NEONATAL INTENSIVE CARE UNIT (NICU)

STAFFING PATTERN OF PICU

1. Medical director/consultant in-charge
The medical director or consultant in- Age should have special training and
experience in the care of critically ill children ding advance skill in monitoring
and life support techniques.
He/she must be available full time for clinical, administrative and
educational ties of the unit.
These activities include following:
- Supervision
- Regular care
- Resuscitation
- Life support measures to all patients
- Quality control and appropriateness of care.
- Co-ordination of multiple subspecialty services.
- Maintenance
- Condemnation and replacement of equipment’s.
- Organization of educational and research activities.
- Staff development and improvement on standard of care.
- Collection of statistical data necessary for evaluation of the unit
effectiveness.
- Implementation of policies and procedures.
It is desirable that the PICU consultant maintains regular participation in
continuing programme in the field.

2. House Staff (Residents)

Twenty hours presence of a qualified doctor in the PICU is necessary. The
doctor should be exclusively designated for the PICU and should e covering
other areas such as the emergency department or other wards
mutinously.
 He must be trained in cardio-pulmonary resuscitation and intubations.

3. Nurses :
Nurses are the most important staff in any PICU for actual delivery of
care. It is essential t6 have high quality, specially trained nurses to
provide 24 hours coverage.
- A kit containing education programme for nurses must be developed
within the unit.
- A common problem in our hospital is frequent change of nursing staff
that should be avoided.
- The in charge of PICU must take up the issues with the concerned
administrative authority to ensure undisturbed availability of trained and
experienced nurses.
- The ideal nurse patient ratio is 1:1, the minimum is one nurse per three
patients in the unit at all times.
- The nurse should have basic understanding of commonly emergency
clinical, condition and should be trained in Resuscitation techniques,
electronic monitoring and use of PICU equipment.

The nurse should be able to recognize and interpret changes in patient

monitoring date, and results of common laboratory samples, perform
venipuncture’s to obtain blood

- Establish an IV lines.
- Administer drugs and parental fluids.
- It is helpful to have protocol for nursing care.
4. Respiratory therapists :-
A person trained in respiratory, care with knowledge ventilation equipment
and basic life support has become an important part of PICU team in the developed
countries.

5. Other staff
- A biomedical and a laboratory technician
- A unit of clerk to handle patient and administrative paper work
- Physiotherapist
- Nutritionist
- A social worker

EQUIPMENT NEEDED FOR PICU

Equipment required for any pediatric intensive care unit and quantity required 6
patient beds:-
- Open care system -4
- Resuscitation set -6
- Positive pressure ventilators -6
- Infusion pump 5-12
- Electronic weighing scale 1-2
- 0, hood, 02 Analysis -6
- Heart rate apnea monitor with scope-6
- Transcutaneous P02 and PCO2 monitors-2-3. Pulse oximeter-6
- Intracranial pressure monitors-1
- ECG monitor without defibrillator4
- Invasive B.P. monitors -1-2.
- Noninvasive B.P. monitors -1-2.
Disposable articles :- Required disposable articles for PICU are Intravenous
catheter

- Intravenous sets
- Bacterial filters.
- Feeding tubes
- Endotracheal tubes
- Suction catheters
- Three way4doptors
- umbilical arterial and venous catheters.
- syringes
- needles
- ventilator tubings,
- trocar and canula
- pressure transducers for invasive blood pressure.

SERVICES THAT SHOULD BE AVAILABLE IN PICU

A. monitoring services
1. cardiac and haemodynamic devices
 heart rate and rhythm ECG
 blood pressure
 CVP and pulmonary artery pressure
 Cardiac output.

2. Respiratory functions
 Respiratory rate.
 Oxygen saturation of Hb(Sa02).
 -Blood gases
 Inspired oxygen and end tidal CO,.
  Monitoring for ventilated children
3. Temperature
4. Cerebral functions
 Intracranial pressure
 electroencephalogram
 cerebral blood flow.
B. Therapeutic or Diagnostic Services
 Emergency resuscitation
 respiratory support.
 cardiac support
 Defibrillation;
Temporary cardiac
pacing.
5. Infusion pumps and pressure infusion devices.
6. dialysis peritoneal/ Hemodialysis.
 Supportive services for PICU
 Radio diagnosis and imaging facility.
 24 hours coverage for portable x-rays of chest, abdomen
 Ultra sound,
 CT. scan.
 ECHO
 Angiography, lung scan.

2. Laboratory services:-. 24 hours availability

 Hematocrit, Hb, blood units.
 Blood glucose urea and electrolytes
 Prothrombine time, platelet counts.
 Body fluid analysis (C.S.F. urinalysis)
 Arterial blood gases,
 Microbiology.
 Blood bio-chemistry
 Toxicology and drug levels measurements.
3. Centralized 02, supply, compressed air and suction facility.
4. Blood Bank services.
5. Physiotherapy and occupational therapy services.
6. Transport services: An ambulance team with a resident trained in
circulation and stabilization of critically ill patient and resuscitation,
equipment, drugs and b monitor equipment’s.

(D) Auxiliary services

 House keeping related to cleaning, HP, electrician, air conditioner
line cleaning, CSSD,
 Communication with PICU and outside through telephone, paging and
intercogn system.
 Computerized record keeping.
 Social services

EQUIPMENT MAINTENANCE AND CARE

Services of bio-medical engineer/technician should be available for
regular frequent servicing of equipment’s to keep it in good working order.

EDUCATIONAL PROGRAMMES AT PICU

 In PICU, there should be continuing education programme for physician
and nurses in the form of lectures, demonstrations, and group discussions.
 The education programme should cover, important issues like resuscitate
sterilization of critically ill children’s, putting in an arterial catheters,
conducting exchange transfusion, maintenance of ventilators etc.
 Educational programmes covering the nurses and physician in the
communication should be developed
 There should be regular meeting with the pediatricians and obstetrician to
discuss about individual high risk child
 Educational programme should be followed regularly.
 DOCTORS ROOM

NURSING STATION
NURSES ROOM
X-RAY PROCEDURE GROWING WAITING
CONFERENCE ROOM

LAB
ROOM ROOM NURSERY AREA

CLEANING
FORMULA ROOM

ROOM-1 ROOM-2 ROOM-3

FUMIGATION CHAMBER
STORE ROOM

ROOM-4
ROOM-5 ROOM-6
SCRUB

Fig: layout map of a 6-room pediatric intensive care unit