Intensive Care afdeling (IC/CCU) IC patiënt 1
Your family member or loved one has been admitted to the Intensive Care/ Coronary Care Unit (IC/CCU) of our hospital. This is a special unit for patients whose vital signs (respiration rate, blood pressure, oxygen saturation, pulse etc.) need to be monitored closely and/or treated. The length of their stay at the IC/CCU may vary from one day (e.g. after major surgery or cardiac catheterization) to several weeks. At the IC/CCU patients may also receive some form of support by means of medical equipment and/or through medication. Examples are artificial respiration and renal replacement therapy, and medication for blood pressure control. Intensive Care/Coronary Care Unit (IC/CCU) The IC/CCU of Van Weel-Bethesda Hospital consists of six single-bed patient rooms (IC beds) and one two-bed room (CCU beds). Each morning physicians and other staff of various disciplines come together for a multidisciplinary consultation meeting at the IC/CCU where treatments are discussed and, if necessary, adjusted. The IC/CCU has several intensivists (physicians who specialize in critical care medicine). They are the attending providers. Our intensivists also work at Maasstad Hospital in Rotterdam. Our IC/CCU collaborates closely with the ICU of that hospital. Occasionally patients are transferred to Maasstad Hospital or vice versa, for example, if one of these two ICUs is filled to capacity. The intensivist at the IC/CCU is often assisted by hospitalists who also work at the ER (emergency room). Nursing care is provided by specialized High Care nurses, Intensive Care nurses, Coronary Care nurses or Intensive Care nurses in training. Physiotherapists and dieticians also visit the IC/CCU regularly. Admission Admissions to the IC/CCU may be scheduled, for example after surgery, but in most cases they involve unexpected events. When a patient is admitted to the IC/CCU, there are usually several staff present. The patient s next of kin are asked to wait in a family room whilst the patient is being connected to all kinds of medical equipment. Often blood samples are taken, a lung x-ray is made and a drip-feed is set up immediately after admission. It is essential that the cause of the problem is found as soon as possible. Furthermore, cultures are obtained from all patients in order to establish whether they are infected with, for example, resistant or contagious bacteria. 2
Visiting Hours The visiting hours are from 14.00-20.00 hrs. The IC/CCU s visiting hours differ from those of the other hospital departments. This is because the patients at this unit require intensive care, and frequent and long visits can deteriorate their condition. In consultation with the nurse, other visiting hours may be arranged. It may happen that nurses need to provide care to the patient during visiting hours and that visitors will be asked to wait in the family room. Patients may not be visited by more than two visitors at a time. Visits by children under the age of 12 are only allowed after consultation with the nurse. If a visitor or someone in their environment has a contagious disease, this should be reported to the nurse. Equipment The patient is connected to the various equipment by means of tubes and leads. Each patient is connected to a monitor that measures the patient s heart rate, blood oxygen saturation, blood pressure. These measurements are also shown on screens in the coffee room and at the nurse s desk. The rooms are also equipped with infusion pumps that can be used to administer precisely-metered infusion fluids and medication intravenously through a catheter inserted in a vein in the arm, neck or groin. The veins in the neck and groin are larger so that more medication can be administered via this route. A urinary catheter is often inserted in the patient s bladder via the urethra so that the nurses can accurately monitor fluid balance. If a patient is unable to take food and drink by mouth, a nasogastric tube is placed to feed the patient. Most of the equipment have screens on which measurements and messages are displayed. The frequent alarm signals may upset the patient s next of kin, but the IC/CCU staff know exactly what the various signals mean, and will respond professionally to them. At the IC/CCU we try to prevent insufficient functioning of vital organs such as the lungs, kidneys and heart. Sometimes we support these functions, for example, by medication or the administration of oxygen. It may also happen that the patient is so seriously ill that the function of an improper functioning organ needs to be entirely taken over by medical equipment. If the lungs do not function properly, this function may be supported by a mechanical ventilator. If the kidney function is seriously disturbed, the patient may be connected to a dialysis machine. See the leaflet Intensive Care Diary for further information about artificial respiration and the leaflet Renal Replacement Therapy for further information about dialysis. 3
IC/CCU Patients Appearance and Behaviour Next of kin are often shocked by the changes in the patient s appearance during hospitalization. These may be caused by the many medical devices and leads to which the patient is connected, but can also have other causes. Swollen Appearance For example, the face, arms and legs of a patient with blood poisoning (sepsis) may have swollen because the walls of the blood vessels leak and allow fluid to escape from the blood stream into tissues. These changes in appearance may upset the patient s next of kin. Once the patient has recovered, the fluid accumulated in the tissues will be absorbed by the blood vessels and the swellings will disappear. Bruises It may happen that a patient gets bruises or hematomas easily, for example, because blood coagulation is disturbed as a result of illness or medication. The insertion of IV catheters required for treatment may also cause bruises. Wrist Restraints In some cases it may be necessary to temporarily use wrist restraints to prevent a patient from pulling out an IV line or breathing tube. Sedated patients, for example, may exhibit reflexes by which they do so. For reasons of safety, wrist restraints may then be required. Although the patient s next of kin may be shocked by this measure, it is sometimes necessary. Confusion and Restlessness IC/CCU patients can sometimes be confused or restless. Possible causes are: medication (e.g. sleeping pills), pain, fever, their being ill, unfamiliar surroundings, a disturbed sleep pattern or feelings of uncertainty. A patient may then react differently from what the family expects. We usually try to improve the situation by administering medication against anxiety and restlessness, and by providing clear information. In most cases, acute confusion (delirium) is a temporary condition. Once the patient feels better physically, their mental state will also improve. See the leaflet Delirium for further information about acute confusion. File Each patient room is equipped with a computer on which the patient file is stored. This file contains all the medical and nursing data concerning the patient. Only medical staff have access to this computer. Clothing, Toiletries, Personal Effects Patients may use their own toiletries. As they are often hooked up to all kinds of medical equipment, they cannot wear their own nightclothes and are therefore 4
given hospital gowns. For hygienic and practical reasons, the nurse will take off any jewellery the patient is wearing and will ask the patient s family to take this jewellery home with them. The hospital cannot be held liable for the loss of a patient s valuables. Because of the risk of infection, flowers and plants are not permitted in the IC/CCU. Contact Persons When a patient is admitted to the IC/CCU, the nurse will ask for the names and telephone numbers of one or two contact persons, and will record these names and telephone numbers in the file. The contact persons may call the attending nurse for information about the patient 24/7. Please avoid calling the IC/CCU at shift transfer times (07:00-07:30, 15:00-15:30, and 23:00-23:30). For privacy reasons we only provide patient information to designated contact persons. If, as a contact person, you wish to receive medical information or talk to the attending physician, you can make the necessary arrangements with the nurse. If you want, you can also make an appointment with a chaplain. Transfer As soon as the patient s condition permits, and providing the attending provider considers it medically safe, the patient will be transferred to a ward (if there is room). It may also happen that a patient is transferred to another hospital, for example, if our IC/CCU is filled to capacity or if another hospital can provide the specialist care the patient may require. Questions If you have any questions, please contact the IC/CCU at tel. 0187 60 74 40. Health Insurance Deductible If you visit the hospital for an examination or treatment, you will need to pay the health insurance deductible. Some examinations or treatments are not covered by the basic and/or supplementary health insurance package. You will need to pay the fees for these examinations or treatments yourself. Please ask your health insurer about the deductible and your health insurance cover before you agree to a medical intervention or treatment. See also the leaflet Hospital Care Expenses (Z09). Intensive Care/Coronary Care Unit (IC/CCU)], English I14/02 16012017 5
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