Hospitals & Services

Clinical Procedures

Introduction

It is inevitable that during your time in the Intensive Care unit, you will be exposed to a number of procedures with which you are not familiar.  All staff are encouraged to become proficient with routine procedures:

 

Intensive Care Procedures:

  • Endotracheal  intubation

  • Peripheral venous catheterization

  • Central venous catheterization

  • Arterial cannulation / PiCCO insertion

  • Pulmonary artery catheterization

  • Lumbar puncture

  • Intercostal drain insertion or Pleurocentesis

  • Naso-gastric tube insertion

Patient consent should be obtained as outlined elsewhere in these guidelines.

No member of staff is permitted to attempt a procedure without adequate training.  Staff with previous experience must affirm this with the Senior Registrar or Duty Specialist prior to attempting unsupervised procedures.  All junior staff should be supervised for their first 2 arterial cannulation and at least 5 central venous access procedures prior to performing these procedures unsupervised.

All procedures must be annotated in the case notes, including the indication / complications for the procedures.

 

Restricted Procedures

The following are specialised procedures and may only be performed by the Senior Registrar and/or Duty Specialist.  They may not be attempted by anyone without prior discussion with the Duty Specialist.

  • Percutaneous tracheostomy

  • Fibreoptic bronchoscopy

  • Transvenous pacing

 

Peripheral IV Catheters

Indications:

  • Initial IV access for resuscitation

  • Stable or convalescent patients where more invasive access is not warranted.

 

Management

 All lines placed in situations where aseptic technique was not known to have been followed must be removed (eg: placement by emergency staff at the roadside).  Acceptable aseptic technique must be followed, including:

  • Thorough hand washing and skin preparation with alcohol swab

  • Occlusive but transparent dressing

  • All lines should be removed if not being actively used, or if >2 days old.  An exception may be made where venous access is challenging (eg: paediatric patients).

Page last reviewed: 13 May 2014
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