ICU Procedures


Understanding critical illness and related ICU procedures



Common Procedures

Intubate/Intubation

To place a tube (endotracheal tube/ETT) into the windpipe (trachea) via the mouth or rarely, via the nose. This helps with breathing, prevents airway from being obstructed/block and prevent unwanted material from getting into the lungs. The patient will not be able to talk when the tube is in place, but may be able to communicate by hand gestures, writing or text.

Chest tube, Chest drain insertion

To place a tube (chest tube or drain) into the chest space outside the lung to remove air (pneumothorax - “hole in lung”) or fluid (pleural effusion - “fluid outside the lung”).

Bronchoscopy

To place a camera into the windpipe to allow the physician to inspect the lungs from within and also to collect samples for testing. Occasionally, this is also perform to investigate and stop the cause of bleeding within the lung.

Tracheostomy

To place a tube (tracheostomy tube) into the windpipe (trachea) via the neck. This involves surgery. This is recommended in certain conditions (such prolonged need for mechanical ventilation or if the patient is expected to take a long time to wake up).

Like intubation, it helps with breathing, prevents airway from being obstructed/block, prevent unwanted material from getting into the lungs and may be more comfortable for the patient. The patient will not be able to talk when the tube is in place, but may be able to communicate by hand gestures, writing or text.

As the patient recovers, the tube can be changed to allow speech, and eventually removal when recovery is complete.

Intravenous access, IV access, IV, drip insertion

To place a tube into a vein in the body to allow for administration of medication and fluid. This maybe placed anywhere in the body but most commonly in the arms.

Central line, central venous line, CVP insertion

To place a long tube into a major vein in the body. This allows administration of medication, blood taking as well as monitoring of pressures in the vein. This tube maybe placed in the neck, upper chest or at the groin. Risks involve include bleeding, infection, line infection, damage to blood vessels or nerves, as well as pneumothorax (“hole in the lung”) if place in the neck or chest.

Arterial line, IA insertion

To place a tube into an artery. This allows blood taking as well as close monitoring of blood pressures. This tube maybe placed in the arm, groin or feet. Risks involve include bleeding, infection, line infection and damage to blood vessels or nerves.

Vascular catheter, Vasc cath, dialysis catheter insertion.

To place a tube into a major vein in the body. It is similar to “Central line, central venous line, CVP insertion” but is of larger size. This allows dialysis to take place. It may also be used to administer medication or sample blood. This tube maybe placed in the neck, upper chest or at the groin. Risks involve include bleeding, infection, line infection, damage to blood vessels or nerves, as well as pneumothorax (“hole in the lung”) if place in the neck or chest.

Nasogastric tube (NG tube) insertion

To place a tube into the stomach via the nose or the mouth. This allows administration of nutrition and medication while the patient is unconscious or unable to swallow safely. It can also be used to remove gastric contents if the intestines are blocked or not working (ileus).

Nasojejunal tube (NJ tube) insertion

Similar to “Nasogastric tube (NG tube) insertion “, this is to place a tube into the small intestine via the nose or the mouth. This allows administration of nutrition and medication while the patient is unconscious or unable to swallow safely.

Scope, Endoscopy (OGD), colonoscopy

To place a camera (scope) into the stomach (oesophagogastroduodenoscopy or OGD) or large intestines (colonoscopy) to allow the physician to inspect the gastrointestinal (GI) tract from within. It also allow samples to be collected for testing (biopsy) or to investigate and stop the cause of bleeding within the GI tract.

Paracentesis

To remove fluid (ascitis) from the abdomen, commonly in patients with liver conditions, for diagnosis of infection or to relief symptoms.

Rectal tube, flatus tube insertion

To place a specially designed tube into the rectum to allow passage of diarrhea/loose stools. This improves hygiene and can help prevent deterioration of skin conditions around the buttocks or groin.

Urinary catheter insertion

To place a latex or silicon tube into the bladder to allow drainage of urine. This also helps the physician monitor the production of urine by the kidneys.

Percutaneous drain insertion

To place a drain or tube via the skin into a pocket of fluid or pus. This is usually performed by an Interventional Radiologist using imaging techniques such as ultrasound or CT scan.

Blood culture

Removal of blood and test for bacteria or fungal growth in a laboratory.