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Introduction

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Intensive care unit (ICU) patients are at their most vulnerable during the period of transport to and from the ICU.

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Definitions and Terms

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  • ▪  Transport: Includes travel to the unit from the floor, emergency room, or operating room and from the unit to the floor, operating room, and off-site test and procedure locations.

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Techniques

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  • ▪  Prior to transport, the transferring personnel should ensure that the receiving personnel has received report on the patient’s status, if applicable.
  • ▪  If the patient is going off-site for a test or procedure, the stability of the patient should be evaluated immediately prior to transport to ensure that the requirement for the test outweighs the risk inherent in the transport.
  • ▪  Prior to transport, all relevant data should be reviewed to ensure that the performance of a planned procedure will not put the patient at additional risk (ie, does the patient have an intravenous [IV] contrast allergy).
  • ▪  Where applicable, lower risk alternatives that can be performed in the ICU should be considered (ie, portable anterior-posterior chest x-ray in ICU vs. formal posterior-anterior and lateral in radiology department).
  • ▪  Are adequate numbers of skilled personnel available to make the trip safely and is adequate coverage available in the ICU?
  • ▪  Appropriate medications and an administration route (ie, patent IV line) should be identified prior to transport.
    • —Make sure resuscitation medications are available where appropriate (ie, atropine).
    • —Make sure all infusion medications are sufficiently full to last through planned transport or that replacement supplies are available.
  • ▪  Additional equipment needed for safe transport should be available (ie, portable suction for chest tubes).
  • ▪  Nursing interventions should be performed prior to transport to diminish the risk of nosocomial infections.
    • —Keep head of bed elevated during transport where possible to diminish the risk of regurgitation and aspiration.
    • —Empty urinary drainage bag to prevent reflux of urine into the bladder.
  • ▪  Evaluate ventilatory status prior to transport to ensure that ICU ventilatory and oxygen support can be reproduced both during transport and at receiving site.
  • ▪  Are adequate oxygen supplies available during transport (check cylinder supply)?
  • ▪  Is a portable ventilator necessary to reproduce positive end-expiratory pressure (PEEP) or ventilator mode during transport?
  • ▪  Is there a ventilator at destination?
  • ▪  Is there a face mask with a self-reinflating resuscitation bag immediately available?

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Clinical Pearls and Pitfalls

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  • ▪  A checklist (Figure 7-1), analogous to those used on commercial aircraft prior to take-off and landings, can be used to ensure that all elements are in place to transport a patient safely.
  • ▪  The transition from mechanical to manual ventilation can be problematic under the following circumstances:
    • —Derecruitment of the lung and consequent problems with oxygenation.
    • —Manual overventilation, with consequent air trapping or auto-PEEP and decreased venous return leading to hypotension—this is readily diagnosed by disconnecting the ventilator and allowing trapped air ...

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