ICU MANUAL

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NEELKANTH HOSPITAL
ICU MANUAL
Document Number NH/MNL/ICU
Prepared By:
Revision Number 00
Name:
Revision Date Original Document
Date of Issue Approved By:
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TABLE OF CONTENT

S.no Content Page no.

1 Introduction
2 Manpower in ICU
3 Duties of Ward Incharge
4 Duties of Staff Nurse
5 Duties of Anesthesia Technician
6 Duties of Ward Boy
7 Duties of Safai karamchari
8 Protocol for Critical Care Management
9 Cleaning
10 Protocol for Admission of a Patient
11 Protocol for Receiving an Unconscious Patient
12 Protocol for MLC
13 Special Instructions
14 Protocol for online Computerized Pharmacy indent
15 Resuscitation Trolley
16 Procedure for Endotracheal / Tracheostomy Suctioning
17 Procedure for Endotracheal Intubation
18 Procedure for Bedside Tracheostomy
19 Procedure for Central line
20 Procedure for Collection of Blood sample for Culture & sensitivity
21 Procedure Intravenous injection
22 Procedure Ryles Tubes Insertion
23 Procedure Catherisation
24 Procedure for Central line
25 Procedure for Arterial line
26 Procedure for PA catheter

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27 Preparation of the patient for OT

28 Daily Check list
29 Check list of Records
30 Precautions for preventing / controlling infection
31 Universal Precaution for infection Control
32 Waste Management

Introduction
Please write your introduction

Manpower in ICU

Anesthesia OT
Physiotherapist
ICU Incharge Doctor Technician

Duty Doctor / Visiting ICU Sister Nurse Incharge

Doctors
ICU Sister Nurse

Ward boys

Safai karamchari

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ICU MANUAL
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Duty Timings

Sister Incharge ICU

8:00AM to 4:00PM
Nurse
Shift I : 8:00 AM to 2:00 PM
Shift II : 2:00 PM to 8:00 PM
Shift III : 8:00 PM to 8:00 AM

Duties of Ward Incharge in ICU

1. Taking over daily of whole ICU by night supervising sister assigned as per duty
roster.
2. Daily census and ventilator patient’s list (Checking)
3. Checking for completion of pending files
4. Nursing care and charting checking
5. Interaction with counter staff and bed side staff and maintain excellent IPR with all
ICU family.
6. Any administrative problem in ICU – inform NS / Consultant Incharge ICU
7. Checking the stock of all items
8. Checking all the inventories and equipments and maintaining them
9. Checking working condition of all equipment

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10. Care of the store cupboard files, all register and controlled drugs.
11. Billing of all chargeable and non-chargeable items and checking billing procedures
12. Preparing and checking Leave roster in coordination with NS
13. Ward orientation to all new staff (ICU protocol, sterile technique, waste
management, admission and discharge, MLC, LAMA, billing procedure, manners,
telephone manners, check list, duty timing, EL, CL, Medical, OFF and maintain
decency of the profession)
14. Orientation about the rules and regulations of the hospital and administration
15. Orientation about – how to indent and maintain stock, loan slip, pharmacy
prescription (emergency and routine), diet slip,
medicine refund, discharge procedure, billing procedure)
16. Prepare duty and work assignments
17. Regular inventory checking of ward
18. Prepare list for condemnation of equipments and articles and submit to all
concerned
19. Submit Confidential reports of staff
20. Prepare all monthly reports & present to ICU Incharge.
21. To make all staff involve in the training programme.
22. Checking all bedside equipment according to the Checklist in case of anything not
working – inform NS.
23. Check waste management on the bed side as well as the waste moving out from
ICU
24. Check cleaning of ward
25. Teaching and orientation of the ICU protocols

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26. Check the census of the patient and send to record section in time.
27. Checking of bed side chart which mentions about bed sore, oral care, ET care,
tracheostomy care (all are mentioned in the chart)
28. Check the proper hand washing before and after procedure
29. Carbolisation of beds before admission of new patient and after discharge of
patient and ready to receive the next patient.
30. Following and supervising all the doctors orders for implementation
31. Maintaining IPR with doctors, nurse and other faculty of the hospital
32. Check the shortage of staff and informing ANS
33. Check the House boy and Ward Boy and assign their daily duties

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Duties of Staff Nurse in ICU

1. Taking over and handing over all the ICU drugs, equipment, registers, controlled
drugs, bill book, census, chargeable and non-chargeable items, CSSD items etc.
2. Taking proper bed to bed over of the patient in details & check the bed side
equipment, inform the sister incharge if there is any fault
3. Preparation of nursing care plan and implementing according to priority needs
4. Daily sponging, mouth care, back care, bed sore care, ET Tube care, central line
care, catheter care, tracheostomy care as per protocol all disposable items are
changed or not. Changing of bed sheet, pillow cover.
5. Check all the medicines of the previous shift given or not (assisting in procedures)
6. Maintaining all charts (ventilator chart, ICU Chart, daily inventory chart,
investigation chart, antibiotic marking etc.)
7. Proper hand wash before and after procedure
8. Dismantling the items after use and after cleaning
9. Following doctor’s orders, giving medication to the patient on time, to the right
patient, checking expiry date.
10. Assisting doctors in various procedure, dressing, intubation, central line,
tracheostomy, peritoneal dialysis etc.

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11. Make sure that all MLC should be informed to Police and hand over all items to
police only.
12. In case of LAMA, check whether LAMA form is filled in properly by the doctor and
get it signed by the relative of patient
13. When the patient is getting discharged ensure that billing should be complete with
final bill attached to the file
14. In case any medicines are left over and the patient is leaving, refunding should be
done according to the protocol
15. Pre-operative check list to be attached before sending the patient to OT and check
the consent also
16. Close observation and monitoring of patient
17. Helping the patient to take meals or feeding the patient of RT is present
18. Attending all the needs of the patient
19. Coordinate with dialysis team for the planning of Hemodialysis & smooth
conduction of procedure bedside in the ICU.

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Duties of Anaesthesia Technician in ICU

1. Checking all the technical items like ventilator, monitors, infusion pump, and all
equipment. In case any problem, inform ANS and company also
2. Assisting doctors in all procedures and check the shortage (tracheostomy, central
line, bronchoscopy, blood gas, arterial line) when ever needed.

Duties of Ward Boy in ICU

1. Cleaning, dusting, waste handling of all ICU items

2. Assisting nurse in shifting and receiving of patient
3. Carrying all investigations to various labs and department
4. Collecting store items alongwith ANS
5. Proper waste disposal as per hospital protocol
6. Hand washing after every procedure
7. Wearing mask and gloves before doing any procedure

Duties of Sweeper in ICU

1. Brooming and sweeping of the ward
2. Emptying of urobag drain, bed pans, urinals, after informing the bed side staff
3. Proper waste disposal as per hospital protocol
4. Cleaning of the dirty linen and send it to laundry

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ICU MANUAL
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5. Hand washing after every procedure

6. Wearing mask and gloves before doing any procedure
Protocol For Critical Care Management

The following should be ensured to keep the cleanliness of the ward to prevent
infection:

 Those who are entering into the ICU should remove their shoes/chappals at the
entrance gate and wear the ICU chappal/shoe cover [kept at the entrance gate]
 On duty staff in ICU should wear the ICU dress and face mask
 Proper care should be taken to dispose the waste materials in the specified
coloured bag as per instructions [yellow bag, black bag, blue bag]
 Before and after touching the patient, hands should be washed properly with
disinfectant
 The clothes and ornaments of the patient should be handed over to the relatives
and obtain the sign from the relatives

CLEANING:

 ICU must be dusted every day (wet mopping only)

 All wooden & steel furniture should be wiped clean with Spirit solution in the
morning & evening
 Floor should be wiped with Bacillocid solution at morning, evening and night
intervals (To be supervised by Sister Incharge ICU).

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 Separate duster mop should be used for cleaning floor, wall, and furniture
 Slippers should be washed everyday
 All suction machine bottles should be emptied immediately after use & they are
cleaned properly
 Suction tubing should be changed after discharging the patient
 Mattress and pillow should be sent for fumigation after the discharge/death of the
patient
 Bed pan, urinal, kidney tray, sputum mug should be washed properly and keep it
separate (best disposable)
 ICU fumigation preferred 3 monthly if possible.
 Visitors to be restricted

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Protocol for Admission of a Patient in ICU

Duty Doctor
1. Duty doctor follow algorhythm of admission.
2. Inform consultant Incharge on phone about the arriving status and take orders
and execute them.
3. Follow triage system in case of more than one patient at one time.
4. Full clinical history & examination mention in file.
5. Confirm treatment advice by the consultant & execute.
6. Talk to the relatives and explain them present status.
7. Take appropriate consent for the procedures if required like central line, arterial
line, ventilator support, other invasive procedures, tracheotomy, dialysis, PA
catheter.
8. Urine Cathetarization with all aseptic precaution.
9. Check MLC & police information co-ordination with casualty/emergency doctor.

Duties of Nursing Staff

1. Receive the patient from trolley
2. Check the vitals i.e. TPR, BP, RBS and record the findings
3. Connect the patient with monitor and close observation and monitoring
4. Assess the patient
5. Keep ready the resuscitation kit, if intubation is required

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6. Remove clothes, all ornaments and other belongings and put ICU clothes
7. Clothes, ornaments and other belongings should be handed over to the patient’s
relatives and take signature in the register.
8. Check for any bedsore. If bedsore is present take signature from doctor
9. make the file and tie all relevant investigations
10. Enter the patient’s name in the admission/ discharge and census book
11. Carry out unit orders and make the treatment book
12. Prepare fresh ICU chart and charting to be done
13. If central line is insertion is needed, arrange all articles
14. Check the central venous pressure
15. ICU bed side chart, ventilator chart and other charting to be maintained properly
16. Give the medications as prescribed
17. Send the samples as ordered
18. Send diet request to the diet department
19. Pharmacy slip to be sent
20. Place Ryle’s tube if needed
21. Bill book to be sent to the billing section
22. Explain the relatives regarding pharmacy, visiting time, bill section, waiting area,
important telephone number & central announcement system etc

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ICU MANUAL
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Protocol For Receiving an Unconscious Patient in ICU

(Patient with RTA)
Duty Doctor
1. Duty doctor follow algorhythm of admission.
2. Inform consultant Incharge on phone about the arriving status and take orders
and execute them.
3. Follow triage system in case of more than one patient at one time.
4. Full clinical history & examination mention in file.
5. Confirm treatment advice by the consultant & execute.
6. Talk to the relatives and explain them present status.
7. Take appropriate consent for the procedures if required like central line, arterial
line, ventilator support, other invasive procedures, tracheotomy, dialysis, PA
catheter.
8. Catheterization urine with all aspolit precaution.
9. Check MLC & police information co-ordination with casualty/emergency doctor.

Duty of nursing staff

1. After receiving the call from CMO, the staff on duty will check the working
condition of bed and bedside articles including ventilators, monitors and
intubation aids

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ICU MANUAL
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2. The counter sister will receive the patient along with the documents. She checks
all documents, especially MLC number and stamp etc. She informs the unit
doctor
3. In the mean time the assigned staff nurse will transfer the patient to the bed
4. While transferring the patient from the trolley to the bed the life support system
should be handled carefully
5. The nurse who receives the patient should make a nursing assessment and make
a plan for nursing intervention.
6. If the patient is not maintaining the airway manage accordingly. For example
respirator support and other oxygen support
7. Connect the monitor and check vital signs that include TPR, BP, RBS
a. Check level of consciousness
b. Maintain Glasgow coma scale
c. Physical examination including, make a note of injury
d. Make a parenteral route and start IV dip
8. Settle the patient – clean the patient, change the clothes & put ICU gown. In case
of MLC, clothes of patient not handed over to the relatives, only the ornaments
and other things should be handed over and take signature in the case sheet
9. Carry out the doctor orders
a. Send routine investigations like ECG, CXR, CBC, LFT, RFT, SE, PT, APTT and
RBS
b. Give medication as prescribed
10. Send emergency medicine slip to the pharmacy
11. Maintain the ICU flow chart and treatment book

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12. Explain the relatives regarding pharmacy, dietary department, visiting time, bill
section, waiting room, telephone number etc
13. Carry out further management as ordered by doctors

Protocol for MLC (Medico-Legal Case) in ICU

Duty doctor’s responsibility

Coordinate with emergency / Casualty doctor.

1. Make sure that the patient is admitted in MLC list

2. Note the MLC number & police station in the case sheet
3. Patient’s cloth should be handed over to CMO. (in case of stab injury, burn cases)
4. Ornaments to be handed over to patient’s relatives after obtaining relative’s
signature.
5. Apply MLC stamp in all papers
6. In case of discharge, LAMA, inform CMO on duty
7. In case of death, inform to CMO on duty or direct to the police
8. The dead body, death certificates, death slip, death summary should be handed
over to police only, after taking signature in the case sheet
9. If dead-body is to be sent to mortuary, mention in the mortuary book also and
label the dead-body properly
10. MLC labeling should be in RED ink
11. Inform the security about the dead-body and MLC case.
12. Rest orders same as protocol for admission of rest patients.
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Special Instructions – ICU

 Triple lumen & single lumen to be heparanized at least four times a day
 No.: 21G needle to be used for central line insertion & pleural aspiration (as 22G is
N/A)
 Betadine to be used only for surgical dressing, bed sore dressing, bladder wash, etc.
 Iodine Tincture IP-66 only to be used for intact skin i.e. for CVP line insertion,
Tracheostomy, for withdrawing blood culture samples, LP, PD etc. & to be cleaned
after with spirit.
 HME Filter to be changed daily.

 Ventilator Circuit
 Catheter Mount to be changed every 7th day

 Closed Suction Catheter

 Central Line
to be changed every 14th day
 Tracheostomy Tube

(If required, can be changed earlier also)

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Protocol For online computerized pharmacy indent

1. Always check date, time, patient’s sticker, and signature of the staff with full name
while sending pharmacy slip
2. Inform pharmacy officer, NS office and treating unit - in case of non-availability of
medicines
3. Always keep printout of the medicine slip in ward after receiving medicine from
pharmacy.
4. After receiving medicines from pharmacy, tally with prescription slip & medicine bill
of every patient along with right dose & expiry date
5. Medicine bills should be handed over to relatives and get the signature
6. Proper replacement of medicines according to the replacement book
7. Refund medicines to pharmacy at proper time and get the refund voucher and enter
it in the refund register
8. In case of transfer of patient from ICU to ward, medicines should be handed over to
relatives and get the signature
9. Free medicine slip to be sent after the signature of MS

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ICU MANUAL
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Resuscitation Trolley – ICU

1 2 3 4 5 6

Defibrillator ECG Cable, Jelly

ECG electrode

O2
Cylinder

Gloves
7, 7.5 Portable electric suction 19
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TOP SHELF:

Ambu Bag + O2 reservoir + O2 tubing + Face mask+Bain’s circuit

6 SMALL OPEN DRUG CONTAINERS:

ATROPINE 10
ADRENALINE 10
AVIL, EFCORLIN 05, 05
25% DEXTROSE 05
SODA BICARB 10
XYLOCARD, CORDARONE 01, 05

FRONT SLAB:

DEFIBRILLATOR, BAG with ECG electrodes, ECG cable, Jelly

DRAWERS:

A. LARYNGOSCOPE & INTUBATION AIDS

1. Laryngoscope (3 blades: S, M, L): 2 sets

2. Spare laryngoscope bulb: 1
3. Spare medium size battery: 1 pair

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4. Xylocaine Jelly: 2
5. Precut Dynaplast: 5
6. Precut Cotton tape: 5
7. Magill’s forceps: 1
8. Xylocaine spray: 1
9. Stylet: 2
10. Laryngoscope bulb 2
B. ENDOTRACHEAL TUBES & AIRWAYS

1. E.T. tubes- cuffed (size: 7.0, 7.5, 8.0, 8.5): 2 each

2. Oropharyngeal airway (size 4, 5): 2 each
3. Nasopharyngeal airway (Size 6, 7): 2 each
4. LMA NO. 3, 4: 1 each
C. OXYGEN THERAPY EQUIPMENT

1. Polymask: 02
2. Ventimask: 02
3. Nasal prongs: 02
4. T-piece with nebuliser kit - 1
D. DRUGS
1. Atropine 05
2. Adrenaline 05
3. Avil 05
4. Efcorlin 05

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5. Dexona 05
6. Fulsed ( midazolam) 05
7. Lasix 05
8. Epsolin 05
9. Aminophylline 05
10. Deriphylline 05
11. Calcium 05
12. NTG 05
13. Dopamine 05
14. KCl 05
15. Dilzem 05
16. Betaloc 05
17. Cordarone 05
18. Xylocard 01

E. SYRINGES, IV CANULA, NEEDLES, 3 WAY STOP COCK

1. Syringes: 10 cc: 10
2. Syringe: 5 cc: 10
3. IV Canula: 20 G: 04
4. IV Canula: 22 G: 02
5. IV Canula: 18 G: 02
6. IV Canula: 16 G: 02
7. Needles: 18 G: 10
8. Needles: 22 G: 10

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9. Needles: 24 G: 10
10. 3 Way stop cock: 04

F. SUCTION CATHETER
1. Suction catheter: 12 G: 5
2. Suction catheter: 14 G: 5
3. Intra kit: 1
BOTTOM SHELF

Gloves: Size 7, 7.5: 1pkt

Cap : 1 pkt
Mask : 1 pkt

Portable electric suction apparatus

OXYGEN CYLINDER WITH REDUCING VALVE & FLOW METER

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Preparation of Isotopes for Infusion

Dopamine: (Dose range 2-20 µg/kg/min)

Body wt. * 3 =mg in 50 ml syringe (e.g. 50 kg * 3 = 150 mg in 50 ml saline)
If going @ 1 ml/hr means 1 µg/kg/min)

Dobutamine Dose range 2-10 µg/kg/min

Body wt. * 3 =mg in 50 ml syringe (e.g. 50 kg * 3 = 150 mg in 50 ml saline)
If going @ 1 ml/hr means 1 µg/kg/min)

Nor adrenaline: Dose range 30-120 ng/kg/min

Body wt. * 3 =mg in 50 ml syringe (e.g. 50 kg * 0.03 = 1.5 mg in 50 ml D5)
If going @ 1 ml/hr means 1 µg/kg/min)

Adrenaline Dose range 10-100 ng/kg/min

Body wt. * 3 =mg in 50 ml syringe (e.g. 50 kg *0.03 = 1.5 mg in 50 ml saline)
If going @ 1 ml/hr means 1 µg/kg/min)

Nitrogylserine: Dose range 0.5-50 µg/kg/min

Body wt. * 3 =mg in 50 ml syringe (e.g. 50 kg * 0.3 =15 mg in 50 ml saline)
If going @ 1 ml/hr means 1 µg/kg/min)

Nitropruside: Dose range 0.5 µg/kg/min

Body wt * 0.3 =mg in 50ml syringe (e.g. 50 kg * 0.3 = 15mg in 50ml Saline)

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If going @ 1 ml/hr means 1 µg/kg/min)

(50 ml Syringe, syringe pump, arterial pm line, three way)

Dopamine 5 ml = 200 mg
Dobutamine 5 ml = 250 mg
Adrenaline 1ml = 1 mg
Nor adrenalin 1 ml = 1 mg
NTG 5 ml = 25 mg
N choparide 25 mg dried powder / 25o mg dried powder

List of Procedures
 Procedure for Endotracheal / Tracheostomy Suctioning in ICU
 Procedure - Endotracheal Intubation in ICU
 Procedure - Bedside Tracheostomy in ICU
 Procedure - Central Line in ICU
 Procedure For Collection of Blood Sample for Culture And Sensitivity in ICU
 Procedure – Intravenous injection
 Procedure – Ryles tube insertion
 Procedure – Catheterisation
 Procedure – Arterial line
 Procedure – PA catheter

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ICU MANUAL
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Procedure for Endotracheal / Tracheostomy Suctioning in ICU

 Always keep in mind that it is a sterile procedure

 Wash your hands thoroughly
 Do the procedure with an assistant
 Always wear sterile gloves
 Give 100% oxygen for 2 minutes before starting suction
 Keep a watch on SPO2 & ECG
 Insert the sterile suction catheter gently, and make sure that no suction pressure is
applied while inserting the suction tube
 Open the suction pressure & withdraw the catheter gently by rotatory movement.
 Do suction only for 3 - 5 seconds each time
 Reconnect the ventilator
 Give 100% oxygen for 2 minutes in between each suction
 Wash the catheter with sterile saline
 Repeat the procedure if necessary
 The suction pressure should not exceed 150 mmHg
 Size of suction catheter:
The outer diameter of the suction catheter should not be greater than one half of
the inner diameter of the endotracheal/tracheostomy tube
Internal diameter of tracheal tube (mm) Size of suction catheter
6.0 10
7.0 12
8.0 14

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 Length of suction catheter to be inserted :

Nasally intubated - three-fourth of suction tube
Orally intubated - two-third of suction tube
Tracheostomy - one-third of suction tube

Note:
1. Single disposable catheter is used every time and then discard.
2. ET & trascheostomy suction cath & oral suction cath separate.
3. Throw away all material in suction bottle & wash suction bottle with fresh
water.

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Procedure - Endotracheal Intubation in ICU

Endotracheal Intubation in most cases is an Emergency procedure and the critical care
staff should always be ready to face the emergency and respond immediately. The
articles be ready at hand and should be provided to the doctor fast and in the following
sequence.
The bed should be made flat and the articles at the head end should be removed &
space has been made between head end of bed & wall to stand.

Articles required

For Adult patient Intubation:

 Pillow
 Bain’s circuit with mask
 Laryngoscope with blade of different sizes. Large, medium & small
 Endotracheal Tube - different sizes 6.5 to 8.5
 Magill’s forceps
 Stillet
 10 ml syringe
 Bandage & tape.
 Suction catheter adult - No. 14
 Suction apparatus
 Sterile gauze pieces

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 Sterile gloves
 Oral airway, nasal airway, T. piece, Nebulisers kit
For Paediatric Patient Intubation:

 Pillow
 Paediatric ambubag
 Laryngoscope with paediatric blade
 Endotracheal tube paediatric size 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0
 Paediatric Magill’s forceps
 Stillet
 5 ml syringe
 Suction catheter no. 8, 10
 Sterile gauze pieces
 Sterile gloves

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Procedure - Bedside Tracheostomy in ICU

1. Inform OT technician about the procedure

2. Take consent
3. Nursing staff should help operating team.

Articles Needed
 Emergency light
 Sand bag
 Extra two bed-sheets (big size)
 Tracheostomy set from CSSD or ICU
 Abdominal pack
 Gown pack
 Cap, mask
 Bronchoscope & dressing set
 Suction machine
 N. Saline 500ml - 02

Cleaning Tray
 Disposable gloves - No. 7, No. 7.5
 Tincture iodine - 1 bottle
 Spirit - 1 bottle

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 Xylocaine 2% - 1 vial
 Xylocaine jelly - 2 tubes
 N. Saline 25ml - 3 amp
 Disposable syringe 10ml - 5
5ml - 5
 Disposable needle - 5
 Surgical blade - No. 10, No. 15
 Percutaneous set or ciaglia set
 Sofratulle

Resucitation Tray

 Bains circuit
 AMBU bag with mask with oxygen connection
 Laryngoscope with blade - big, medium, small
 ET tube No. 7.5, No. 8 - two each
 Magille's forceps , stilet (portex)
 Xylocaine jelly
 Syringe, oral airway, nasal airway, laryngeal airway mask (no. 4)
 Cook's airway catheter
 Head ring
 Suction catheter No. 12, 14

Emergency Injections
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 Altropine, Adrenaline, Sodium bicarbonate, Calcium gluconate

Sedations/Muscle Relaxant
 Medazolam, propofol, fentanyl, butrophenol, vecuronium, atracurium,
pancuronium.

List of Tracheostomy set

To be Seen by surgical team and provided by OT CSSD.

Procedure - Central Line in ICU

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Articles Needed

 Cut open set

 Gown pack
 Gloves - size : 7.0, 7.5
 Mask, Cap
 Sand bag
 CVP manometer
 3 ways
 Triple lumen
 Inj. Heplock
 Tegaderm with pad : 3589
 I/V Bottle with I/V set
 Syringe needles

CLEANING TRAY

 Spirit
 Tincture iodine
 Xylocaine 2%
 Disposable syringe
 N. Saline ampules
Procedure For Collection of Blood Sample for Culture And Sensitivity in ICU
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Articles needed
1. Sterile gloves
2. Culture bottle/Bact alert Bottle Aerobic/Anaerobic.
3. 10 cc /20c syringe
4. Spirit
5. Tincture Iodine
6. Sterile gauze
7. Kidney tray
8. Sterile Towel
9. Extra Needles
10. Micropore

Procedure

i. Arrange the articles for the procedure

ii. Hand wash (Medical) before the procedure and select the area for the vein
puncture. Call an assistant to help you during the procedure.
iii. Prepare the site by cleaning with spirit and let it dry.
iv. Release the tourniquite if applied.
v. Hand wash and apply sterillium on the hand
vi. (Donot dry the hand with unsterile paper towel)
vii. Wear sterile gloves and ask your assistant to apply tourniquite on the patients
selected site.
viii. Clean the area with spirit and let it dry

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ix. Place a sterile towel below the punture site.

x. Again clean the area with tincture Iodine , ask the assistant to give you the
syringe .
xi. Strech the fore skin Prick the vein and draw 10 ml/bottle, after the blood is
drawn remove the syringe and needle from the puncture site.
xii. Apply sterile cotton on the area (after the syringe is removed.)
xiii. Change the needle and open the flip of the bottle clean it with spirit and gently
pour the sample into the bottle. Note no froth should be formed when pouring
the sample.
xiv. Change the needle if the sample is to be poured to another container.
xv. After the procedure wash hands.

Note
i. Fill the form by the person who have taken the sample.
ii. Note the Bottle No. on the form also complete the label on the bottle.
iii. Send the form to Microbiology Department.
iv. The one who sends the sample should fill the form .
v. Complete name of the person drawing the sample should be written on the form
and nurses over book.
vi. Only AEROBIC sample should be send for bactalert if anaerobic sample needs to
be send the doctor will specify.
vii. Two Aerobic samples should be send from different puncture site and if central
Line is present one central Line and another peripheral line sample should be
send.

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viii. When central line sample is sent clean the area and the first 10 ml should be
discarded.

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Maintain Sterile Technique All Through The Procedure.

Procedure - Intravenous injection
Articles
A tray containing
 I/V fluids according doctors order
 Medication to be added in I/V fluid as required and I/V set
 Vein flow or butter fly cannula
 Syringes as required
 Spirit swab
 A pair of clean gloves
 Tega derm or Micro pore
 Mackintosh
 Kidney tray & Tourniquet

Procedure
 Always remember the basic principles of 5 right
 Right patient
 Right medication
 Right dose
 Right time
 Right route / and method of administration
 Explain the procedure
 Wash hands

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 Wear gloves
 Select the site of vein
 Tie the tourniquet to make the vein prominent then insert the vein flow
 Fix the tegaderm and release the I/V fluid
 Regulate the flow
 Make the patient comfortable
 Replace the articles in their proper place
 Wash hands and record the procedure

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Procedure – Ryles Tube Insertion

Articles

Tray, bowl, kidney tray, syringe, gauze, oxylocaine jelly, Ryles tube, small towel, water,
stethoscope, A pair of gloves.

Procedure
 Explain the procedure to the patient
 Place the patient in semi fowlers position
 Wash hand and wear gloves
 Place the towel around the neck and measure the Ryles tube from the Ear lobe
till the tip of the nose and further to the xyphoid sternum
 Lubricate the Ryles tube and insert through the nostril while inserting the tube
instruct the patient to keep swallowing
 After inserting the tube check if the tube is in place by putting the end of tube in
a bowl of water and check for bubbles or aspirate for stomach contains
 If the tube is in the correct place, secure it above the nose with a tape and either
clamp it or attach it to continue drainage a per order
 Make the patient comfortable
 Replace the articles in their proper place
 Wash your hands and record the procedure

Procedure – Catheterisation

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Sterile pack containing

 A bowl with cotton swabs
 Sterile towel
 Artery forceps
 A pair of gloves

A clean tray containing

 Foleys catheter in a sterile pack, urobag with tubing
 Distilled water/ syringe and needle
 Betadine and lubricant
 Kidney tray
 Specimen container if required

Procedure
 Explain the procedure to the patient (if patient conscious)
 Provide privacy and wash hands
 Place the patient in proper position
 Wear gloves and clean the urethra (perineal area) with betadine, the cleaning is
to bedone using one direction only that is from up to down starting from the
opposite side discard the cotton, then the side near to you discard the cottone
and finally clean the middle portion
 Lubricate the catheter and gently insert it
 Inlflate the balloon with the required solution and leave the catheter in place
and connect it to the urobag

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 Keep the patient comfortable

 Wash hands and replace the article in their proper place

Preparation Of The Patient in ICU - For O.T.

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Check before sending to OT:

CONSENT:
 Consent should be taken from relative
 Explain about the operation by doctor
 Full name & relationship should be written in the consent form & take the
signature
 High risk, etc. should be taken according to the patient and doctor's order
 Pre-anaesthetic consent (PAC)
 Make sure that PAC has been done or not
 Follow the PAC orders like, pre-medication, NPO, investigation etc.

PART PREPARATION:
 Operation site should be prepare according to the site of the operation
 Identity tag should be tied on wrist before sending the patient
 Patient should be in OT dress
 Remove the ornaments, nail polish, if denture
 Ornaments and dress should be handed over to relative and obtain the signature
 Before sending the patient make sure that patient is having patent IV line
 Sending the patient along with case-sheets, all X-rays, MRI, CT scans, completed
nurse's pre-check list and investigations

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Daily Check List - ICU

To be checked by staff nurse on duty:

1. Suction tube / change & suction check
2. Flow meter: water change / check flowmeter
3. Resuscitation tray - cleaning
4. Check Ambubag / Laryngeoscope / ETT /styllet / mask
5. Alpha bed working
6. BP Apparatus/ stethoscope/ thermometer / Probe / Cable
7. Cleaning of bed
8. Dusting

Tasks for technician:

Cleaning of monitor/ventilator/infusion pump
Bed No. : _______
Above mentioned items checked properly by :

Date Morning Evening Night Signature Of Counter

Incharge

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Bedside Check List - ICU

Date:
Name of the Equipment Working Morning Evening Night Counter Incharge Remarks
Condition
Monitor
Ventilator
Infusion Pumps
SPO2 Finger Probe
ECG Leads
ETCO2
NIBP Cuff
BP Apparatus with Connector
Intubation Aid
Laryngoscope with Blade
Ambubag with mask and tubing
Magill's forceps
Thermometers
Stethoscope
O2 Flow Meter
O2, Air & Vacuum Point
Bedside Articles

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Emergency light

Check List of Records in Each Counter in ICU

1. Stock Register
2. Patients file and reports
3. Treatment recording book
4. Chargeable items (Book I & II)
5. Narcotic Drugs Register
6. Medicine Overtaking Book
7. Medicine Refund Register
8. Medicine Replacement Register
9. Glucostic Stock Book
10. Assignment Book
11. Census Book
12. Bill book – ventilator, bill book
13. Diet Book
14. Pharmacy routine requisition, emergency
15. Death, discharge summary receiving register
16. Handover taking book
17. Lab book
18. Mortuary book
19. Admission, discharge register
20. Medicine bill distribution book

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21. Complaint Book

Precautions for preventing / controlling infection in ICU

 On duty staff in ICU should wear ICU dress and face mask.
 Follow proper hand washing technique.
o Before entering the ICU (wash hands with soap & dry with disposable
towel)
o Before and after touching a patient (wash hands with chlorhexidine)
o Before and after doing a procedure (wash hands with chlorhexidine)
o Before leaving the unit (wash hands with soap & dry with disposable
towel)
 After hand washing, dry hands with paper towel and close the tap with same
towel.
 Every bed should have chlorhexidine hand rub.
 Use chlorhexidine/ alcohol skins antiseptic before and after touching the patient
and procedures
 Whenever doing a sterile technique (procedure, injections, dressing etc) use
surgicare gloves
 Injections and medicines should be prepared in a sterile area in sterile method and
should be administered in a sterile manner.
 Follow sterile technique mentioned in “Central Line Care protocol”
(proper hand washing, use of chlorhexidine hand rub and disposable surgi care
gloves.

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loading trays should be maintained in a sterile way using sterile cozy towel / sterile
towel.
Use sterile cotton swab with chlorhexidine for cleaning the tip of the clave
connectors, which is already connected to central line lumens.)
 All infectious patients should be isolated in separate rooms/ cubicals (HIV, HbsAg,
HcV, MRSA etc)

 Ensure that housekeeping workers in ICU are following and maintaining the
proper technique, that is:
o Using the separate cleaning solutions (clea-N-sept tab: dil: 1 tab in 2 litres
H 2O
o Using separate mops in different counters and frequent changing of
cleaning solution.
o They should also follow the universal precautions
o Cleaning of bed and unit with bacillol spray with clean dusters every day.
o Bed unit should be carbolized with bacillol spray after discharging,
death / transfer out of patients.
 Changing of suction tubings after discharge/ transfer out/ death of the patient.
 All items used should be disposable (ventilator circuit, closed suction/ suction cath
filter, suction tubing, thermometer, syringes)
 Proper disposal technique of waste material as per hospital disposal technique.

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Universal Precautions For Infection Control In ICU

1. Blood, body fluids and tissue samples should be collected and transported in
sturdy containers with securely fitting screw caps to prevent leakage. Care should
be taken not to contaminate the outside of the container and the laboratory
forms.
2. Gloves should be used while drawing blood, giving IV/IM injections.
3. Wash gloves with soap and water (like you wash hands) after every procedure.
4. Use fresh/ autoclaved pair of gloves every day.
5. If blood / body fluids splashes into the moth, eyes or nose wash thoroughly with
plenty or running water by rinsing and splashing.
6. Do not bend manipulate or recap disposable needles after use.
7. Destroy needle and syringe hub in needle and syringe destroyer.
8. Place syringe needle in double jacketed buckets having sodium hypochlorite
solution (0.1%)
9. Place non sharps e.g. gauze, cotton, clothing, contaminated with blood/ body
fluids in polythene bags (Marked yellow).
10. Tubings including catheters, Ryle’s tube, syringes to be put in hypochlorite
solution and then in black bags. Class IV employees who dispose of these bags /
containers to the incinerators should wear heavy-duty gloves.
11. All accidents and exposures to infectious materials should be reported
immediately to the laboratory supervisor and appropriate medical attention
treatment and counseling provided.

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Waste Management in ICU

Care should be taken to drop the waste in the specified colored bags:

YELLOW BAGS: For infectious waste

 Solid dressing
 Plasters/ caste
 Human and Animal organ/ tissue/ parts
 Discarded medicine cytotoxic drugs without breaking ampoules/ vials/ bottles

BLACK BAGS: For non-infectious waste

 Paper cardboard
 Plastic Glass/ cups
 Bottles
 Metal cans
 Kitchen waste

BUCKET OF SODIUM HYPOCHLORITE SOLUTION

 Syringes
 I/V sets
 Disposable tubing
 Catheters
 Artificial Kidney
 Blood bags
 Urine bags vacationers (after draining)

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 All the above are put in the blue bag and send for Autoclaving
Management for the sharps:
 All needle are to be destroyed from tip to the end
 Needle/ Surgical blades / Shaving blades
 Should be treated with sodium hypochlorite solution for 30 minutes, in a puncture
proof container and from here they are taken for autoclaving, shredding and finally
deep burial in the place identified for the same.

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 BIOMEDICAL WASTE MANAGEMENT

Glass waste- whole & broken glass, empty injection

Plastic bags / bins/puncture proof
Blue / White vials, glass slides, needles, syringes, scalpels, blades
container cardboard
etc.
Infected plastic – plastic contaminated with blood
Plastic bags / bins/disinfected con- or human secretions, syringes, IV sets, plastic cul-
Red
tainer ture plates, tubes, catheters, cannula, drains, surgi-
cal gloves
Infected waste-pathological and anatomical waste,
blood/pus soiled cotton, linen dressings, animal car-
casses, microbiological and other laboratory waste.
Yellow Plastic bags / bins
Amputated body parts, plasters cytotoxic and dis-
carded medicines.
microbiological and other laboratory waste.
General waste, office waste, left over eatables from
Black Plastic bags / bins kitchen/canteen, disposable glasses/plates/
papers/wrappers, cardboard, metal container.
 Fire Drill in ICU
Steps to be followed:
1) Try to extinguish fire with the help of portable fire extinguisher then and there
2) In case of major fire pull down the handle of MCP located nearby and call ‘9’ for
paging Code Red (will be done by the incident commander)
3) Patients closest to the fire to be shifted first
4) Bedside activities done in the following order for patients at ICU and OT complex
a) Disconnect from the ventilator (whenever connected)
b) Fix the ambu bag (when required)
c) Disconnect from the monitor
d) Chest drain and urine bag to be hung on the bed
e) Hang the vaculator(fluid bottle, blood bag etc) on the stand fixed to the bed
5) Close the gas valve
Note: Done only when all the patients requiring oxygen are fixed with ambu bag.
6) Shift the portable oxygen cylinders from the vicinity of fire
7) Switch off the electric supply
Note: Done to a particular area depending on the need and situation and can be
practiced as a later step. If required this will be done by the electrician on duty
8) Transfer the patients one by one
Note: Three people per patient required while shifting
9) If time permits move the equipment as well
10) Close the door when the room is cleared