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University of Lahore Teaching Hospital

SOPs: ICU Admission and Discharge

University of Lahore Teaching Hospital

University of Lahore Teaching Hospital

University of Lahore Teaching Hospital


SOPs: Investigations on Admission in ICU

University of Lahore Teaching Hospital


SOPs: Weaning from Mechanical Ventilation in ICU

University of Lahore Teaching Hospital

University of Lahore Teaching Hospital

University of Lahore Teaching Hospital


SOPs: Initial Assessment and Resuscitation on ICU
Arrival
A.
Assign responsibilities to ICU staf
B.
Start initial assessment and resuscitation
C.Take focused history and Perform focused physical
examination
D.
Send basic investigation
E.Discuss with ICU consultant
F. Assess response to initial resuscitation
G.
Assess intensity of support
H.
Seek Consultations for specific problems that
might require expertise
I. Construct a working diagnosis and plan for further
management
J. Discuss further with the ICU consultant
K.
Brief the relatives

University of Lahore Teaching Hospital


SOPs: Central Line Placement
A.
B.

Assess the need for central line placement


Check for any contraindications (Coagulopathy,

Local site infection or burn)


C.Choose the appropriate site (Internal Jugular is
preferred, Femoral if low Platelets and Coagulopathy)
D.
Choose the appropriate catheter (Triple lumen or
Double lumen)
E.Know the relevant anatomy
F. Take informed consent
(Pros/Cons/Indications/Complications)
G.
Keep all equipment ready and Set up the
transducing system
H.
Procedure of Central line placement (Use CVP
insertion bundle)
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.

Wear the cap and the mask.


Wash hands with alcohol-based hand rub for 35 min
and minimum three applications.
Put on a sterile gown and gloves (Performer and
Assistant)
Clean the skin of the patient with 2% chlorhexidine in
alcohol preparation.
Give a frictional scrub in a circular manner to at least
10 cm area from the insertion Site, Do not shave if hair
is present
Place large sterile drapes over the insertion site. Do not
occlude the air supply or field of vision when draping
neck areas of conscious patients
Local anesthesia at insertion site
Use Seldinger technique for cannulation
Aseptic dressing at the end of procedure

University of Lahore Teaching Hospital


I. Check CV pressure with pressure Transducer & Get
chest X-ray for CV Line position (Not applicable for
Femoral line)
SOPs: Arterial Catheterization (Radial Artery)
A.

Assess the need for intra-arterial pressure

monitoring indications
B.
Check for any contraindications (Coagulopathy,
Local site infection or Burns)
C.Choose the appropriate site (Radial Preferred)
D.
Check perfusion of the extremity
E.Take informed consent
(Pros/Cons/Indications/Complications)
F. Keep all equipment ready for arterial cannulation and
pressure Transducing
G.
Set up the pressure transducing system
H.
Positioning (Extension at wrist with a small pillow
beneath wrist)
I. Procedure of Radial arterial cannulation
a. Wear the cap and the mask.
b. Wash hands with alcohol-based hand rub for 35 min
and minimum three applications.
c. Put on a sterile gown and gloves (Performer and
Assistant)
d. Clean the skin of the patient with 2% chlorhexidine in
alcohol preparation.
e. Give a frictional scrub in a circular manner to at least
10 cm area from the insertion Site
f. Place large sterile drapes over the insertion site. Do not
occlude the air supply or field of vision when draping
conscious patients

University of Lahore Teaching Hospital


g. Local anesthesia at insertion site
h. Use Over-the-Needle Technique or Over-the-Wire
Technique for Radial Artery Cannulation
i. Aseptic dressing at the end of procedure

J. Secure the catheter and check perfusion


K.
Check the arterial waveform and MAP with
pressure Transducer
SOPs: Thoracentesis
A.
B.

Assess the need of thoracentesis


Check for any contraindications (Coagulopathy,

Local site infection or Burns)


C.Keep all equipment ready for the procedure
D.
Take informed consent
(Pros/Cons/Indications/Complications)
E.Place the patient in proper position (Preferably
sitting)
F. Procedure of Thoracentesis
a. Wear the cap and the mask.
b. Wash hands with alcohol-based hand rub for 35 min
and minimum three applications.
c. Put on a sterile gown and gloves (Performer and
Assistant)
d. Clean the skin of the patient with 2% chlorhexidine in
alcohol preparation.
e. Give a frictional scrub in a circular manner to at least
10 cm area from the insertion Site
f. Place large sterile drapes over the insertion site. Do not
occlude the air supply or field of vision when draping
conscious patients
g. Local anesthesia at insertion site
h. Needle thoracentesis For Diagnostic Thoracentesis
i. Thoracentesis with intravenous cannula - For
Therapeutic Thoracentesis

University of Lahore Teaching Hospital


j. Aseptic dressing at the end of procedure

G.

Send pleural fluid for the laboratory tests

University of Lahore Teaching Hospital


SOPs: Chest Tube Placement
A.
B.

Assess the need of chest tube insertion


Check for any contraindications (Coagulopathy,

Local site infection or Burns)


C.Take informed consent
(Pros/Cons/Indications/Complications)
D.
Premedication (Pain meds etc.) & Patient
position (lying with arm abducted and above head on
side of chest tube insertion)
E.Selection of site (Triangle of safety) & Selection of
Drain size (Small for pneumothorax, large for
empyema)
F. Keep all equipment ready for the procedure
G.
Procedure for Chest tube insertion (Use Chest
Tube Insertion Bundle)
a. Wear the cap and the mask.
b. Wash hands with alcohol-based hand rub for 35 min
and minimum three applications.
c. Put on a sterile gown and gloves (Performer and
Assistant)
d. Clean the skin of the patient with 2% chlorhexidine in
alcohol preparation.
e. Give a frictional scrub in a circular manner to at least
10 cm area from the insertion Site
f. Place large sterile drapes over the insertion site. Do not
occlude the air supply or field of vision when draping
conscious patients
g. Local anesthesia at insertion site
h. Use whatever method of insertion is appropriate;
Guidewire tube thoracostomy, Trocar tube
thoracostomy, Operative tube thoracostomy
i. Aseptic dressing at the end of procedure
j. Attach to underwater seal

University of Lahore Teaching Hospital


H.

Verification of chest tube placement Get Chest

X-ray
SOPs: Lumbar Puncture
A.
B.

Assess the need for lumbar puncture


Perform fundoscopy & Order CT head before

lumbar puncture
C.Check for any contraindications (Coagulopathy, Local
site infection or Burns)
D.
Take informed consent
(Pros/Cons/Indications/Complications)
E.Keep all equipment ready for the procedure
F. Position the patient (left lateral preferred)
G.
Know landmarks and anatomy
H.
Procedure of Lumbar puncture
a. Wear the cap and the mask.
b. Wash hands with alcohol-based hand rub for 35 min
and minimum three applications.
c. Put on a sterile gown and gloves (Performer and
Assistant)
d. Clean the skin of the patient with 2% chlorhexidine in
alcohol preparation.
e. Give a frictional scrub in a circular manner to at least
10 cm area from the insertion Site
f. Place large sterile drapes over the insertion site. Do not
occlude the air supply or field of vision when draping
conscious patients
g. Local anesthesia at insertion site
h. Use small L.P needle (FG 22, FG 23, FG25), Insert
between L3-4, L4-5 and collect CSF in 4 vials labeled A
to D
i. Aseptic dressing at the end of procedure

University of Lahore Teaching Hospital


I.

Send samples A, B, C to lab, Store Sample D for


future tests

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