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[머리말]

본 매뉴얼은 미국 중환자간호협회에서 발간한 'Procedure Manual for Critical Care'5판을 근간으로 준비한 것으로 필요한 최신 임상 수기술 및 간호동향을 추가하였다. 3권은 신경계, 소화계 관련 내용을 담아 중환자간호사들에게 직접적으로 도움을 줄 수 있는 자료를 담았다.

UNIT 1 Pulmonary System _ 1
SECTION 1
Airway Management_1
1 Combitube Insertion and Removal _ 1
2 Endotracheal Intubation(perform) _ 9
3 Endotracheal Intubation(Assist) _ 23
4 Endotracheal Tube and Oral care _ 32
5 Extubation/Decannulation(Perform) _ 39
6 Extubation/Decannulation(Assist) _ 44
7 Laryngeal Mask Airway _ 49
8 Nasopharyngeal Airway Insertion _ 62
9 Oropharyngeal Airway Insertion _ 67
10 Suctioning：Endotracheal or Tracheostomy Tube _ 73
11 Tracheal Tube Cuff Care _ 83
12 Tracheostomy Tube Care_ 93
SECTION 2
Special Pulmonary Procedures _ 103
13 Continuous End-Tidal Carbon Dioxide Monitoring _ 103
14 Continuous Mixed Venous Oxygen Saturation Monitoring _ 111
15 Oxygen Saturation Monitoring by Pulse Oximetry _ 119
16 Pronation Therapy _ 127
SECTION 3
Thoracic Cavity Management _ 142
17 Autotransfusion _ 142
18 Chest Tube Placement(Perform) _ 147
19 Chest Tube Placement(Assist) _ 157
20 Chest Tube Removal(Perform) _ 164
21 Chest Tube Removal(Assist) _ 172
22 Closed Chest Drainage System _ 179
23 Needle Thoracostomy(Perform) _ 201
24 Thoracentesis(Perform) _ 206
25 Thoracentesis(Assist) _ 214
SECTION 4
Ventilatory Management _ 220
26 Arterial-Venous Oxygen Difference Calculation _ 220
27 Auto-PEEP Calculation _ 224
28 Compliance and Resistance Measurement _ 229
29 Manual Self-Inflating Resuscitation Bag _ 233
30 Indices of Oxygenation _ 242
31 Shunt Calculation _ 246
32 Ventilatory Management-Volume and Pressure Modes _ 251
33 Weaning Criteria-Negative Inspiratory Pressure, Positive End-Expiratory Pressure,
Spontaneous Tidal Volume, and Vital Capacity Measurement _ 269
34 Weaning Procedure_ 275


UNIT 2 Cardiovascular System _ 290
SECTION 5
Cardiac Emergencies _ 290
35 Automated External Defibrillation _ 290
36 Cardioversion _ 298
37 Defibrillation(External) _ 310
38 Defibrillation(Internal) _ 319
39 Emergent Open Sternotomy(Perform) _ 325
40 Emergent Open Sternotomy(Assist) _ 331
41 Pericardiocentesis(Perform) _ 336
42 Pericardiocentesis(Assist) _ 344
SECTION 6
Cardiac Pacemakers _ 351
43 Atrial Electrogram _ 351
44 Atrial Overdrive Pacing (perform) _ 361
45 Epicardial Pacing Wire Removal _ 369
46 Implantable Cardioverter-Defibrillator _ 373
47 Permanent Pacemaker (Assessing Function) _ 385
48 Temporary Transcutaneous(External) Pacing _ 396
49 Temporary Transvenous Pacemaker Insertion(Perform) _ 404
50 Temporary Transvenous and Epicardial Pacing _ 413
SECTION 7
Circulatory Assist Devices _ 428
51 Intraaortic Balloon Pump Management _ 428
52 External Counterpressure with Pneumatic Antishock Garments _ 450
53 Ventricular Assist Devices _ 457
SECTION 8
Electrocardiographic Leads and Cardiac Monitoring _ 487
54 Electrophysiologic Monitoring：Hardwire and Telemetry _ 487
55 Extra Electrocardiographic Leads：Right Precordial and Left Posterior
Leads _ 499
56 Continuous ST-Segment Monitoring _ 510
57 Twelve-Lead Electrocardiogram _ 520
SECTION 9
Hemodynamic Monitoring _ 529
58 Arterial Catheter Insertion (Perform) _ 529
59 Arterial Catheter Insertion(Assist), Care and Removal _ 536
60 Blood Sampling from an Arterial Catheter _ 552
61 Blood Sampling From Central Venous Catheters _ 560
62 Blood Sampling From a Pulmonary Artery Catheter _ 565
63 Cardiac Output Measurement Techniques(Invasive) _ 572
64 Central Venous Catheter Removal _ 590
65 Central Venous Catheter Site Care _ 595
66 Central Venous/Right Atrial Pressure Monitoring _ 599
67 Esophageal Doppler Monitoring of Aortic Blood Flow：Probe Insertion _ 608
68 Esophageal Doppler Monitoring of Aortic Blood Flow：Care and Removal _ 615
69 Left Atrial Catheter：Care and Assisting With Removal _ 621
70 Noninvasive Hemodynamic Monitoring： Impedance Cardiography _ 629
71 Pulmonary Artery Catheter Insertion(Perform) _ 641
72 Pulmonary Artery Catheter Insertion(Assist) and Pressure Monitoring _ 650
73 Pulmonary Artery Cathter Removal _ 673
74 Pulmonary Artery Catheter and Pressure Lines, Troubleshooting _ 680
75 Single-and Multiple-Pressure Transducer Systems _ 697
SECTION 10
Special Cardiac Procedures _ 710
76 Arterial and Venous Sheath Removal _ 710
77 Pericardial Catheter Management _ 718
78 Transesophageal Echocardiography(Assist) _ 731
SECTION 11
Vascular Access _ 740
79 Arterial Puncture _ 740
80 Central Venous Catheter Insertion(perform) _ 749
81 Central Venous Catheter Insertion(Assist) _ 764
82 Implantable Venous Access Device：Access, Deaccess, and Care _ 775
83 Peripheral Intravenous Catheter Insertion _ 786
84 Peripherally Inserted Central Catheter _ 798
85 Venipuncture _ 811


UNIT 3 Neurologic System _ 821
SECTION 12
Neurologic Monitoring _ 821
86 Bispectral Index Monitoring _ 821
87 Brain Tissue Oxygen Monitoring : Insertion(Assist), Care, and Troubleshooting
_ 836
88 Intracranial Bolt insertion(Assist), Monitoring, Care,
Troubleshooting, and Removal _ 846
89 Intraventricular Catheter Insertion(Assist), Monitoring, Care, Troubleshooting and
Removal _ 858

90 Jugular Venous Oxygen Saturation Monitoring：Insertion(Assist),
Care, Troubleshooting, and Removal _ 868
91 Lumbar Subarachnoid Catheter Insertion(Assist)
for Cerebral Spinal Fluid Pressure Monitoring and Drainage _ 879
92 Neurologic Drainage and Pressure Monitoring System _ 888
93 Transcranial Doppler Monitoring _ 903

SECTION 13
Special Neurologic Procedures _ 916
94 Cerebrospinal Fluid Drainage Assessment _ 916
95 External Warming/Cooling Devices _ 920
96 Ice-water Caloric Testing for Vestibular Function(assist) _ 929
97 Lumbar Puncture (perform) _ 934
98 Lumbar and Cisternal Punctures (Assist) _ 942
SECTION 14
Traction Management _ 949
99 External Fixation Device Insertion(Assist) _ 949
100 Halo Traction Care _ 955
101 Tong and Halo Pin Site care _ 963
102 Traction Maintenance _ 967
SECTION 15
Pain Management _ 974
103 Epidural Catheters ：Assisting With Insertion and Pain Management _ 974
104 Peripheral Nerve Stimulators _ 986
105 Patient-Controlled Analgesia _ 996
106 Peripheral Nerve Blocks (Assist) _ 1004


UNIT 4 Gastrointestinal System _ 1015
SECTION 16
Special Gastrointestinal Procedures _ 1015
107 Esophagogastric Tamponade Tube _ 1015
108 Gastric Lavage in Hemorrhage and Overdose _ 1025
109 Monitoring Gastrointestinal Perfusion With a Gastric Tonometer _ 1034
110 Intraabdominal Pressure Monitoring _ 1049
111 Nasogastric Tube Insertion, Care, and Removal _ 1057
112 Paracentesis (Perform) _ 1067
113 Paracentesis (Assist) _ 1075
114 Peritoneal Lavage (Perform) _ 1081
115 Peritoneal Lavage (Assist) _ 1090
116 Scleral Endoscopic Therapy _ 1098


UNIT 5 Renal System _ 1105
SECTION 17
Renal Replacement _ 1105
117 Continuous Renal Replacement Therapies _ 1105
118 Hemodialysis _ 1133
119 Peritoneal Dialysis _ 1151
SECTION 18
Special Renal Procedures _ 1162
120 Apheresis, Plasmapheresis , and Plasma Exchange (Assist) _ 1162


UNIT 6 Hematologic System _ 1171
SECTION 19
Fluid Management _ 1171
121 Blood and Blood Component Administration _ 1171
122 Blood Pump Use _ 1183
123 Continuous Arteriovenous Rewarming _ 1187
124 Massive infusion devices _ 1199
125 Transfusion Reaction Management _ 1211
SECTION 20
Special Hematologic Procedures _ 1218
126 Bone Marrow Biopsy and Aspiration(Perform) _ 1218
127 Bone Marrow Biopsy and Aspiration(Assist) _ 1225
128 Determination of Microhematocrit via Centrifuge _ 1231


UNIT 7 Integumentary System _ 1237
SECTION 21
Burn Wound Management _ 1237
129 Donor Site Care _ 1237
130 Burn Wound Care _ 1245
131 Skin Graft Care _ 1260
SECTION 22
Special Integumentary Procedures _ 1270
132 Intracompartmental Pressure Monitoring _ 1270
133 Pressure-Reducing Devices：Lateral Rotation Therapy _ 1281
134 wound closure _ 1289
135 Suture Removal _ 1302
SECTION 23
Wound Management _ 1308
136 Cleaning , Irrigating , Culturing , and Dressing an Open Wound _ 1308
137 Debridement ：Pressure Ulcers, Burns, and Wounds _ 1319
138 Dressing Wounds With Drains _ 1327
139 Drain Removal _ 1333
140 Pouching a Wound _ 1337

141 Vacuum-Assisted ClosureTM (V.A.C.)£ó System for Wounds _ 1342


UNIT 8 Nutrition _ 1358
142 Enteral Nutrition _ 1358
143 Parenteral Nutrition _ 1368
144 Percutaneous Endoscopic Gastrostomy( PEG ), Gastrostomy,
or jejunostomy Tube Care _ 1377
145 Small-Bore Feeding Tube Insertion and Care _ 1382


UNIT 9 End of Life _ 1387
146 Advance Directives _ 1387
147 Determination of Death _ 1394
148 Care of the Organ Donor _ 1404
149 Identification of Potential Organ Donors _ 1409
150 Request for Organ Donation _ 1414
151 Non-Heart-Beating Organ Donation (Donation After Cardiac Death) _ 1419
152 Withholding and Withdrawing Life-Sustaining Therapy _ 1426


UNIT 10 Calculating Medication Doses _ 1433
153 Calculating Doses, Flow Rates, and Administration Of
Continuous Intravenous Infusions _ 1433