Welcome to the Intensive Care Unit (ICU)
An Orientation for Patients & Families
Hello, and welcome to the Intensive Care Unit or ICU at the University of Texas M.D. Anderson Cancer Center. I am Janet, a registered nurse who works on this floor. I would like to acquaint you with the people who will be taking care of you during your stay. I will also be talking about how to prevent infections, how to wean off a ventilator and what to expect from our Visitation Policy. The ICU houses about 54 beds and is divided into six separate sections. We refer to these sections as critical care units or Pads, which are identified by letters A through F. Some patients are here for a high level coordinated care and monitoring after surgery, while others are here for more complicated or life threatening issues. Regardless of their reason, every patient at MD Anderson receives a multidisciplinary level of care, which means that many of your care providers are from different departments and work together as a team to provide the safest and best care possible. In fact, because there are so many care providers on the ICU team, you may have difficulty recognizing who does what. So, let's take a look at each member of our ICU multidisciplinary team and the role each will play.
Hello, my name is Dr. Donna Calabrese. I am one of the ICU's attending physicians. Our main role is to help treat the medical problems that are causing your critical illness. Another important part we play is to coordinate the medical care needed as it relates to these problems. This care includes providing you with a treatment plan that is based on the efforts of the ICU's multidisciplinary team, your oncologist and other physician specialists who may be called to care for you as consultants.
Hi, my name is Wendy. I am an acute care nurse practitioner who works side by side with our physician assistants. At MD Anderson we are known as mid-level care providers. We are the eyes and the ears of the physician. A large part of our job centers around prompt and clear communication. We are in constant contact with your oncologists and other physician specialists to update and work on your overall treatment plan. We will continually monitor your status and your response to treatment.
Hi, I am Rhea. I am a critical care nurse and as a critical care nurse, I have specialized training in caring for critically ill patients. My main role is to care for you and monitor how you are doing. I am responsible for giving you your medications, monitoring the equipment alarms in your room and most importantly, carrying out physician orders and contacting the physician if your condition changes. And as the team works together through this critical phase of your illness, our goal is to provide the best possible care to you and optimize the quality of your ICU stay.
Hi, I am Lola. I am a nursing assistant. As a nursing assistant it is my job to help make you as comfortable as possible during your stay by making sure the room is clean and tidy. It is also my job to maintain a safe and healthy environment and helping nurses to bathe, lift and to position patients.
Hi, my name is Emi. I am a respiratory therapist. As a respiratory therapist, my role in the ICU focuses on treating breathing problems and preventing respiratory complications. My duties and responsibilities include giving breathing treatment, responding to respiratory emergency, and drawing and analyzing special blood samples. I also monitor oxygen and respiratory equipment. Different types of ventilation or breathing equipment may be used in event of respiratory failure. This equipment or respiratory support may be needed for a brief or extended period of time. Respiratory support is defined as invasive when a tube is inserted through your mouth and into your lungs and attached to a ventilator. It is non-invasive when you receive pressurized air through a mask or tubing that is attached to a ventilator.
Hi, I am Jeff. I am a clinical pharmacy specialist. Pharmacists have a special role on the ICU team. We participate in patient care rounds everyday serving as the medication experts and working with the ICU team to help select the best drug treatment for each individual patient. We also contribute to the planning for specialized nutrition support in the ICU. Our goal is to make sure that each patient receives the right medications at the right time and in the safest manner possible.
Hi, my name is Karen. I am a social worker. Social workers are highly skilled and professionally trained counselors. We know that having a loved one in the ICU is an overwhelming experience. Because we understand that critical illness in the setting of cancer can impact your life in many ways, we offer referrals and information about resources that can assist you with health insurance questions, financial support, and legal advice, such as assisting with living wills and medical power of attorney.
Hi, I am Farhad. I am a patient advocate. Each patient is assigned a patient advocate at registration. We are here to make sure your concerns are addressed in a professional caring manner, provide access to MD Anderson resources, provide an opportunity for you to voice a complaint, concern, problem or request in a confidential setting and seek a resolution and to provide the information about your patient rights and responsibilities. We respect your rights and unique health care needs. If you have any questions, do not hesitate to contact your patient advocate.
As you can see, there are a variety of multidisciplinary team members. Each team member is committed to providing you with the best care possible.
In the Intensive Care Unit, we want to make sure your environment is safe. Let's take a look at some key safety issues. To prevent the spread of infection, wash your hands with soap and water or use the alcohol gel every time you enter and leave the patient's room. Do not bring food, drinks, live plants, or flowers into the patient's room. If a patient is in isolation, read the isolation sign on the patient's door. This sign will tell you if you need to put on gloves, gown, and/or mask. These items are in a special cart outside the patient's room. Before leaving an isolation room, take off your gloves first, then your mask without touching your face and then your gown. Discard these items in the trash can inside the patient's room. Immediately upon coming out of the patient's room, wash your hands with soap and water or alcohol gel.
In the ICU, we want to do everything we can to prevent infections. We do this by following recommended guidelines, but we need your help to make sure we follow these guidelines. There are three primary types of infections that we take extreme care in preventing: Ventilator-associated pneumonias, central line related bloodstream infections, and Foley catheter related urinary tract infections.
To prevent ventilator-associated pneumonias, this is what you should see. Just like you, nurses and other health care providers should wash their hands with soap and water or alcohol gel every time they enter and leave the patient's room. To prevent bacteria from getting into the lungs through saliva in the patient's mouth, the patient's head should be elevated at least 30 degrees. Ask the nurse or respiratory therapist to show you how far the head of the bed should be raised. You should also see proper oral care procedures being followed. In each patient's room, there is a special oral care kit. A patient's mouth should be cleaned and suctioned about every four hours. Please note however, there may be some exceptions.
To help prevent central line related bloodstream infections, you should see nurses taking these steps: The dressing on the central line site should be changed about once or twice a week. The patient's IV tubing should be changed every three to four days, and the ports of the patient's IV tubing should be cleaned with chlorhexidine or alcohol before nurses access it.
To help prevent Foley catheter related urinary tract infections, you should see us clean the catheter tubing and the area around the catheter every eight hours. Nurses and staff should check to make sure the tubing is secured to the patient's leg and is not pulled or disturbed in any way. They should also check to make sure the catheter is draining well.
Procedures are often performed at the bedside for critically ill patients. Most procedures require the patient or responsible family member to sign an informed consent once a physician or mid-level provider has given an explanation of the procedure. Most procedures require a sterile area around the patient, which is an area free from germs, to prevent infection. Because we follow very strict safety precautions, visitors may be asked to leave the room during a procedure. Please understand that this is only done to minimize the risk of infection. We will work very closely with you to help you understand your illness and the necessary steps we take to prevent infections during your procedure.
Weaning From the Ventilator
If you are on a ventilator, the respiratory therapist, nurses, and doctors will continuously evaluate you to determine if you can be weaned. First, we will look at your level of consciousness. Here we will look at how sleepy or how awake you are. If you are too sleepy or drowsy, it may not be safe to wean you off the ventilator. Second, we will evaluate your oxygen level. The amount of oxygen each patient needs will vary, but the amount of oxygen you require will need to be at a low enough level to support weaning you off the ventilator. Third, we will assess the strength of your lungs. The respiratory therapist may assist you in doing some breathing tests to determine if your lungs are strong enough to come off the ventilator. Fourth, we will look at your spontaneous breathing or whether or not you can take your own breaths. We will also look at how many breaths per minute you take and how big or small the breaths are. Finally, in addition to your breathing, we will check your blood pressure and heart rate to make sure you are stable. If your health care team has determined that you are not ready to come off the ventilator, the respiratory therapist will continue to evaluate you. As your condition improves, the respiratory therapist will adjust the ventilator to provide less support. If your condition worsens however, the respiratory therapist may need to increase the amount of ventilator support you receive. During the time you are on the ventilator, we will most likely have restraints on your wrists. The restraints help prevent you from reaching up and pulling the tube out of your airway, which can be very traumatic. If you have more questions about restraints, please talk to your nurse. When you are ready for the breathing tube to be removed, several things will happen. We will have you sit upright in the bed, we will suction out the tube and deflate the balloon at the end of the tube, we will pull out the tube, we will ask you to cough and breathe deeply. The respiratory therapist will then teach you and your family how to do the breathing exercises that will strengthen your lungs. So, if you need a ventilator, our goal is to treat whatever is keeping you on the ventilator and work toward weaning you off the ventilator as quickly and safely as possible.
Now, I would like to go over our Visitation Policy. You will be given a copy of the Visitation Policy which includes our visiting hours, ICU rules and helpful phone numbers. Due to the level of care in our unit, we ask that no more than two people visit in the room at a time. To protect your family, children 12 years of age and under are not allowed in the ICU or the ICU waiting rooms. During a shift change, nurses are completing final tasks and relaying confidential patient information to other staff members. Nurses coming on for the next shift are handling urgent orders that the physicians have written. Because this is a critical time for caregivers and patients, visitors will be asked to leave the area. In addition, one family member may stay overnight. However, showers and restrooms located inside the patient's room are for patient's use only. Family members will be asked to use the restrooms located on either end of the hallway. For everyone's safety, all electronic devices such as cell phones or computers must be clear for use by MD Anderson Cancer Center. Some devices will be permitted in designated areas only. Also, please be aware that we are a very large and busy unit, so it is important for you to keep track of your personal belongings. MD Anderson is not responsible for lost items. We greatly appreciate your cooperation with our Visitation Policy. This will help us provide the best possible care to our patients. MD Anderson Cancer Center is consistently ranked as one of the top oncology hospitals in the United States. You can be assured that the care provided in our Intensive Care Unit is efficient, safe and compassionate. We hope this video has provided you with helpful information about our multidisciplinary team, our infection control practices, our ventilation weaning procedures and our Visitation Policy. If you have any questions or concerns, please talk with a member of your team.