Page 106 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

74 PART 1: An Overview of the Approach to and Organization of Critical Care

The method of carrying transport equipment depends on local prefer- for computed tomographic brain scans demonstrated that a signifi-
ences, but modular backpacks or compartmentalized hard plastic cases cant number of patients showed reductions in the partial pressure of
work well for securely carrying equipment in an accessible manner oxygen in their brain tissue following the transfer, most notably in
(Fig. 11-1). For most hospital environments, it is necessary to use a dif- those with impaired lung function. 58
ferent pack for interhospital and intrahospital transfers from that used Patient oxygen requirements can be calculated using the formula
for prehospital care where the demands are different. below.
Whichever system is used for carrying equipment it should be well
organized, and should contain a thoughtfully designed, comprehensive Delivered Oxygen Flow (L/min) × Duration of Transfer (min)
but not exhaustive list of equipment and medications informed by the = Oxygen Required (L)
relevant guideline. A robust mechanism should be in place for regular As a pragmatic measure, this figure is usually doubled to allow for
checking of the transfer kit contents and replenishment of any consum- unexpected delays.
ables that have been used. A training package should be in place for Cylinder size and availability will then determine the number of cyl-
those members of staff expected to use the transfer kit. inders required (Table 11-3). Each cylinder should be checked and full.
The type of transport ventilator used may depend on patient char-
acteristics. While transportable ventilators provide superior ventilation Medication: All drugs should be stored in an easy to access container,
compared to manual ventilation in terms of reliability of oxygenation at the appropriate temperature. Expiry dates should be checked prior
and tidal volumes, many portable ventilators offer inferior triggering to departure and adequate supplies should be taken for the entire
systems and tidal volume maintenance when compared to standard ICU journey plus some extra in case of delays or diversions. Controlled
ventilators. 54,55 It can prove difficult to manage patients with severe lung drugs should be signed out and held by an appropriate member of the
injury using transport ventilators, and it may occasionally be necessary transfer team. All medication should be prescribed and accounted for
to use an intensive care ventilator for intrahospital transfers rather than in the patient documentation.
attempting to use a portable ventilator. Preparing the Team: Transfer team members should ensure that they have
Transfer equipment should be 56 orientated themselves with their transfer vehicle and, especially in the
case of aircraft, are briefed on emergency and evacuation procedures.
• Easy to use and familiar to all nursing and medical staff Each team member should ensure that they have the following items:
• Robust
• Light and easy to carry • Money—to pay for return journey if required
• Easy to read with a clear, well-lit display • Mobile phone and contact details of discharging and referring units
• Reliable during vibration and movement in transfer • Food and drink
• Able to use a portable power supply, eg, external batteries • Adequate clothing
• Compatible with aircraft systems • Antiemetic if known to suffer from motion sickness
• High-visibility clothing
All equipment should be stowed carefully during the transfer, ideally
on the floor near the bulkhead on a road ambulance or secured to the Individuals are responsible for arranging and checking their own
floor in an aircraft. Under no circumstances should equipment be stored professional liability and insurance cover, as in some countries this is not
on the patient. In the event of a collision or turbulence, unsecured necessarily provided by the hospital or health care organization.
equipment can become dangerous projectiles. All monitors and syringes
should be visible to staff throughout the transfer. 8 During Transfer: The patient should be reassessed immediately prior
to transfer. In the event of physiological deterioration or other sig-
Oxygen: Hypoxemia must be avoided during transfers to avoid nificant change in condition, a decision should be made to delay or
adverse events such as acidosis and cardiac ischemia. A study of cancel the transfer.
57
patients with traumatic brain injury undergoing intrahospital transfer Most vehicles use a purpose built trolley or stretcher (Fig. 11-2). Some
organizations use dedicated, standardized transfer trolleys. Indeed, this
is recommended by the UK Intensive Care Society. If used, the trans-
8
fer trolley should be compatible with the vehicle. When transferring
the patient on to the stretcher, it is important to consider access in the
vehicle. Most road ambulances load their stretchers such that access to
the left side of the patient is limited. Lines, tubing, and monitors should,
therefore, be positioned on the right side of the patient.
Provided that adequate assessment and stabilization have been
undertaken prior to departure, little or no active intervention should be
required during the journey. Ensuring that there is no interruption in
21
monitoring of vital signs or support of vital functions can reduce risk
to the patient. Apart from patients undergoing mechanical ventilation
20
TABLE 11-3 Oxygen Cylinder Sizes and Capacities
Size (UK) C D E F G J CD ZX
Capacity (L) 170 340 680 1360 3400 6800 460 3040
http://www.bocsds.com/uk/sds/medical/medical_oxygen.pdf.
Size (US) M7 C D M22 E M60 M90 MM
Capacity (L) 196 255 425 640 680 1738 2549 3455
FIGURE 11-1. A typical modular backpack configured for intrahospital transfer. http://www.respiratorygroup.com/products/high_pressure/med_o2_spec.aspx.

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