CORONARY CARE

introduction to coronary care 

CARDIOLOGY DEPARTMENT

The Department of Cardiology has comprehensive acute coronary care unit (CACCU), wards and cath labs. CACCU is divided into ICU-I and ICU-II and is fully equipped with bedside multifunction hemodynamic monitors, defibrillators, transcutaneous pacing facility, infusion pumps, ventilators, ECG machine, cardiac reader, activated clotting time machine etc. The patients who receive care in cardiology include patients with unstable angina, acute myocardial infarction, post myocardial infarction complication, pulmonary edema, cyanotic spell, life threatening arrhythmias and patients who have undergone interventional procedures like coronary interventions including primary precutaneous transluminal  coronary angioplasty (PTCA) and stenting, non-coronary interventions including dilatation of stenosed valves and arteries: percutaneous transluminal mitral commisurotomy (PTMC), balloon mitral valvotomy (BMV), balloon pulmonary valvotomy (BPV), balloon aortic valvotomy (BAV), device closure of congenital defects like atrial septal defect (ASD) and ventricular septal defect (VSD), patent ductus arteriosus (PDA), radiofrequency ablation (RFA); dilatation of severe tricuspid valve stenosis or coarctation of aorta; cardiac catheterisation and coronary angiogram. Percutaneous interventions include atherectomy using rotablater device. Neonates and infants who need emergency life saving procedures like balloon atrial septostomy and balloon dialatation of aortic and pulmonary valve is also done here.

Cardiology beds

There are 35 beds in the ward including pediatric beds for management of less critically ill cardiac patients including admission for invasive and interventional procedures. We have three cardiac catheterization labs and one 2D Echo color doppler laboratory adjacent to CACCU functioning continuously from 8am to 5pm on all working days. Sophisticated procedures like transesophageal echo, pharmacologic stress echo (dobutamine), and tissue doppler imaging are performed here. The non-invasive cardiac laboratory provide holter monitoring system with advanced features like signal averaging, pacemaker analysis, and monitoring heart rate variability.

Equipments in intensive care unit

Operation of any equipment should be tested before it is being used. It is also important to keep them in good condition in proper place. Nurses should have thorough knowledge about all the equipments in critical care unit, because they have the responsibility for its proper use and maintenance.

Arterial blood gas machine: Arterial blood gas is a blood test that is performed by using arterial blood. This test is done to determine pH, PO2, PCO2, bicarbonate, lactate, hemoglobin and electrolytes. This machine is very handy.

Bair hugger provides warmth and prevents hypothermia

Cardiac monitors

Monitors are kept mounted on the wall near the head end of the patient. This position gives a clear view to the person who is looking after the patient. These monitors have the facility to display ECG, heart rate, arterial blood pressure, central venous pressure, pulmonary arterial pressure, left atrial pressure, pulmonary capillary wedge pressure, non-invasive blood pressure, temperature, SPO2 and respiratory rate. Accessories of cardiac monitors are cable, ECG lead wires and electrodes. Monitors are not shifted from one place to another to avoid damage to the equipment. Alarm and screen display setup must be functioning properly. Make sure that the personnel from Biomedical Engineering department (BME) are checking the systems daily. Do not allow any liquid into the system.

Cardiac output monitor               

It is used for evaluating the hemodynamic status of a patient, for measuring the forward flow of blood in the vascular system. Flow track transducer is being used to monitor the cardiac output continuously.

Cardiac reader       

It is used for fast, point-of-care results for diagnosis of acute coronary syndrome, deep vein thrombosis, pulmonary embolism and heart failure. The cardiac reader enables healthcare providers to determine troponin T, myoglobin, D-dimer and pro BNP (brain natriuretic peptide or B-type natriuretic peptide) levels from a single heparinized whole blood sample in minutes.

Chest vibrator is a device used to assist expectoration of retained secretion.

Defibrillator is an electronic device that creates a sustained myocardial depolarisation of a patient's heart in order to stop cardiac arrhythmias by administering electric shock. (For details please refer to “Cardioversion and defibrillation”).

Deep vein thrombosis prophylaxis machine

It is a device to promote circulation of blood and lymph in the disabled region of the arm and leg. It helps to reduce pulmonary embolism and deep vein thrombosis. Do not block the ventilation slots located on both sides of the machine. Lack of ventilation may cause the cardiograph to overheat and components to fail.

Glucometer

It is a medical device for determining the approximate concentration of glucose in the blood. It is easy to use and handle and result is ready within seconds.

Hemodialyzer

It is known as “artificial kidney.” The dialyzer is a hollow plastic tube about a foot long and three inches in diameter that contains many tiny filters. There are two sections in the dialyzer; the section for dialysate and the section for the blood. A semi-permeable membrane divides the two sections so that they don't mix together.

Incentive spirometer

It is a medical device used to improve the functioning of the lungs. It promotes maximum inspiration and loosens secretions.

Intra Aortic Balloon Pump (IABP) is a device that provides physiologic assistance to the failing heart by decreasing myocardial oxygen demand and improving coronary perfusion. (For details please refer to care of patient on IABP).

Nebulizer is used to provide inhalation to the patient. It converts water into minute molecules that mimics fumes, which helps loosen the pulmonary secretion.

Negative pressure wound assist therapy machine

It is used to enhance circulation and remove waste from the lymphatic system. It provides a minimally invasive method of promoting wound healing and works by the local application of sub atmospheric pressure. Wound assist system comprises console providing the suction, disposable container to collect the exudates and a sterile dressing pack.

Pressure bag  

It is a special bag used with deflatable intravenous bottle. The pressure pump is used to help the IV fluids either run faster or continuously flow to the patients. This helps to provide rapid administration of fluids and blood in emergency situations.

Pressure transducer converts mechanical energy to electrical energy, used in all invasive pressure lines.

Pulse oxymeter is a device to monitor arterial oxygen saturation percentage and pulse rate.

Self-inflatable alternating pressure releasing bed. It operates on an electric motor. It helps to prevent bed sore and provides comfort to the recumbent patient.

Suction equipment is a negative pressure system to suck out secretions. It may also be used to apply negative pressure to drainage system.

Syringe pump is a device designed to ensure continuous controlled administration of life supporting drugs intravenously like inotropic drugs, anticoagulant, chemotherapy medication etc. The pumps are controlled by microcomputer equipped with comprehensive alarm system.

Temporary pacemaker is a pulse generator used in the management of cardiac arrhythmias (For details please refer to “Care of patient with atrio-ventricular disorder”).

Ventilator is a device that provides artificial respiration. (For details please refer to “Care of patient on ventilator”).

Maintenance of equipment

All devices with rechargeable battery should be kept charged even when it is not in use. No fluid should be poured over the syringe pump because it may produce electric short circuit. If any irregularity is detected in functioning, stop immediately and contact BME personnel. Check daily, whether the device is functioning normally. It needs periodical check up by the BME personnel also. Avoid direct sunlight, humidity, corrosive materials and extreme temperatures to all electronic and electric devices.

Avoid wetting the electrical connectors. The cardiograph can be damaged, if plugged into power socket with incorrect voltage. It can be set to operate at nominal voltages at 115 or 230 Volts. Probe of the pulse oxymeter is kept in its box. Do not twist the connector while attaching the probe. Keep the pacemaker in a separate box in switch off position with its leads. Check the charging of the battery frequently. Do not soak or immerse the system in any liquid.Keep the system always dry. Do not autoclave, pressure sterilize or gas sterilize. Periodical servicing is required for all equipment.

All equipments after use should be thoroughly cleaned and dried before replacing. Do not use strong disinfectant/ solvents or abrasive material for cleaning. Do not autoclave the electrical cable or immerse it in any disinfectant. If any fluid is spilt on the equipment, clean immediately with gauze and keep it dry. Clean the electrode jelly in the defibrillator paddles with gauze after the use, dry and keep it in the place provided for the paddles. The outside surface of the cardiograph and its accessories are to be cleaned with mild soap and water or isopropyl alcohol. Patient cable should not be cleaned with Isopropyl alcohol. Use weak soap solution to clean monitors and ECG leads. Follow manufacturer's instructions in cleaning and troubleshooting of all equipment.

CONCLUSION

The machine alone cannot save the life of the patient. The timely intervention of medical professionals, the maintenance of the equipment by the technicians and the meticulous monitoring and patient care by the nursing staff are crucially important factors which determine the  health of the patients.

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