EP8-F - CTICU - Criteria for 1-1 and 2
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CTICU Criteria for 1:1 Nurse-Patient Ratio Transplant Heart Liver Pancreas or KidneyPancreas Hemodynamic Respiratory Renal Neurological EKG * Cardiac index < 2.0 l/min/m2 or * MAP < 60 mm Hg for four consecutive hours before next shift requiring treatment such as the following: Hourly titration of 2+ vasoactive medications for three consecutive hours or fluid boluses to maintain blood pressure before next shift * Patient requiring full hemodynamic support: Intraaortic balloon pump or Extracorporeal membrane oxygenation (ECMO) As above or * Patient with hemoglobin < 7 g/dl requiring transfusion of six or more transfusions of blood in previous shift * Patient requiring full support mechanical ventilation: Assist Control or SIMV with rates > 6/min * ABG: PaO2 < 70 mm Hg or SaO2 < 90% for three consecutive hours before next shift * FiO2 > 0.6 for four consecutive hours while intubated * Suctioning > 2x/hr for three consecutive hours before next shift * Ventilatory failure requiring Rotoprone bed As above *Continuous renal replacement therapy requiring hourly adjustment of fluid volume status *Cerebral perfusion pressure < 60 or > 100 mm Hg AND pharmacologic management *Ventricular fibrillation or ventricular tachycardia within 24 hours * Keep 1:1 for 48 hours * Bleeding from chest tubes > 100 ml/hr for three consecutive hours before next shift * Open chest * Aquadex therapy As above As above As above As above As above As above As above As above Keep 1:1 for 10 hours or until extubated (whichever is less) * Bleeding from JP > 50 ml/hr for three consecutive hours * Can be doubled out of OR (See hemodynamic) * 1:1 next morning for Nuclear Med Scan (for 4 hours) Vasoactive medications: Neosynephrine, Epinephrine, Norepinephrine, Dopamine (greater than 5 mcg/kg/min), Dobutamine, Vasopressin Any patient who is having organs donated for Gift of Hope is 1:1 * = criteria for 1:1 Nurse to patient ratio Miscellaneous CTICU Criteria for 1:1 Nurse-Patient Ratio Cardiac CABG, Valve replacement, DOR procedure, Maze procedure Ventricular Assist Device implant Thoracic surgery Pneumonectomy, thoracotomy, esophagectomy, Hemodynamic Respiratory Renal Neurological * Cardiac index < 2.0 l/min/m2 or * MAP < 60 mm Hg for four consecutive hours before next shift requiring treatment such as the following: Hourly titration of 2+ vasoactive medications for three consecutive hours or fluid boluses to maintain blood pressure before next shift * Patient requiring full hemodynamic support: Intraaortic balloon pump or Extracorporeal membrane oxygenation (ECMO) * Patient requiring full support mechanical ventilation: Assist Control or SIMV with rates > 6/min * ABG: PaO2 < 70 mm Hg or SaO2 < 90% for three consecutive hours before next shift * FiO2 > 0.6 for four consecutive hours while intubated * Suctioning > 2x/hr for three consecutive hours before next shift * Ventilatory failure requiring Rotoprone bed As above *Continuous renal replacement therapy requiring hourly adjustment of fluid volume status *Cerebral perfusion pressure < 60 or > 100 mm Hg AND pharmacologic management *Ventricular fibrillation or ventricular tachycardia within 24 hours * Keep 1:1 for 6-10 hours or until extubated (whichever is less) * Bleeding from chest tubes > 100 ml/hr for three consecutive hours before next shift * Open Chest * Aquadex therapy As above As above Not applicable Keep 1:1 for at least 48 hours or until extubated *Open Chest As above As above As above * Patients with lumbar drains with pressures greater 10 mm Hg *Ventricular fibrillation or ventricular tachycardia within 24 hours Not normally 1:1 * Patient with hemoglobin < 7 g/dl requiring transfusion of six or more transfusions of blood products in previous shift *MAP < 60 mm Hg for four consecutive hours before next shift requiring treatment such as the following: Hourly titration of 2+ vasoactive medications for three consecutive hours or fluid boluses to maintain blood pressure before next shift * Patient with hemoglobin < 7 g/dl requiring transfusion of six or more transfusions of blood products in previous shift EKG Miscellaneous Vasoactive medications: Neosynephrine, Epinephrine, Norepinephrine, Dopamine (greater than 5 mcg/kg/min), Dobutamine, Vasopressin Any patient who is having organs donated for Gift of Hope is 1:1 * = criteria for 1:1 Nurse to patient ratio CTICU Criteria for 1:1 Nurse-Patient Ratio Thoracic surgery Abdominal aortic aneurysm repair Pre-liver transplant Fulminate liver Hemodynamic Respiratory Renal Neurological EKG *MAP < 60 mm Hg for four consecutive hours before next shift requiring treatment such as the following: Hourly titration of 2+ vasoactive medications for three consecutive hours or fluid boluses to maintain blood pressure before next shift * Patient with hemoglobin < 7 g/dl requiring transfusion of six or more transfusions of blood products in previous shift * Patient requiring full support mechanical ventilation: Assist Control or SIMV with rates > 6/min * ABG: PaO2 < 70 mm Hg or SaO2 < 90% for three consecutive hours before next shift * FiO2 > 0.6 for four consecutive hours while intubated * Suctioning > 2x/hr for three consecutive hours before next shift * Ventilatory failure requiring Rotoprone bed *Continuous renal replacement therapy *Cerebral perfusion pressure < 60 or > 100 mm Hg AND pharmacologic management * Patients with lumbar drains with pressures greater 10 mm Hg requiring hourly drainage of cerebral spinal fluid *Ventricular fibrillation or ventricular tachycardia within 24 hours *MAP < 60 mm Hg for four consecutive hours before next shift requiring treatment such as the following: Hourly titration of 2+ vasoactive medications for three consecutive hours or fluid boluses to maintain blood pressure before next shift * Patient with hemoglobin < 7 g/dl requiring transfusion of six or more transfusions of blood products in previous shift * INR greater than 4 and requiring more than 6 units of fresh frozen plasma in previous 12 hour shift As above As above * Cerebral perfusion pressure < 60 or > 100 mm Hg AND pharmacologic management to treat cerebral edema * Ammonia levels greater than 100 mcg/dl and requiring greater than every 6 hour lactulose therapy * decorticate or decerebrate posturing As above requiring hourly adjustment of fluid volume status Vasoactive medications: Neosynephrine, Epinephrine, Norepinephrine, Dopamine (greater than 5 mcg/kg/min), Dobutamine, Vasopressin Any patient who is having organs donated for Gift of Hope is 1:1 * = criteria for 1:1 Nurse to patient ratio Miscellaneous Not normally 1:1 CTICU Criteria for 2:1 Nurse-Patient Ratio Any patient immediate postoperative (within the first hour) after VAD placement or cardiac transplant Hemodynamic * Transfusion of four or more blood products (PRBC, FFP, platelets) each hour with or without use of the Level 1 rapid infuser *Bedside sternonotomy for one hour after sternonotomy * Patient bleeding more than 200 ml/hr from any source (chest tube, JP) * Active titration or starting of vasoactive drugs- every 15 minutes, or more frequently until medications take effect (i.e., MAP > 60 mm Hg) Respiratory Renal Neurological * Neurological deterioration (alert to obtunded or alert to comatose) requiring either drug titration at least every 15 minutes, or bedside craniotomy EKG * Ventricular fibrillation or ventricular tachycardia within 1 hour of arrhythmia Miscellaneous Flexing Staff Every 4 hours assess staffing needs Anticipated ORs, pts. off unit for procedures/exams, or on unit procedures, for example MRI External transfers Patients ready to move ICU bed availability ICU staffing needs Look at unit staffing needs for current (patients here and patients that will be here in the next few hours while also considering the patients that are RTM) patient needs Flex staff down or up to meet the needs of our patients Place staff on stand by or cancel if you will not need them the entire 12 hour shift Utilize stand by staff when the needs arise—admissions, transfers, acuity changes
