TRANSPORT OF THE

CRITICALLY ILL
PATIENT
DR SALIM- ai
DEPT OF ANESTHESIA &
INTENSIVE CARE,
GHKL.
INTRODUCTION

 Critically ill patients have absent or small

physiological reserves
 Adverse physiological changes can occur
during transport and threaten life
 Patient at risk :
 Ventilated patient
 Haemodynamically unstable patient
INDICATION FOR TRANSPORT
 Additional care either for technology not
available at current location

 Or specialist care not available at current

location
DESTINATION

 • Intra ICU - transport within ICU

 • Intra Hospital - transport within hospital
(Radiology / OT)
 • Inter Hospital - transport between
hospitals (Paediatric / Neurosurgery)
OBJECTIVE OF TRANSPORT
OPERATION

 • Must be indicated – benefits outweigh

risks
 • Must be safe uninterrupted monitoring &
treatment
 • Must be smoothly manage
STEPS IN TRANSPORT
OPERATION
 • Planning
 • Pre-transport coordination and communication
 • Patient preparation
 • Accompanying personnel
 • Equipment accompanying patient
 • Monitor during transport
 • Passage
 • Arrival procedures
 • Documentation
 • Quality Assurance
 • Education and training
PLANNING

 • Must define :
 􀂾 Where is the patient going?
 ( CT Scan room, OT )
 􀂾 Why is the patient going?
 ( Diagnostic, therapeutic )
 􀂾 Who is the patient going with?
 (staff nurse, medical assistant or officer )
 􀂾 What equipment does the patient need?
 ( Ventilator, monitors, suction )
PLANNING

 􀂾 When is the patient going?

 􀂾 Which way is the patient going?
 􀂾 What mode is the patient going?
(ambulance, air borne )
PRE-TRANSPORT
COORDINATION &
COMMUNICATION
 • Transport team must be free from other
duties
 • Receiving staff must be notified
 • Equipment must be checked
 • Patient’s documents must be checked
available
PREDEPARTURE EQUIPMENT AND
DOCUMENT CHECKLIST

 •Capnograph monitor
functioning
 •Pulse Oximeter
monitor functioning
 •BP monitoring
functioning
 •ECG monitoring
functioning
 •Ventilator functioning :
Respiratory variable set
 •Manual resuscitation
bag functioning
PREDEPARTURE EQUIPMENT
AND DOCUMENT CHECKLIST
 •Patient notes, X-ray, request form, consent forms are
available and covered to maintain patient’s confidentially
 •Chest clamps are available
 • Spare batteries are available for all battery powered
equipment
 •Spare intravenous fluids or blood products are available
if needed
 •Additional drug are made available if indicated
 •‘Crash Bag’ checked and ready
 •Defibrillator is available and functioning
PATIENT PREPARATION

 • Patient must be reassessed before

transport begins
PATIENT STATUS CHECKLIST

 •Under water seal drain is not clamped

 •All drains are functioning and secured
 •PEEP/CPAP (if set) and FiO2 Levels are
correct
 •All equipment alarm are switched on
 •Ventilation is adequate
 •Airway is secure and patent
PATIENT STATUS CHECKLIST

 •Patient is being monitored

 •Patient is covered by sheets or blanket
during transport
 •Patient is safely secured on trolley
 •Intravenous drip & infusion pump
functioning
 •Venous access is adequate and patent
EQUIPMENT ACCOMPANYING
PATIENT

 • Equipment used must be dedicated transport

equipment used solely for transportation
 • Equipment should be compatible with
destination site
 • Equipment chosen depend on patient’s status
 • Equipment used are readily available and
regularly checked
CRASH BAG’S CONTENT
 • Emergency Drugs:
 􀀹 Adrenaline
 􀀹 Atropine
 􀀹 Lidocaine
 􀀹 Magnesium
 􀀹 Calcium Cloride
 􀀹Dextrose 30%, 50%
 􀀹 Sodium Bicarbonate 8.4%
 􀀹Water for injection
CRASH BAG’S CONTENT
 • Drugs for airway Mx:
 􀀹 Midazolam
 􀀹 Propofol
 􀀹 Fentanyl
 􀀹 Suxamethonium
 􀀹 Vecuronium
 􀀹 Atracurium
 􀀹 Lubricant gel
 *Other drug: medication
required by the patient while
out of ICU
CRASH BAG’S CONTENT
 • Equipment
 􀀹 Laryngoscope = long, short & straight blade
 􀀹 Guedel airway = size 3
 􀀹 ETT & adapters = size 6,7,8
 􀀹 Tracheostomy tubes = size 6,7
 􀀹 Introducer / stylet
 􀀹 Suction catheters = size 12x2, size 14x2
 􀀹 Yankeur sucker x2
 􀀹 Minitrache set
 􀀹 Manual resuscitation bag =1 liter bag
 􀀹 Masks (incl. LMA)
CRASH BAG’S CONTENT
 • Equipment
 􀀹 Magills introducing forceps
 􀀹 Cannula’s branulas = size 16, 18, 20G
 􀀹 Sterile glove = size 6, 7, 8
 􀀹 Syringes = 2, 5, 10mls
 􀀹 Needles = 18, 21, 23, 25G
 􀀹 4 Scissors
 􀀹 ECG dots
 􀀹 Tapes, ribbon
 􀀹 Small torch light
 􀀹 Spare Batteries
MONITORING DURING
TRANSPORT
 • ECG should be continuously monitored for sign of
dysrhythmias
 • Heart rate should be monitored continuously
 • BP should be monitored continuously
 • Respiratory rate should be monitored intermittently
 • Airway pressure should be monitored if a transport
ventilator is used
 • Tidal volume should be monitored intermittently to assure
appropriate ventilation
 • Continuos pulse oximetry may be useful in patients with
borderline respiratory function
 • Breath sounds should be monitored intermittently
JOURNEY

 • Ensure a smooth and

uninterrupted ride
 • All equipments and bed
must be able to fit
doorways and lifts
 • Minimize abrupt
movements and
vibrations
 • Patient is transported
feet first
ARRIVAL PROCEDURES

 • The receiving monitoring, ventilation, gas, suction

and power facilities are checked
 • The patient must be assessed when new
monitors, ventilators, gas and power supplies are
established
 • A complete hand-over is given to the team leader.
The transport staff must remain with the patient
until the receiving team is fully ready to take over
care
DOCUMENTATION

 • The clinical record should document

patient’s clinical status during transport until
handover occurs at the destination
QUALITY ASSURANCE

 • The process of transport of patient should

be continually evaluated to identify system
problem and recommended improvement
EDUCATION AND TRAINING

 • Competency base training and

assessment should be developed to ensure
the highest possible standards of care for
the critically ill patient requiring transport
maintain
CONCLUSION

 • Ensure patient is covered by sheets or

blankets during transport, maintaining the
patient temperature and dignity
 • Covering all documents accompanying
patient to ensure patients confidentiality
CONCLUSION
 • Patient bedrails in upright position-
minimize the risk of the patient falling
down from the bed during transport
 • Ensure all equipment are not protruding
from the bed parameters and not resting
on the patient
CONCLUSION
 • The nursing and medical staff is to be positioned
at the head of the bed to allowed and provide
easy and fast assess to the patient for purpose of
observation and airway maintenance
 • All monitoring equipment during transportation
should have both visual and audible warning
alarm activated at all times
CONCLUSION
 • Load all infusion to a minimum number
of IV poles to reduce equipment load
 • Emergency IV drug line should be clearly
marked and accessible
CONCLUSION
 • The nurse should remain and monitor the
patient at all times (as situation permits it)
 • Patient therapeutic management is
maintained at all times