What to Expect
Patients admitted to the intensive care unit (ICU) are usually connected to a variety of lines and monitors. These help staff monitor and assess any change in their condition. Your family member may not be able to look after themselves. Staff will provide for their basic needs as necessary. Physiotherapists will also work with them to maintain or regain their strength and conditioning while in hospital.
Substitute decision makers
A temporary substitute decision maker may be needed to make necessary legal decisions on behalf of the patient. This may or may not be the same person as the spokesperson. The health care team will keep both of these individuals, and any other representative the family identifies, fully informed of conditions and plans for treatment.
The substitute decision maker:
- Informs the health care team if the patient has legally documented wishes about being put on life support
- Informs the health care team about the patient’s thoughts or wishes about being put on life support when no legal documentation exists
- Makes decisions based on the patient’s best interests when the substitute decision maker has no knowledge of the patient’s wishes regarding life support
Identifying a substitute decision maker
If the patient signed a legal representation agreement naming a decision maker, this person will be required to sign consents on behalf of the patient. If the patient hasn’t identified a substitute decision maker, the first person who qualifies and is available (in the following order) will be assigned the role:
- Anyone related by birth or adoption
Qualifications to be a substitute decision maker include:
- At least 19 years of age
- In contact with patient within last 12 months
- No dispute with patient
- Capable of performing the role: giving, refusing or revoking consent
- Willing to comply with substitute decision maker duties
Common equipment in the ICU
There is a wide variety of equipment used in the ICU to both monitor the patient and help treat their illness. Below are some of the more common things you may see in the unit. Please feel free to ask a staff member if you need more information.
- Monitoring - The patient will be connected to a bedside monitor that may display some or all of the following: heart rate (and rhythm), blood pressure and respiratory rate. Oxygen saturation and CO2 may also be displayed to give information to the staff about how well the patient is breathing.
- Intravenous (IV) catheters - An intravenous or IV catheter (tube) may be inserted into a blood vessel to allow the team to give fluids and drugs. A peripheral line is a small catheter inserted into one of the blood vessels in the hand or arm. If the patient requires an increasing amount of fluid or medications, a larger catheter called a central line or central venous catheter (CVC) may be inserted by the physician into a larger blood vessel (usually in the neck, chest or groin).
- Ventilation (breathing) - If the patient is having trouble with their breathing a ventilator may be used to support their breathing. Ventilation can be provided by either a tight fitting face mask or more commonly, a tube called an endotracheal (ET) tube is inserted through the mouth into the trachea (windpipe). There are many differenttypes of ventilators (breathing machines). Your nurse or respiratory therapist can provide you with any additional information you may need. If support is required longer term (more than a couple of weeks), the physician may discuss a tracheostomy where the breathing tube is inserted through the neck into the windpipe. This is considered more comfortable for long term use.
- Arterial lines - A catheter may be inserted into an artery (usually in the wrist, groin or foot) and connected to the bedside monitor to allow for continuous blood pressure monitoring and to also allow for frequent drawing of blood specimens.
- Pacemakers - If the heart is not beating properly a device called a pacemaker may be used. The pacemaker produces an electrical current that stimulates the heart to beat. Pacemakers can be placed on the skin (short term – a few hours), inserted through a central venous catheter into the heart (used for days to weeks) or if needed long term can be surgical implanted under the skin of the chest wall.
- Chest tubes - If air or fluids get into the chest wall, the lung may not fully expand and the patient may have trouble breathing. If this occurs, a tube may then be inserted through the chest wall to help remove the air and/or fluid and allow for full expansion of the lung.
- Tube feeding or Parenteral Nutrition - When patients are very sick, they may not consume enough calories to allow them to heal. If they are on a ventilator, they will also be unable to swallow anything because of the breathing tube. To provide the needed nutrition, a tube is inserted through either the mouth or nose down into the stomach or small intestine. The patient can then be given tube feeds. If the stomach is not working properly or can’t be used for some reason, the necessary nutrients can be broken down into more basic liquids and it can be given straight into the blood stream (total parenteral nutrition or TPN).
Meet the ICU health care team
Members of the health care team may differ from unit to unit and their roles may be unfamiliar to you. A brief description of these roles is given below. If you wish more information, feel free to ask the staff member more about their role.
- Unit Clerks - These are usually the first people you will meet on admission. They will assist you when you wish to visit or communicate with any of the health care team. They also provide clerical duties for the unit.
- Physicians - Most critical care or intensive care units are what we call “closed units” meaning that once within the unit, care is determined by the core group of physicians that staff the unit. These physicians may be respirologists, cardiologists, internists or intensivists depending on the type of unit. All have specialty training to manage the overall care of the critically ill patients.
- Critical Care Nurses - Nurses with specialty training in critical care provide most of the direct hands-on care for the patient. The scope of this care ranges from providing for basic needs to managing the highly specialized drugs and equipment that may be necessary to support the heart and lungs. Depending on the unit, some care may also be given by a licensed practical nurse (LPN) or a nurse aide (NA).
- Respiratory Therapists (RTs) - Respiratory Therapists are specialists in managing all therapies related to breathing. Care provided by RTs includes breathing treatments and tests, management of artificial airways and artificial ventilation (breathing machines).
- Physiotherapists - Physiotherapists assist patients as necessary to cough, turn and mobilize (get up). Maintaining strength and conditioning is an important factor in getting better and transferring out of the critical care unit and physiotherapists are here to help you do that.
- Pharmacists - The clinical pharmacist ensures that important chronic medications are continued. He or she will work with the team to make sure that your loved one receives the best possible medications for their illness, including optimizing the types and doses given, as well as monitoring for effectiveness, important interactions, and side effects.
- Social Worker - A social worker can help in setting up meetings with the physicians, clarifying information or providing any needed supports for the family. Social work can also assist with any legal or financial matters that may occur as a result of hospitalization. Please feel free to request to talk to the social worker.
- Dietitians - Patients in the ICU have higher than normal (and different) nutritional needs. Dietitians calculate the individual needs for the patient and monitor their nutritional intake to ensure it is adequate given their changing needs.
- Aides - Aides may be used to stock and clean equipment, assist with transporting patients and other supportive tasks.
- Housekeeping - Housekeepers have specialty training to provide cleaning within hospitals (measures to prevent spread of infection) and for management of isolation rooms.
- Students - If at a teaching hospital, care may also be given by residents, medical students or students of any health care profession under the supervision of our staff.
Treatment for your family member includes the following:
- Routine tests: Patients may need blood tests and x-rays on a daily basis and more often if needed. A variety of other diagnostic tests may be ordered. MedlinePlus, a service of the U.S. Library of Medicine, is a good resource that explains many different types of diagnostic tests.
- Rounds: The health care team providing care for your family member meets several times a day to review their changing conditions and needs. Visiting may be restricted during this time to maintain confidentiality for all our patients.
- Family conferences: The doctor will meet informally and formally to update you about your family member's condition and the plan for care. You can request a meeting through a nurse or social worker.
- It is often uncertain how long a patient will stay in the ICU. Talk to the doctor about what to expect for your family member’s length of stay.
- Sometimes a patient may be unable to communicate their needs. Their family, with the support of the health care team, may need to make decisions in the patient’s best interest.
Advance care planning
The doctor will discuss the patient’s condition and treatment plan with the family. As appropriate, limitations to treatment may be discussed. You may wish to discuss plans for future health care. One important consideration is making informed decisions about Cardiopulmonary Resuscitation (CPR). CPR is not always appropriate for all patients. You can learn more about advance care planning by visiting our Advance Care Planning resource section.
Least Restraint Policy for adult patients
Health care providers will only use restraints when all other safety measures have been unsuccessful. If there is an identified risk for potential danger to the patient or others, restraint will be used for the shortest possible time period. The brochures available for download, below, explain our policy for providing a safe environment for patients, including the use of restraints if necessary.
Some of the above information is also available for download in Chinese, Korean, Punjabi and Spanish.