icu transport protocol - Intensive Care & Coordination Monitoring Unit

INTENSIVE CARE SERVICES
(ICU/HDU)
(CONCORD HOSPITAL)
INTRAHOSPITAL TRANSPORT PROTOCOL
INTRODUCTION:
Operating Theatre Transfers
(For ICU and HDU patients only)
In the Intensive Care Unit (ICU) or the High Dependency Unit (HDU) critically ill patients have reduced or absent
physiological reserves. These patients are often unstable, requiring ventilatory or inotropic support. Adverse events
in these patients during intrahospital transfers are common. Thus the decision to transfer a patient should be made
only after consideration of the benefits and risks associated with the transport.
Transport of ICU and HDU patients to and from the Operating Theatres (OT) has many similarities with
transport of these patients to other areas of the Hospital. Some differences do exist and they relate to:
a) Non-ICU staff take over care of the patient for the duration of the transfer out of ICU.
b) The transfer consists of phases where the patient is transported relatively short distances to and from
the OT but they then may undergo a procedure that takes quite a long time and that will put the
patient under great physiological stress (surgery, anaesthesia, fluid volume changes, pain etc).
c) Communications between the ICU and the OT staff needs to be clear and detailed both in the predeparture
period and on arrival back in the ICU.
d) Ventilatory support is not usually provided using ICU ventilators or the transport ventilators during
transit and anaesthetic ventilators are used during the anaesthetic/surgery.
ICU staff must become familiar with the transport process itself as well as the equipment and drugs used during the
transport. Medical and nursing staff should act as a team and cross check all activities.
STAFFING:
1. CLINICAL ESCORT
a) Medical
- The medical member of the Transfer Team should be at least Registrar level. For stable patients
who require only minimal ventilatory support an experienced Anaesthetic RMO would be
suitable for the medical escort.
- The Registrar should have experience in transport of critically ill patients.
b) Nursing
- An experienced member of the OT nursing staff should be part of the Transfer Team.
2. NON-CLINICAL ESCORT
a) Porters/Wardsmen/Orderlies/Runners:
- One or more are needed for each transport
- Porters should not be kept waiting unnecessarily
- Porters usually come from the OT
PATIENT STATUS:

1. As stated above, the benefit of the proposed intervention should outweigh the risk of moving the critically
ill patient.
2. Patients who require an FiO2 equal to or more than 0.40 and/or CPAP equal to or more than 10 cmH2O will
require assisted ventilation using the Laerdal self-inflating resuscitator and the CPAP connector and an
appropriate CPAP valve. (It is recommended that ventilatory support settings be increased during the
transfer eg CPAP 10 to CPAP 12.5).
EQUIPMENT:
a) General:
All staff must be familiar with each item of equipment. All equipment must be prepared and
checked prior to the transfer. All electrical items must be fully charged. Power cords and/or
rechargers should be taken in case there is a delay in the transfer. Whenever stationary, plug into
power outlets and connect to wall oxygen.
Staff should check prior to any transfers that any destination environment will support the level of
care required for the patient. This includes O2 and suction outlets as well as a safe electricity supply.
Equipment used in the transfer should be stowed safely and not placed on the patient. Staff need to
familiarise themselves with the location of the disposable and non-disposable equipment within the
ICU/HDU.
b) Specific items:
i) Oxygen cylinders (two)
ii) Portable Monitor (including ETCO2 where deemed necessary)
iii) Transport Box: check contents of the box
iv) Laerdal Resuscitator:
• The Resuscitator is kept sterile in the white container or sealed sterile cover until use
o Resuscitator
o CPAP attachment (expiratory and connector)
o Masks
• Resuscitator attachments are stored in one of the Maxibins
o 10" disposable circuit tubing
o Green O2 tubing
o Disposable Portex Thermovent 1200 Patient Filter
o 2L black bag as a “dummy” lung
• approach set up by checking main unit first then check CPAP attachment then join the two
• MAIN UNIT
o Assemble correctly with all valves in place
o Attach green tubing to O2 inlet
o Check function NB: use 2L black bag as a “dummy” lung
• CPAP ATTACHMENT
o Laerdal CPAP unit
o 10" disposable circuit tubing
o CPAP valve – disposable; level of CPAP (cmH2O) 5, 7.5, 10. 12.5, 15, 20
o Attach to the main unit and check function of whole assembly.
TRANSPORT PROCEDURE :

a) Pre-transfer:
i) Patient:
a. Appropriateness: patients on significant respiratory and/or significant inotropic
support or are otherwise unstable should not considered suitable for intra hospital
transport; exceptions can be made if the reason for the transport is deemed
absolutely necessary;
b. Review current stability
c. Check cardiovascular support
o current parameters
o need for inotropes
o check line placement(s) and security
o identify line for dedicated IV access during transport
d. Check ventilation parameters
o check ETT for placement and security
o ensure recent suction has been carried out
o check recent ABG
o because patients will be lying supine and/or will be in transit for lengthy periods
of time it is recommended that the CPAP settings be increased and/or PS
ventilation is added or the level increased
ii) Equipment: use tray below the bed to store resuscitator, Transport Box etc.
a. Check:
o O2 cylinders / Transport Box
o Laerdal resuscitator
o infusion/syringe pumps/spare power cords
o IV poles for bed
o BED: can be raised and lowered, head up and head down, power cord is to
go on transfer
o Remove unnecessary equipment - e.g. mattress pump, calf compression
o NB: FOR PATIENTS GOING FOR TRACHEOSTOMY, in
general one or more appropriately sized Mallinckrodt
Tracheostomy tube will be sent with the patient; the OT transfer
Team (in particular the Doctor) has the responsibility of ensuring
that the surgical team insert the tracheostomy tube that is sent
with the patient.
b. carry appropriate support drugs:
o sedation
o vasoactive drugs
o IV fluids
o carry any drugs that may need to be given while away from the ICU e.g.
antibiotics; patients on inotrope infusions should have an additional pre-loaded
syringe available;
iii) Documentation:
a. Consent
b. Imaging films
c. Patient notes
iv) Communications:
a. It is imperative that all aspects of the patient’s current status are conveyed to the OT

Transfer Team.
b. Information to be conveyed to the OT Transfer Team should at least include:
i. Current stability
ii. Need for antibiotics
iii. Ventilation requirements
iv. Infection control status
v. Specific information eg chest drains, tracheostomy recommendations
b) In the Operating Theatre:
i) Wear gowns and gloves at all times and eye protection when deemed necessary; patients
infected or colonised with epidemiologically significant organisms (eg MRSA, MR
Acinetobacter, MR pseudomonas etc) should be transferred using the current infection
control practices (i.e. contact barrier precautions). All attempts should be made to minimise
the risk of transfer of these organisms to the OT environment.
ii) Stay with patient at all times
iii) Continuously monitor: ventilation and respiratory parameters
cardiovascular parameters
iv) All activities associated with the patient during their time in the OT should be documented
c) Post-transfer:
1. Patient stabilisation:
i) Ensure the patient is connected to the bedside ventilator and monitor
ii) Check stability of the patient: clinical examination and ABG and CXR
iii) Document the patient’s condition before, during and after the transfer
2. Handover:
i) The OT Transfer Team must ensure that the patient is stabilised before they leave
ii) The OT Transfer Team must handover the patient to both the ICU medical and nursing staff
iii) The medical member of the OT Transfer Team will call ahead to the ICU and indicate an
estimated time of arrival back in the ICU. The ICU staff must make themselves available to
take the handover from the OT staff.
iv) The medical member of the OT Transfer Team must handover to one of the ICU medical
team (in-hours this must be one of the registrars, out-of-hours it is preferable to handover to
a registrar but this may not be possible).
3. Other:
i) Any drugs that were drawn up in syringes for the transfer must be now discarded.
ii) Clean all non-disposable equipment including power cords
November 2003