Intensive care unit (ICU) patients are at their most vulnerable
during the period of transport to and from the ICU.
- ▪ 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.
- ▪ 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
- ▪ 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
- ▪ 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
- ▪ 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?
Clinical Pearls and Pitfalls
- ▪ 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
- —Derecruitment of the lung and consequent problems
- —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 ...