General Considerations



As ICU patient volume and acuity increase, there has been a parallel growth in the use of technology to assist in management. Several issues must be considered when determining where and how to perform certain procedures in critically ill and injured patients. Much forethought and planning are required to establish a successful intensive care unit (ICU)-based procedural environment – from concerns regarding the availability and reliability of pertinent equipment to more complex issues of acquiring competency and pursuing credentialing. It is essential to pay adequate attention to these general ­considerations to ensure that ICU-based procedures are accomplished with equivalent safety and results as those performed in more traditional settings.


Intensive Care Unit Intensive Care Unit Setting Percutaneous Tracheostomy Intensive Care Unit Staff Central Venous Catheter Placement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Grover A, Robbins J, Bendick P, et al. Open versus percutaneous ­dilational tracheostomy: efficacy and cost analysis. Am Surg. 2001;67(4):297–301.PubMedGoogle Scholar
  2. 2.
    Upadhyay A, Maurer J, Turner J, et al. Elective bedside tracheostomy in the intensive care unit. J Am Coll Surg. 1996;183(1):51–55.PubMedGoogle Scholar
  3. 3.
    Jones PW, Moyers J, Rogers J, et al. Ultrasound guided thoracentesis: is it a safer method? Chest. 2003;123(2):418–423.PubMedCrossRefGoogle Scholar
  4. 4.
    Hind D, Calvert N, McWilliams R, et al. Ultrasonic devices for central venous cannulations: meta-analysis. BMJ. 2003;327(7411):361.PubMedCrossRefGoogle Scholar
  5. 5.
    Society of Critical Care Medicine. Guidelines for granting privileges for the performance of procedures in critically ill patients. Crit Care Med. 1993;19(2):275–278.Google Scholar
  6. 6.
    Martin LD, Howell R, Ziegelstein R, et al. Hospitalist performance of cardiac hand-carried ultrasound after focused training. Am J Med. 2007;120(11):1000–1004.PubMedCrossRefGoogle Scholar
  7. 7.
    Gunst M, Sperry J, Ghaemmaghami V, et al. Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma / critical care: the BEAT exam. J Trauma. 2007;63(6):1432.Google Scholar
  8. 8.
    Mazareshahi RM, Farmer JC, Porembka D, et al. A suggested curriculum in echocardiography for critical care physicians. Crit Care Med. 2007;35(8 Supp):S431–S433.CrossRefGoogle Scholar
  9. 9.
    Alexander JH, Peterson E, Chen A, et al. Feasibility of point-of-care echocardiography by internal medicine house staff. Am Heart H. 2004;147(3):476–481.CrossRefGoogle Scholar
  10. 10.
    Langlois SLP, FRANZCR. Focused ultrasound training for clinicians. Crit Care Med. 2007;35(5 suppl):S138–S143.CrossRefGoogle Scholar
  11. 11.
    Gardiner Q, White PS, Carson A, et al. Technique training: endoscopic percutaneous tracheostomy. Br J Anaesth. 1998;81(3):401–403.PubMedCrossRefGoogle Scholar
  12. 12.
    Indeck M, Peterson S, Smith J, et al. Risk, cost and benefit of transporting ICU patients for special studies. J Trauma. 1988;28(7):1020–1025.PubMedCrossRefGoogle Scholar
  13. 13.
    Damm C, Vandelet P, Petit J, et al. Complications [Complications during the intrahospital transport in critically ill patients. Ann Fr Anesth Reanim. 2005;24(1):24–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Jaramillo EJ, Trevino JM, Berghoff KR, et al. Bedside diagnostic ­laparoscopy in the intensive care unit: a 13-year experience. J Soc ­Laparoendoscopic Surg. 2006;10(2):155–159.Google Scholar
  15. 15.
    Simpson, Day, Jewkes, et al. The impact of percutaneous tracheostomy on intensive care unit practice and training. Anaesthesia 1999;54(2):186–189.PubMedCrossRefGoogle Scholar
  16. 16.
    Hunter M. Peripherally inserted central catheter placement at the speed of sound. Nutr Clin Pract. 2007;22(4):406–411.PubMedCrossRefGoogle Scholar
  17. 17.
    Carr BG, Dean A, Everett W, et al. Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study. J Trauma. 2007;63(3):495–500.PubMedCrossRefGoogle Scholar
  18. 18.
    Nicolaou S, Talsky A, Khashoggi K, et al. Ultrasound-guided interventional radiology in critical care. Crit Care Med. 2007;35(5 Suppl):S186–S197.PubMedCrossRefGoogle Scholar
  19. 19.
    Berenholtz SM, Pronovost P, Lipsett P, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med. 2004;32(10):2014–2020.PubMedCrossRefGoogle Scholar
  20. 20.
    Sing RF, Smith C, Miles W, et al. Preliminary results of bedside inferior vena cava filter placement: safe and cost-effective. Chest. 1998;114(1):315–316.PubMedCrossRefGoogle Scholar
  21. 21.
    Nussbaum MS. Invited lecture: American Board of Surgery Maintenance of Certification explained. Am J Surg. 2008;195:284–287.PubMedCrossRefGoogle Scholar
  22. 22.
    Neri L, Storti E, Lichtensetein D, et al. Toward an ultrasound curriculum for critical care medicine. Crit Care Med. 2007;35(5 suppl):S290–S304.PubMedCrossRefGoogle Scholar
  23. 23.
    Powner DJ. Credentialing for critical care in small hospitals. Crit Care Med. 2001;29(8):1630–1632.PubMedCrossRefGoogle Scholar
  24. 24.
    Sloan FA, Conover C, Provenzale D, et al. Hospital credentialing and quality of care. Soc Sci Med. 2000;50(1):77–88.PubMedCrossRefGoogle Scholar
  25. 25.
    Kovacs G. Procedural skills in medicine: Linking theory to practice. J Emerg Med. 1997;15(3):387–391.PubMedCrossRefGoogle Scholar
  26. 26.
    Eisen DM, Baron T, Dominitz J, et al. Methods of granting hospital privileges to perform gastrointestinal endoscopy. Gastrointest Endosc. 2002;55(7):780–783.PubMedCrossRefGoogle Scholar
  27. 27.
    Sharma VK, Coppola A, Raufman J, et al. A survey of credentialing practices of gastrointestinal endoscopy centers in the United States. J Clin Gastroenterol. 2005;39(6):501–507.PubMedCrossRefGoogle Scholar
  28. 28.
    American Society of Anesthesiologists Task Force on Sedation and ­Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004–1017.CrossRefGoogle Scholar
  29. 29.
    Soifer BE. Procedural Anesthesia at the bedside. Crit Care Clin. 2000;16(1):7–28.PubMedCrossRefGoogle Scholar
  30. 30.
    Brady M, Kinn S, O’Rourke K, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD004423. DOI: 10.1002/14651858.CD004423Google Scholar
  31. 31.
    Brady M, Kinn S, O’Rourke K, Randhawa N, Stuart P. Preoperative fasting for preventing perioperative complications in children. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005285. DOI: 10.1002/14651858.CD005285Google Scholar
  32. 32.
    Davis N, Pohlman A, Gehlbach B, et al. Improving the process of informed consent in the critically ill. JAMA. 2003;289(15):1963-1968.PubMedCrossRefGoogle Scholar
  33. 33.
    Fan E, Shahid S, Kondreddi V, et al. Informed consent in the critically ill: a two-step approach incorporation delirium screening. Crit Care Med. 2008;36(1):94–99.PubMedCrossRefGoogle Scholar
  34. 34.
    Joint Commission on Accreditation of Healthcare Organizations. Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. as accessed on 4/23/08
  35. 35.
    Michaels RK, Makary M, Dahab Y, et al. Achieving the National Quality Forum’s “Never Events”: prevention of wrong site, wrong procedure, and wrong patient operations. Ann Surg. 2007;245(4):526–532.PubMedCrossRefGoogle Scholar
  36. 36.
    Clarke JR, Johnston J, Finley E, et al. Getting surgery right. Ann Surg. 2007;246(3):395–403.PubMedCrossRefGoogle Scholar
  37. 37.
    Egorova NN, Moskowitz A, Gelijns A, et al. Managing the prevention of retained surgical instruments – what is the value of counting? Ann Surg. 2008;247(1):13–18.PubMedCrossRefGoogle Scholar
  38. 38.
    Ponrartana S, Coakley F, Yeh B, et al. Accuracy of plain abdominal radiographs in the detection of retained surgical needles in the peritoneal cavity. Ann Surg. 2008;247(1):8–12.PubMedCrossRefGoogle Scholar
  39. 39.
    Greenberg CC, Diaz-Flores R, Lipsitz S, et al. Bar-coding surgical sponges to improve safety: a randomized controlled trial. Ann Surg. 2008;247(4):612–616.PubMedCrossRefGoogle Scholar
  40. 40.
    O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51(RR-10):1–29PubMedGoogle Scholar
  41. 41.
    Edwards PS, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2004;3:CD003949PubMedGoogle Scholar
  42. 42.
    Moylan JA, Fitzpatrick KT, Davenport KE. Reducing wound infections. Improved gown and drape barrier performance. Arch Surg. 1987;122(2):152–157PubMedCrossRefGoogle Scholar
  43. 43.
    Webster J, Alghamdi AA. Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev. 2007;4:CD006353.PubMedGoogle Scholar
  44. 44.
    Bratzler DW, Dale W, Houck PM, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection ­Prevention Project. Clin Infect Dis. 2004;38(12):1706–1715.PubMedCrossRefGoogle Scholar
  45. 45.
    Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines ­Writers Workgroups. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005;189(4):395–404PubMedCrossRefGoogle Scholar
  46. 46.
    Fein JA, Ganesh J, Alpern ER. Medical staff attitudes toward family presence during pediatric procedures. Pediatr Emerg Care. 2004;20(4):224–227.PubMedCrossRefGoogle Scholar
  47. 47.
    Bradford KK, Kost S, Selbst S, et al. Family member presence for procedures: the resident’s perspective. Ambul Pediatr. 2005;5(5):294–297.PubMedCrossRefGoogle Scholar
  48. 48.
    Shapira M, Tamir AD. Presence of family member during endoscopy. What do patients and escorts think? J Clin Gastroenterol. 1996;22(4):272–274.PubMedCrossRefGoogle Scholar
  49. 49.
    MacLean SL, Guzzetta CE, White C, et al. Family presence during cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses. Am J Crit Care. 2003;12(3):246–257.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Trauma Acute Care and Critical Care SurgeryShock Trauma Center, Penn State Milton S. Hershey Medical CenterHersheyUSA

Personalised recommendations