Traveling with #CTICU
patients—for me— is one of the most nerve-wracking experiences. Oftentimes patients are ordered for STAT scans for a variety of reasons, for which they must be transported off the unit to have the studies performed. This may not seem like a big deal; however, when your patient is on multiple high-dose pressors and is hemodynamically labile, it becomes a huge act of coordination and teamwork.
Communication is crucial in the orchestration of these types of transports.
The nurse must be in close contact with the radiology room in order to pinpoint an approximate time for the study. Respiratory Therapy must be present for the transport (the patient is bagged until arrival in the CT room), so is important to keep them up to date on the timeframe so that they can disconnect the patient from the vent and get everything situated prior to rolling. The perfusionist must be present for ECMO patient transports. Another individual who must be included in the transport plan is the actual transporter. They play an important role in knowing how to get from point A to point B the quickest. They also are the ones who wrangle the sometimes self-thinking ICU beds and ensure the smoothest ride possible. In addition to these individuals, any bystanders are quickly recruited to assist with the transport.
Meanwhile, the bedside nurse must work to quickly (but carefully) disconnect the patient from central to transport monitoring, relocate pumps and other devices to the bed frame, and get rid of any other unnecessary equipment (SCD pumps, Kangaroo pumps). The RN must think ahead and plan for any potential complications that could occur while not on the unit: are any drips about to run dry? Do we have a means to further sedate the patient if they should start rustling around once the scan is in progress? Do we have our ACLS drugs? What if a pump malfunctions—do we have a backup? And then my LEAST favorite part: Attempting to fit all of the equipment (and bodies) into a single elevator!
My go-to transport drugs: Epi, calcium carbonate, sodium bicarb; I will typically bolus off the pump (prop, fentanyl, versed) for patients with increased sedation requirements.