MICU Nurses, input please

[ckh23, BSN, RN]

I work in a community hospital ICU and am I considering applying for a MICU position in a large teaching hospital. What kind of patients do you guys see in the MICU? What kind of hemodynamic monitoring? What kind of drips? etc.

[sunnycalifRN]

I work in a medical/surgical ICU, but I'll just mention the types of medical patients. Lots of sepsis, respiratory failure, DKA, pneumonia, chronic kidney disease, liver failure, EtOH withdrawal, infected wounds, and GI bleeds . . . I'm sure I forgot a few. Types of hemodynamic monitoring, everyone gets an art line, and a central line; occasionally, a PA cath.

[detroitdano]

I work in one of the largest teaching hospitals in the state, we are also one of two hospitals in the state that can transplant any organ so we get a ton of stuff.

Tons of sepsis, DKA, drug overdoses, liver/kidney failure/rejections, GI bleeds, hypertensive crisis, pulmonary hypertension, transplant workups, hemo/pneumothorax, just to name a few.

Unless someone is septic or on long-term antibiotics, they usually don't get a central line. If they have a poopy BP or need frequent vent changes/ABG draws, they get an arterial line. Septic patients that have an MI, or pulmonary hypertension patients, are usually the only ones that get Swans. Even then they're usually out within a few days once we stop doing stuff with the numbers.

We use non-invasive items such as the Vigileo and SvO2 monitors quite a bit.

I've seen the Blakemore tube come out a few times but typically by the time we have it set up the patient is dead. If you need one your prognosis probably isn't that great.

Most common drips are Levo and Lasix, and every now and then we see Neo, Flolan, BP/rate control drips like Nipride, Cardizem, and Esmolol. Most everyone that's vented is on Fentanyl and Versed titrating to a MAAS score, occasionally Propofol if the Versed isn't touching them. Very rarely we use Nimbex.

We end up with a LOT of people that just camp out, trach'd, PEG'd, simply because we can't chase down a high WBC count or cause of fever. It gets annoying, as they only stay longer and get more infections or complications. I feel really bad for these folks, but we're kind of the be-all/end-all for these patients, they can't go to any higher level of care, as our hospital is the flagship within the system.

[meandragonbrett]

MICU=Sepsis, Pneumonia, CHFers, COPDers, GI Bleeders, DKA, HHNK, Altered Mental Status, MI (when CV is full), post-op surgical patients when SI is full.

Lots of MICUs tend to be over flow for other specialty ICUs when they're full.

You're likely to see: Dopamine, Dobutamine, Neo, Levo, Epi, Lasix, Bumex, THAM, Bicarb, Insulin, Nexium, Fentanyl, Versed, Propofol/Propoven, Precedex, Cistracurium/Atracurium, Xigris, Heparin

Probably the occasional swan, a-line, CVP, rotoprone/rotorest. etc

[edogs334]

What others have said, plus we get a fair number of neuro patients in my unit- because the Neuro ICU in my hospital is regularly full. Plus, we get a lot of oncology patients who are in acute crises of various kinds. Basically, we get anything under the sun that isn't surgical- and some of our patients might as well be surgical because (for example) the soft tissue service is following their nec fasc (s/p debridement). A lot of our patients are vented, but many are not on any kind of continuous sedation- only scheduled and PRN IV push. I'm a new graduate, so I could probably count the number of times I've had patients on continuous sedation with the fingers of my two hands. When patients are on continuous sedation, they are usually on Fentanyl, Versed or Propofol for a good reason- most patients I've seen on continuous sedation are REALLY, REALLY sick. They are usually vented AND sedated for airway protection, or their vital signs are so labile that any stimulation would change them significantly, or they're doing the "oscillator shuffle":eek: (among other reasons). We rarely, if ever, use paralytics (even for oscillator patients- we keep PRN Vec at the bedside in those cases), and if we do use them, we use them only PRN/temporarily for procedures (I've only seen the docs push paralytics twice).

We routinely have patients with central venous access, CVP monitoring, bladder pressure (to watch for abd compartment syndrome), and art lines. Vigileos are slightly less common- but there are always a few to several patients on our unit who have them (we hook them up to their art lines).