FREQUENTLY ASKED QUESTIONS IN ICU
The Intensive Care Unit can be a busy & frightening place.
Visitors often have questions that they are too worried to ask.
Some common questions and answers are listed below.
- Why are they in the Intensive Care Unit?
- Why are they asleep? How long will they be asleep for?
- Can they hear me?
- Can I hold their hand?
- How are they eating & drinking?
- Are they in pain?
- Will they remember being here?
Patients may be admitted to ICU for a number of reasons. They may be recovering from major surgery, require specialist machines to support them that aren't available elsewhere in the hospital, or simply require closer observation than is possible on the ward where the nurses & doctors may have to look after larger numbers of patients. Sometimes patients who aren't very sick are admitted because they are at risk of getting worse quickly and would benefit from being monitored more closely.
When patients are very sick it is often safer to give them sedatives or an anaesthetic to allow them to rest & recover from their illness or operation. Some of the procedures on the ICU can be unpleasant and sedating patients for these is less distressing for them. Some patients may appear sleepy or be asleep because of the illness that has brought them to the ICU in the first place, particularly if they have suffered an injury to their brain. If you are unsure, please ask the nurse by the bedside whether someone is asleep because of medication we are giving them or because of their illness.
To help them breathe while they are sedated, a plastic breathing tube is usually inserted through their mouth into their lungs and attached to a breathing machine ('ventilator'). Patients are given anaesthetic until it is safe to turn it off to allow them to 'wake up' and there are a number of things that determine how long this carries on for. Some patients need to be sedated for hours, days or even weeks. Usually when the problem for which they were admitted to the ICU has gone away, the anaesthetic will be turned off so they can be assessed. If they are doing well then the breathing tube can be taken out.
Everyone is different so please ask the nurse or doctor how long your loved one is likely to be sedated for.
Probably - we don't know for sure. This will depend on how much sedation they have been given or any injury to their brain that they may have. If they can hear you, they are unable to speak if they have a breathing tube in their mouth. We know from asking awake patients that they remember things that were said to them when they were sedated.
It is better to assume they can hear you & talk to them normally, even if the conversation is only one-way.
Yes. Don't be afraid of upsetting the machines or the monitor. Holding their hand may be important for you and may also be helpful for them.
If you are worried about this, please ask the nurse looking after them.
Please remember to wash your hands before you come into and after you leave the bedside as infection brought from outside ICU can be a serious problem for people who are already very sick. If you see any nurses or doctors touching your loved one without cleaning their hands first, please don't be afraid of asking them to do so.
Many sedated patients in the ICU will have a tube placed through their nose or their mouth that passes through into their stomach. A liquid feed is then pumped through this tube to provide the water and nutrients that they need. ICU patients are regularly reviewed by our dietician and doctors to ensure they are receiving the right amount of water and nutrients for their illness.
Patients who are unable to be fed into their stomach or intestine can be given the nutrients through a drip directly into their bloodstream.
If they are likely to be sedated for only a short period of time (such as recovering from an operation) then fluid can be given directly into their veins through a drip with the hope they will be able to eat relatively soon after they are awake and the breathing tube is taken out.
If your loved one shows signs of distress or pain then we will give them painkillers to alleviate this. These may range from simple painkillers like paracetamol tablets through to morphine that can be injected into a vein. Even though someone appears asleep, they may still experience pain. Our nursing staff are aware of this and will give painkillers as and when they think your loved one may need it. Some of the tubes may cause discomfort and it is natural for people to try to pull these out; in situations where the tubes are still needed, painkillers can be very helpful.
When patients are awake, they may be given a pump containing morphine or a similar drug with a button to press if they are sore that gives them a small controlled dose of painkiller.
Often not but this varies depending on how heavily they were sedated and how long they were 'awake' in the ICU afterwards. Patients often don't realise how sick they were until their family and friends who sat by their bedside tell them. Forgetting the things that happen in ICU may not be a bad thing.
Some patients who stay for longer are offered 'Patient Diaries' for friends and relatives to complete that may help fill in the gaps and piece together their time in ICU.
- What does the breathing machine do? What is the breathing tube for?
- What do the pumps do?
- What does the monitor do?
- What is the plastic tube in the neck for?
- What are the other machines for?
Patients who are having difficulty breathing due to a pneumonia or other illness (such as an injury to their brain) will often be placed on a breathing machine (also called a ventilator). This machine provides oxygen through a breathing tube and takes over the effort of breathing to allow the patient's lungs to be rested and the underlying cause to be treated with antibiotics or other therapies. Once the original illness for requiring the machine has improved, the amount of work the ventilator is doing can be reduced and the breathing tube removed.
Patients often require sedation to tolerate the ventilator as the tube can be quite uncomfortable. If the tube is likely to be required for a longer period of time (usually over a week) then the doctors may talk to you about a tracheostomy which is a shorter breathing tube inserted directly into the patient's neck. This procedure is nearly always reversible with most patients having these tubes removed either in ICU or on the ward prior to discharge from hospital.
In some patients, it may be more appropriate to support their breathing through a tight-fitting mask that goes over their face. This is sometimes preferable to putting them back to sleep to insert a breathing tube. The doctors will be able to discuss which option is best for your loved one.
Some medications in ICU such as sedation and drugs that increase blood pressure need to be given continuously. These drugs are given directly into a vein (usually through a plastic tube in the neck or under the collar bone) and are pushed through by computer-controlled pumps. The nursing staff will control the speed of the pump based on observations taken from the monitor and other vital signs. Sometime the pumps will make noises to tell us that the lines are blocked or that they are nearly empty. Don't be alarmed by these sounds - the nurses are able to troubleshoot and fix most problems immediately.
The pumps contain batteries and are able to accompany patients around the hospital should they need to be moved for an operation or a scan.
The bedside monitor provides important information that alerts the staff to potential problems. A lot of the wires and tubes you will see allow continuous monitoring of a patient's heart rate, blood pressure and oxygen levels as well as other important parameters. These allow us to adjust levels of medication and react to sudden or slower changes in patient's conditions.
The monitor has many alarms that will often make noises or show alerts. These are usually nothing to worry about. Please ask the bedside nurse if you are concerned.
Many patients require strong drugs to be administered that can be dangerous if given through a small vein in the arm. Patients in ICU will often have a 'central line' inserted into their neck or under their collar bone that allows these drugs to be safely & reliably given directly into the large veins of the body. These lines also allow us to monitor some of the pressures in the heart.
There may be other devices that are sometimes needed to support patients when they are very ill. These include dialysis machines and pumps to help the heart that may be required after cardiac surgery or a heart attack. Sometimes these machines can be noisy and will also have their own sets of alarms to notify staff when there may be problems. Please do not be alarmed by these and ask the bedside nurse if you are worried.
- Why am I not allowed to visit when I want to?
- Why am I not allowed to bring flowers?
- Can I read my loved one's medical notes?
- When can I meet with the doctors?
- Why is there a different nurse every time I visit?
- Why does it take so long to answer the door or telephone?
- What if there are some people that my loved one wouldn't want to visit them?
- Why are only two visitors allowed in at a time?
- Why is my loved one being sent to the ward?
Visiting hours are restricted to the times shown on the Visitor Information page for several reasons.
It is very important that patient confidentiality is maintained and for this reason we ask people not to be present during the ward rounds and nursing handover. Sometimes the nurses and doctors are performing procedures such as inserting or removing tubes that may be distressing for your to watch. Patients may also be being washed or toileted when you wish to visit. Some patients or their families sometimes request that only certain named visitors be allowed.
For these reasons we ask you to be patient if you are unable to come in immediately when you arrive. Once the bedside nurse is aware you are waiting, we will try to allow you to visit as soon as is possible.
Flowers can bring infection into our unit and can be an electrical hazard if water is spilt. Many sedated patients are unable to appreciate them. For these reasons we ask that you don't bring them to patients in ICU.
No. Patient's medical records are private and confidential. Individuals can apply for access to their records in writing to the hospital. An appointment will then be made where they can be reviewed with a member of the medical or nursing staff present to help interpret them.
The medical records are available to any visiting doctor or nurse providing care for the patient. For ease of rapid access, they are kept by the bedside whilst the patient remains in the ICU.
At any time. Please ask the bedside nurse if you specifically wish to talk to a member of the medical staff and they will arrange a meeting. Our team will try to meet with you regularly to update you on your loved one's condition; the frequency of these meetings may be determined by how sick they are. We may ask to meet with you if we are concerned about their condition. If you are not in the hospital then we will telephone you.
In the event of an emergency we may not be able to meet with you immediately but we will aim to meet with you as soon as possible.
We also recommend that a family spokesperson be nominated to ensure clear communication. This person also acts as a single contact point should an emergency occur.
There are over 100 nurses who work in our ICU providing round-the-clock cover for up to 18 patients, working 12 hours shifts. As such, it is inevitable that different people will be looking after your loved one. If they remain in ICU for more than a few days then you will likely meet several different nurses & doctors. We handover detailed information on each patient several times a day and keep written notes in the medical record so all information is recorded. These notes are available to any member of staff involved in the care of your loved one.
During the day, we have a ward administrator who will try to answer calls as quickly as possible. In the evening and at night, the nursing staff have to answer the telephone and the door as well as providing patient care so there may be some delay before they are able to talk to you. Although we appreciate that delays can be frustrating, we ask you to be understanding and realise that patient care is always our priority. During an emergency, there may be significant delays.
If there is anyone that you or they would not wish to visit them or obtain information on the telephone, then please provide the nurse with their name and details. The unit is locked & accessible by intercom only so certain people may not be allowed in if requested. To enforce this we ask that the locked door not be held open for other people and that it never be propped open to allow members of your family to visit without them having to ring through first.
We usually ask for a named spokesperson to take responsibility for this so we can refer visitors who are refused entry to them.
Our nursing staff must always be able to provide safe care for our patients and large numbers of visitors can make this difficult. Our bedspace areas are relatively small and when occupied by machines, access to patients can be difficult. Large numbers of visitors can also be overwhelming for people recovering from severe illness. We prioritise the parents of children who may be in our unit and they are able to stay around the clock should they so wish.
When our patients no longer require the level of support and nursing care that we provide then we will discharge them to an in-patient ward in Wellington or transfer them back to the hospital they came from. All discharges are approved by the senior medical & nursing staff and are usually planned in advance, particularly if the patient has been in ICU for some time. There is a written and verbal handover to the ward staff taking over care to make sure all relevant information is passed on. We will always notify family prior to discharge.
We recognise that discharging long-term patients to a ward can be a stressful time for both patients and their family but without this we would not be able to provide support for other patients who may need Intensive Care.
All patients discharged from ICU will be seen by the Patient At Risk nurse within 4 hours of leaving to ensure the transition has gone smoothly.
This page was last updated on Monday, 04 March 2013 10:23:04