6. Annex A: Proposed procedures in detail
Imaging carried out away from the bedside (x-ray, ultrasound, transthoracic echocardiography and CT/MRI scan)
88. Most x-rays on patients in intensive care are carried out at the bedside using portable units, and will not require transfer to a radiology department. X-rays are used to image a part of the body (usually the lungs or bones) and involve moving a body part to allow a radiographic plate to lie under the area, to allow the image to be captured.
89. Ultrasound can be carried out either at the bedside or in a radiology department. The procedure is commonly used to image areas of soft tissue. The procedure involves exposing the area to be imaged, ultrasound jelly being placed on the skin and the use of a probe to send ultrasonic waves to image the body part. An image is displayed on a monitor to allow diagnostic information to be viewed. A transthoracic echocardiogram is a type of ultrasound imaging technique.
90. For an MRI or CT scan, the patient is transported from the ICU on their bed to the radiology department. The patient will be transferred onto a set of mobile equipment to allow their treatment and monitoring to be continued while they are out of the ICU. They will remain sedated and kept comfortable during this process. While in the radiology department, the patient will be moved on to the scanner table and will have the scan performed. During the scan, it is sometimes necessary to inject dye to identify structures within the body. This dye in administered via a drip already placed in the patient. Occasionally it may be necessary to insert a drip for the purposes of the scan. At the end of the scan, the patient is transferred back onto their bed and taken back to the ICU.
91. The procedure is carried out without moving the patient and the patient is kept comfortable during the procedure. As part of the routine care of the patient in the ICU, they will already have a breathing tube inserted into their trachea to facilitate ventilation. A fine camera (bronchoscope) is passed down this breathing tube to allow visual inspection of the lungs. If secretions are present, these are removed via the bronchoscope. Samples of these secretion may be sent to a laboratory for analysis, to look for infection or malignancy.
92. The area to be biopsied will be identified and cleaned to ensure sterility. Local anaesthetic will be injected to the area and an incision will be made, not usually larger than 2cm. A dressing is applied at the end of the procedure. This may be carried out, for example, on a skin lesion to check for malignancy. The tissue is sent to a laboratory for analysis to provide relevant diagnostic information.
Scraping or swabbing of a body orifice (other than mouth, nostril or ear canal)
93. To swab an area, a swab (much like a cotton bud) is rubbed over the area to be sampled. This allows cells or secretions requiring sampling to attach to the swab to later be analysed in the laboratory. Scraping an area involves using an instrument specifically designed for this purpose to scrape off cells or layers of skin to later be analysed in the lab. The primary reason for doing these procedures would be to look for either malignant cells or infection.