CTVS

1. King George’s Medical University
Name of presenter : Nidhi Tripathi
Final Year

3. Design of ICCU/ICTU
Presentation Description

4. General objective
At the end of the presentation you all will be able to explain
the knowledge regarding design of

5. Specific objective
At the end of this class students will be able to understand
covered topics -

6. TOPIC COVERED
• definition
• objectives of ICCU/ICTU
• design of ICU
• Functional criteria
• definition of levels of care
• management of equipment

7. CONT…
• floor plan and connections
• STAFFING: Cardiac team
• medical staffing
• definition of intensive care patients

8. Introduction
ICU has sometimes been referred to as hospital. ICU includes patient
monitoring, respiratory and cardiac support, pain management,
emergency resuscitation devices, and other life support equipment
designed to care for patients who are seriously injured, have a critical
or life-threatening illness, or have undergone a major surgical
procedure, thereby requiring 24-hour care and monitoring.

9. Definition of an intensive care unit
It has a defined geographical location concentrating the human and
technical resources, such as manpower, professional skills and
competencies, technical equipment and the necessary space.

10. Coronary ICU:
Cardiac or coronary care units is used by the patients who have or are
thought to suffer from acute MI, arrhythmias or some other cardiac
emergency conditions.

11. Objectives of an ICCU/ICTU
• to provide care to patients who have or are thought to suffer from
acute MI, arrhythmias or some other cardiac and thoracic emergency
conditions.
• to provide specialized care to patients with specific conditions.
• For the monitoring and support of threatened or failing vital functions
in critically ill patients.
• to perform adequate diagnostic measures and medical or surgical
therapies to improve outcome.

12. Design of ICU

13. Functional criteria

14. Location
An ICCU/CTICU will be situated in a hospital with appropriate
departments to ensure that the multidisciplinary needs of
intensive care medicine are met.

16. Size
An ICCU/CTICU should accommodate as a minimum at least 6
beds, with 8–12 beds considered as the optimum.

18. Definition of levels of care
Three LOCs are proposed: III, II, and I.

19. • Level of care III (highest). LOC III represents patients with multiple
acute vital organ failure of an immediate life-threatening character,
Patients on mechanical ventilator, patients immediately after cardiac
surgery.
• Level of care II. LOC II represents patients requiring monitoring and
pharmacological and/or device-related support of only one acutely
failing vital organ system with a life-threatening character.
• Level of care I (lowest). LOC I patients experience signs of organ
dysfunction necessitating continuous monitoring and minor
pharmacological or device-related support.

20. LOC Nurse/patient ratio Nursing FTE per ICU bed
III 1/1 6
II ½ 3
I 1/3 2

21. Required number of intensive coronary care beds
The number of intensive care beds has to be calculated as a
function of the type of the hospital, admission of patients, the
geographic location of the hospital, number of acute beds, etc.

22. Quality control
Quality control encompasses a wide variety of activities and items
needed to objectivate and explain the excellence of performance,
and benchmark with peers.

23. Each ICCU/CTICU should evaluate its activity, bearing in mind that a
critical minimum amount for hospital acquired infections,
complications or errors is necessary to maintain medical and nursing
expertise at adequate levels.

24. Every ICCU/CTICU is required to have a quality assessment
and improvement program in order to compare with a
national/European benchmark.

25. Management of equipment

27. Consumables
Disposable material raises problems of storage and
distribution because of its volume and turnover.

28. Durable equipment
Criteria for the selection, purchasing, storage, servicing,
sterilization, and replacement of durable equipment.
• Intensive coronary care unit equipment includes:-
• patient monitoring
• life support and emergency resuscitation devices
• diagnostic devices

29. PATIENT MONITORING EQUIPMENTS
• Acute care physiologic monitoring system
• Pulse oximeter
• Cental venous pressure monitor
• Apnea monitor
• Arterial BP monitor
• Holter monitor
• Portable ECG and ECO machine
• TEE

30. LIFE SUPPORT & RESUSCITATIVE EQUIPMENTS
• Ventilator
• defibrillators
• infusion pump
• crash cart
• Intra aortic baloon pump

31. DIAGNOSTIC EQUIPMENTS
• mobile x-rays
• portable clinical lab. devices
• blood analyzer

32. Floor plan and connections
• The unit consists of a geographically distinct entity in the
hospital with controlled access. The through-traffic of
patients and provisioning not intended for the ICCU should
be avoided.

33. • Layout of the ICCU/CTICU should allow rapid access from the
following:
The emergency
department
Postoperative
areas
The medical
imaging
department
The functional
testing facilities
e.g., catheter
lab, endoscopy
The operating
theatre s

34. • Fast and easy connections have to be established with the
following
Blood
transfusion
service
Technical
support services
Laboratory service
Microbiology
service
Physiotherapy
service
Pharmacy and
pharmacology
services

35. Accommodation
1. Patient area
2. Visual observation
of the patient

36. Management functions in the patient area
1.Communi
cation
2.
Administrative
equipment
3. X-ray film
viewer
4. Storage

37. Cont …
5. Separate pass
6. Monitoring
equipment

38. Central nursing station
Shelves for forms,
library
Telephone,
intercom, and
emergency call
systems
Satellite storage
room
Optional visual
display
Drug
preparation
area
Computer
terminal(

39. Storage Utility
Nurse’s
office
Medical
office

40. Secretariat Staff lounge
Physician-
on-call
bedroom
Laboratory

41. Seminar room
/conference
room
Cleaners’
room
Interview
room
Corridors

42. Floor
coverings
Wall
decoration and
ceiling
Fire safety Floor plan

43. Smoke and
toxic gases
Means of
escape
Related
issues
Central
services

44. STAFFING: CARDIAC TEAM

45. Surgical Team includes
• Surgeon
• Assistant Surgeons
• Cardiologist
• Surgical Nurse
• Perfusionist
• Anesthesiologist
• Anesthetic nurse
• Technichian : technicians trained in cardiac and vascular care
• researchers, including doctors, nurses and scientists who help to find
new treatments.

46. Medical staffing
• Director of the intensive coronary care unit
• Medical staff members
• Medical trainees
• Continuity of medical activity
• Nursing staff
• Head nurse
• Nurses

47. Allied health care personnel
• Physiotherapists
• Technicians
• Radiology technician
• Dietician
• Psychologist
• Occupational therapist
• Clinical pharmacist
• Administrative personnel
• Cleaning personnel

48. Activity criteria
To assure optimal patient care, a complex and time-critical interplay
among different groups of professionals, using a wide range of
pharmacological interventions, treatments, and procedures, is needed
• This includes the following:
– Presence of inter-professional clinical rounds
– Standardized and structured processes of handover and of
interdisciplinary and interprofessional information transfer
– Use of a clinical information system (patient data management
system)

49. Definition of intensive care patients
Two types of patients are likely to benefit from admission to
an ICU:
1. Patients requiring monitoring and treatment because one or more
vital functions are threatened by an acute disease or by the sequelae of
surgical or other intensive treatment leading to life-threatening
conditions.

50. 2. Patients already having failure of one of the vital functions such as
cardiovascular, respiratory, renal, metabolic, or cerebral function but
with a reasonable chance of a meaningful functional recovery.

52. Summary
Summary