of the day. Exceptions to
these general rules may be made in consultation with
senior ICU nursing and medical staff. At times there may
.be some special requirements to control infection

THE CARDIOTHORACIC INTENSIVE CARE UNIT

(CICU)
The Cardiothoracic ICU (CICU) cares for patients who need
heart (cardiac) and chest (thoracic) surgery. Surgical
procedures may include operations on the heart, the
.hearts blood vessels, the chest or the lungs
The cardiothoracic patient will require continuous
monitoring of the heart and may require insertion of a PA

Catheter (Pulmonary Artery Catheter or Swan-Ganz

.Catheter) or an Intra-Aortic Balloon Pump (IABP)
Some cardiothoracic patients, for a short time after their
operation, will require a ventilator (breathing
machine) to assist their breathing. This means they will
be attached to the machine by a tube in the patients
.mouth (or nose) to the windpipe (trachea)
Most cardiothoracic patients are only in the CICU for 1 3
days. Some patients may need a longer stay. A few
patients may not improve as quickly and may require
.transfer to the general ICU for further management
There are no cardiothoracic intensive care units in the
rural areas of NSW. Patients requiring cardiothoracic
surgery will be transferred to a major teaching (tertiary)
.hospital in Sydney
In Sydney, CICUs can be separate units or combined with
.a general ICU

THE NEUROSURGICAL INTENSIVE CARE UNIT

(NICU)
The Neurosurgical Intensive Care Unit cares for patients
with brain or spinal cord conditions and occasionally other
medical or surgical problems. Many hospitals combine the
specialised care of neurosurgical patients with that of
seriously ill trauma patients and manage the patients in

the Intensive Care Unit. However, some hospitals separate

.patients who have had neurosurgery into a specific area
Reasons for admission to a NICU include conditions such
:as
head injuries (from traumas such as car accidents,
assaults, falls)
strokes (cerebrovascular accident or CVA)
vascular (blood vessel) surgery, e.g. aneurysm
(weakness or bulging of an artery) repairs and
infections
The Neurosurgical ICU and Intensive Care Units that have
neurosurgical services provide brain and spinal cord
monitoring and treatments that are specific for the
neurosurgical patient. For example,
continuouselectroencephalogram
(EEG) monitoring, intracranial pressure
(ICP) monitoring and special spinal cord stabilization
.techniques are available
In rural hospitals, many patients with head injuries that do
not require surgery are cared for in the local hospitals
ICU. Those patients with a severe neurosurgical condition
that is likely to need surgery will require transfer to a
major teaching (tertiary) hospital in Sydney. Some rural
hospitals close to other state-borders, may transfer these
.patients to Canberra, Melbourne, Brisbane or Adelaide

WHAT IS A CORONARY CARE UNIT (CCU)?

The Coronary Care Unit or CCU cares for patients who
have heart disease and occasionally other medical or
.surgical problems
Conditions such as myocardial infarction (heart
attack), angina (chest pain), congestive heart failure
(CCF)and arrhythmias (abnormal heart beats) are
.common reasons to be admitted to CCU
Patients may come to this unit following procedures such
as cardiac angioplasty or the placement of stents in their
.coronary blood vessels
The CCU provides the ability to monitor the hearts rhythm
continuously and to use specialized treatment such as
thrombolytic therapy (medication that dissolves or breaksup blood clots). Some tests such as electrocardiography
.(ECG) may also be performed within the CCU
Most patients within the CCU can breath without the
assistance of a machine (ventilator) though most will
require oxygen (either by nasal prongs or mask). Some
may require special masks that assist breathing and
.oxygenation (CPAP or BiPAP machine)
In most rural hospitals the Coronary Care Unit is often
combined with the Intensive Care Unit and the High
Dependency Unit to form a Critical Care Unit. In Sydney,

Coronary Care Units are specialised units usually separate

.from the Intensive Care Unit
If a patient in CCU requires an operation on their heart or
heart vessels (cardiac surgery), the patient will be
transferred to the Intensive Care Unit (ICU) or
Cardiothoracic Intensive Care Unit (CICU) after surgery. In
the rural centres, this means the patient will generally
need to be transferred to a metropolitan unit prior to
.surgery

WHAT IS A HIGH DEPENDENCY UNIT (HDU)?

Patients admitted into the hospital may require a level of
care that cannot be provided on a general ward but does
not require admission into an Intensive Care Unit. This
area is often referred to as the High Dependency Unit
.(HDU)
At the same time, patients in the Intensive Care Unit who
have had an improvement in their condition may also
require a stay in the High Dependency Unit (HDU) before
.admission to a general ward
The HDU is similar to ICU except that patients admitted to
the HDU are usually less ill or beginning to recover from
their operation. There may be fewer nurses and doctors
than in the ICU because the patient is not as ill and does
.not require as much treatment
Similar to the ICU, patients in the HDU are monitored

frequently, assessed daily and the need for continued HDU

.care is continuously re-evaluated
In most rural hospitals the HDU is a part of the ICU. In
Sydney, the HDU can either be a part of the ICU or a
.separate unit altogether
The guidelines, policies and protocols contained within this
library are provided as REFERENCE material and are not to
be viewed as patient care directives. Before using this
material users are directed to read the full
.DISCLAIMER which outlines the conditions of use

ICU Equipment
INTENSIVE CARE UNIT EQUIPMENT
Equipment used in the ICU varies from the familiar, such
as devices to measure blood pressure, to very specialized
devices, such as bedside monitors or dialysis machines.
These pages are designed to give a lay-persons
description of each piece of equipment, the information
provided includes an explanation of how it works, when
and for how long it is generally used, and possible
complications. These pages were authored by members of
the Consumer Webpage Working Party
(CWPWP) which is comprised of senior nursing and
medical clinicians from NSW intensive and critical care

units as well as consumer, allied health and legal

.representative
Arterial Catheter
Balloon Tamponade Tubes
Beds
Bedside Monitors
Biospectral Index monitor (BIS)
BiPAP (Bi-Level Positive Air Pressure)
Brain Tissue Oxygen Monitor
Central Venous Catheters (CVC)
Clinical Information Systems
Cooling and Warming Blankets
Dialysis Catheter
Dialysis Pumps
EEG - Electroencephalography
Endotracheal Tube (ETT or Breathing Tube)
Epidural Catheter
Extracorporeal Membrane Oxygenation (ECMO)

 Intra-Aortic Balloon Pump (IABP)

Intracranial Pressure Monitoring
Intravenous Infusion Pumps
Mattress, Pressure Relieving
Nasogastric Tubes (NG Tube)
Oxygen Masks
Pacemaker
Patient Controlled Analgesia (PCA)
Peripheral Lines
PiCCO
Pulmonary Artery Catheters
Saturation Monitor
Sequential Compression Devices
Suction Catheters
Syringe Driver / Syringe Pump
Under Water Seal Drain and Chest Tube
Tracheostomy

 Ventilators (Breathing Machines)

Ventricular Assist Devices
Wound Drains
Indwelling Urinary Catheter (IDC)

Ventilators (Breathing Machines)

Ventilators are commonly known as breathing machines
because they support patients to breathe for themselves,
or can take over breathing for a patient completely. Some
people also refer to them as life support machines,
.although this is not strictly true
A Bennet Ventilator

Care Fusion High

Frequency Oscillation Ventilator

ARE ALL VENTILATORS THE SAME?

Ventilators come in many shapes and sizes but all
generally work in the same way. The ICU team are able to
set the ventilator to give individual patients exactly what
they need. This could range from assisting the patient's
own breaths to full support by taking over a patient's
breathing completely. Patients who are ventilated require
close monitoring, so they are allocated one nurse to look
after them. When the patient has improved and is able to
do all of their own breathing, the breathing tube will be
.removed. This procedure is called extubation

HOW DOES A VENTILATOR WORK?

A patient is connected to a ventilator via a breathing tube
(endotracheal tube) that is inserted into the windpipe
(trachea). This tube is introduced into the trachea via the
mouth or the nose during a procedure called intubation.
This tube is held in place by cotton or adhesive tape and is
then connected to the ventilator. There are many reasons
:why someone may need to be ventilated, including
To protect the airway and lungs if the person is not
awake enough, eg after surgery, or if they have had a
stroke

 If the patient has respiratory (lungs) muscle

weakness and they are not strong enough to breathe
for themselves
If they have suffered damage to their lungs from an
infection or trauma

ARE THERE ANY COMPLICATIONS?

All Intensive Care interventions and procedures carry a
degree of potential risk even when performed by skilled
and experienced staff. Please discuss these issues with
the medical and nursing staff who are caring for the
.patient