INTENSIVE CARE UNIT

YRMC’s Intensive Care Units (ICUs), also called the Critical Care Units, is where our patients receive constant care and close monitoring with state-of-the-art equipment.

At YRMC West, we have one 8-bed ICU for medical and surgical patients, and a second 8-bed CVICU (Cardiovascular Intensive Care Unit) that specializes in the care of cardiac, vascular and thoracic surgical patients. At YRMC East, we offer an 8-bed ICU for medical and surgical patients. In all of our ICUs, a minimum 1:2 nurse-to-patient ratio is maintained at all times, with a nursing assistant on duty every shift.

We understand and appreciate that it’s very difficult having a loved one in intensive care, and do our best to make the experience as stress free as possible.

ICU GUIDELINES:

• Visiting time starts at 9 a.m. and ends at 10 p.m. Patient rest periods are from 1 p.m. to 4 p.m. and from 6 p.m. to 8 p.m., and visiting is discouraged during these times. If patient care of any type is being performed, or unit activity is at a heightened level, you may be asked to leave. Your cooperation is expected and appreciated. You will be allowed to return as soon as possible.
• Visiting is limited to two (2) persons in the patient’s room at one time.
• Children under the age of seven are not permitted.
• No visiting from 7 p.m. to 8 p.m. to allow for nursing shift change.
• Please hold phone calls concerning patient status until after 8:30 a.m. to allow for the nursing shift change. This allows nursing staff to provide you with better information.
• Patients up to age 16 may have one (1) parent or parental designee stay (and sleep) in the patient’s room at all times.
• No other sleeping in patient rooms, at any time.
• Cell phones are allowed, but not encouraged. Please put cell phones in silent notification mode so they do not disturb the patients.
• Please limit the sending of flowers and plants to one small arrangement, as space is very limited in patient rooms. After the patient is transferred out of ICU, flowers may be sent.
• If the patient is in isolation, all of your personal items must be left outside of the patient’s room. Preferably, these items will be left outside of the ICU/hospital with other family members or in your car. This helps us protect your loved one, other patients and family members from germs.
• If the patient is sleeping during a visitation hour we may request that you not visit at that time. Our patients need to get as much sleep as possible so that they may return home as soon as possible.

GUIDELINE EXCEPTIONS

As always, some exceptions to visitation guidelines need to be made and are handled on a case-by-case basis. They include but are not limited to:

• The imminent death of a loved one.
• The withdrawal of life support and the expectation that death will occur within the next 24 hours.
• Severe impairment of mental status that has yet to respond to medical treatment.
• Language barrier without an available translator.
• Hearing impairment that does not respond to known prosthetic devices and/or a patient who doesn’t read lips and requires a sign language interpreter.

INSIDE THE ICU

The ICU is a busy place and your loved one may look or act differently than he or she normally would. Be prepared to see a lot of wires, tubes and equipment. Your loved one may be unconscious or asleep; may have pale, flushed or ashen skin; and may look puffy or swollen, especially in the face, hands and feet. He or she may also feel cold or hot and clammy to the touch. This is the body's normal reaction to stress, low blood pressure, some medications and some illnesses. Also be prepared for:

• Alarms. Alarms on monitors will sound to alert the nurse when something needs to be checked. Alarms are not always cause for concern. Sometimes, patient movements may sound an alarm.
• IV Lines and tubes. Your loved one will have one or more IV (intravenous) lines and tubes. IV lines allow for the administration of medications and/or nutrition. Some measure blood or heart pressure. Don’t worry if you see air bubbles in the lines. All lines and tubes are closely monitored.
• Tests and treatments. Tests and treatments are conducted frequently, and at these times you may be asked to leave the room. Blood may also be drawn frequently, but don’t worry. The body contains a large volume of blood and soon replaces any blood that is drawn.
• Pulse oximetry. This measures the oxygen saturation of the patient’s blood. The probe is a small red light located on the finger, earlobe, forehead or bridge of the nose.
• Anthrombic stockings. These special stockings may be applied to the lower extremities to help prevent blood clots.
• Medication. Your loved one may receive several types of medications, which can cause sleepiness, nausea or confusion. Medications can include antibiotics, sedatives and painkillers. Let the nurse know if your loved one seems to be in pain.
• Restraints. Restraints must sometimes be used to prevent your loved one from pulling out tubes and wires. They are usually applied to hands, and rarely to feet or the chest. The nurse may allow you to remove them during your visit. If so, you need to watch carefully and keep your loved one from pulling on any tubes or wires.

WHAT YOU CAN DO

• Appoint a family spokesperson to serve as a link between the family and the medical staff.
• Establish a code word (chosen by the patient if he/she is able) to be used by family members or friends with whom you wish to have the patient’s medical condition discussed. Be selective – everyone with the code word will have access to all of the patient’s medical information.
• Remember to take care of yourself. Very competent staff is taking care of your loved one. He/she needs rest most of all, and so do you. Eat healthy foods and arrange family visits in shifts.

YRMC MULTIDISCIPLINARY TEAM

Although we work as a team, each of the healthcare professionals caring for your loved one has special knowledge and skills. Doctors plan your loved one’s care. Nurses do most of the hands-on care and monitoring. Others who may be on the care team include:

• Respiratory Therapists (RT) treat breathing difficulties and manage respiratory treatments/ventilators.
• Physical therapists (PT) and Occupational therapists (OT) help patients improve strength and flexibility.
• Dieticians give advice about special eating concerns and nutritional support.
• Social workers and case managers help the family with financial concerns, resources, insurance and long-term care assistance or placement.
• Pharmacists help monitor medications that patients receive.
• Clergy offer spiritual support to patients and family.

FREQUENTLY USED TERMS

ABG: Arterial blood gas is a measurement of oxygen, carbon dioxide and acid in the blood, which is used to monitor how the lungs are working, with or without a ventilator.

Arterial Line: A special IV (intravenous) site that allows continuous monitoring of a patient’s blood pressure and also allows us to draw blood for lab work.

Central Line: An IV line that is inserted into a vein in the neck, chest or groin. It allows medication or special feeding to be administered to the patient.

EKG or ECG: Both are abbreviations for electrocardiogram, a monitoring test that provides information about heart rate and rhythm.

ET Tube: A plastic tube that is passed through the mouth or nose into the windpipe. It assists in breathing and allows removal of secretions from the lungs. While the tube is in place the patient cannot talk.

Feeding Tube: A small flexible tube that is inserted into the nose or mouth and goes to the stomach or small intestine, for providing nutrition or medication.

Foley tube: A tube that is inserted into a patient’s bladder to allow urine removal and collection.

Hemodialysis: If a patient’s kidneys fail to work adequately, he or she may be placed onto a dialysis machine, which will gently cleanse the blood. This is done through a special IV catheter placed in the patient’s neck, chest or groin.

Intubated: When a patient has either an ET Tube or Tracheostomy.

Naso-Gastric Tube: A plastic tube that is passed through a nostril and into the stomach to empty stomach contents and prevent vomiting. Sometimes used to administer medications or nutrition.

NPO: This designation signifies that a patient is not allowed to take anything (ice chips, water, food, etc.) by mouth.

PA Line: Sometimes called a SWAN-Ganz catheter, this allows direct measurement of pressure in the heart and provides information on how a heart is functioning and the patient’s fluid volume status; i.e., is the patient dehydrated or overloaded.

PCA: Patient controlled analgesia, or PCA, is a pain medication device that allows patients to safely administer their own pain medication whenever it is needed.

Suctioning: The removal of secretions from the lungs or mouth.

Tracheostomy: The trachea is commonly known as the windpipe. In this procedure, a surgical incision is made into the trachea, into which a tracheostomy tube is placed and through which a patient will breathe.

Ventilator: This machine is attached to the patient via the ET or the tracheostomy tube, to help the patient breathe.