Introduction
Crash cart is a specially designed trolley, used for transporting and dispensing medicines and equipment located in areas of life-threatening occurrence used for lifesaving measures. All the healthcare professionals must be familiar with the contents of this cart.
Definition
An emergency trolley or crash cart or code cart (crash trolley) is a set of trays/drawers/shelves on wheels used in hospitals for transportation and dispensing of emergency medication/ equipment at the site of medical/surgical emergency with life support protocols (ACLS/ALS) to potentially save someone’s life.
Purposes
- To enhance the efficacy of Code Blue team’s response to the patient with medical or surgical emergency.
- To provide immediate access to supplies and medications in lifesaving measures.
- To save the time in emergency situations.
- To provide systematic care to the patient.
Indications
- Medical emergency.
- Surgical emergency.
Types of Crash Cart
- Adult emergency crash cart.
- Pediatric emergency crash cart.
- Newborn intensive care crash cart.
Setting up or evaluating procedure trolleys in the ICU:
1. Customization for ICU Procedures
- Procedure-Specific Kits: The contents should be customized to the most common ICU procedures. This might include central line insertion kits, arterial line placement tools, wound care supplies, and other equipment necessary for minor invasive procedures.
- Sterile Versus Non-Sterile Items: Often, the trolley will have designated compartments separating sterile supplies from non-sterile ones to help maintain asepsis during procedures.
2. Organization and Layout
- Systematic Arrangement: A logical, standardized layout is crucial. Items should be arranged methodically, ensuring that healthcare providers can quickly locate equipment under stress.
- Clear Labeling: All drawers, bins, and compartments should be clearly labeled. This fosters consistency across the ICU, reducing confusion and the risk of delays in emergency situations.
3. Mobility and Ergonomic Design
- Easy Maneuverability: Given that ICU spaces can be tight, the trolley should be lightweight, compact, and equipped with locking wheels. This ensures the trolley can be moved easily but remains secure during procedures.
- Ergonomic Features: The design should facilitate accessibility—minimizing the need for providers to bend or reach awkwardly. An ergonomic layout helps reduce staff fatigue and maintains focus on patient care.
4. Infection Control and Sterility
- Easy-to-Clean Surfaces: Materials used should withstand frequent and thorough disinfection. The trolley needs to be cleaned rigorously between procedures to prevent cross-contamination.
- Dedicated Zones: Some trolleys incorporate separate areas or covers—such as removable sterile trays—to safeguard supplies that must remain uncontaminated during patient care.
5. Integrated Features for ICU Functionality
- Accessory and Power Integration: In some designs, there are options to integrate power outlets or mounts for devices like ultrasound machines. This integration supports complex procedures that require additional technologies.
- Modular Design: Flexibility in configuration allows the trolley to adapt to various procedures. For instance, adjustable shelves or detachable components can reconfigure the trolley’s layout based on the specific need.
6. Maintenance and Regular Checks
- Inventory Management: Regular audits and restocking are critical. A checklist system can help ensure that all supplies are current and that the trolley is always ready for immediate use.
- Scheduled Maintenance: Routine testing and inspection of all components (especially any integrated electronic devices) prevent equipment failures when they matter most.
7. Standardization Across the Unit
- Uniformity: All procedure trolleys within an ICU should follow a standardized format. This consistency means that every staff member will have a predictable reference for where critical items are located, thus improving response times during urgent care.
- Staff Training: Regular training sessions on the setup and content of the trolley ensure all team members are familiar with its organization for both routine and critical procedures.
Organizing Crash Cart
| Main Items | Specific Supplies |
| Side of the cart | Oxygen cylinder, face mask, and O2 tubing. |
| Open tray on the top | Disposable syringes (2, 5, 10, 20 mL), insulin syringes, IV cannula, disposable needles, intraosseous needle, spinal needle. |
| Top: Defibrillator, inventory checklist/Code Blue sheets, clip board, code recorder, and drug calculation reference sheets | ECG leads, electrodes, conduction gel or pads, possible transcutaneous pacemaker or combination unit. |
| Bottom of crash cart | Plastic apron, intubation tray, intubation pillow, ICD set, percutaneous tracheotomy set. |
| Compartments: Airway and breathing | Oral and nasal airway, ET tube: size 5.5, 5, 4.5, and 4 (5.5-2.0 mm) stylet, laryngoscope with curved and straight blades, Magill forceps, lubricating jelly, Ambu bag, nasal cannula, venturi mask, nebulization kit, intubation tray, suction catheters, endotracheal tubes, tracheostomy tubes, inner cannula, chest tubes, Buggi stillet and laryngeal mask, HME filters. |
| Circulation | Venflon size: 146, 166, 186, 20G, and 22G, adhesive tape, syringes, needles, and adapter. IV fluids: Isolyte P, 500 mL, 0.9-45% normal saline (NS), Ringer lactate (RL), dextrose with normal saline (DNS), 25% dextrose, 5% dextrose, 10% dextrose and IV tubing, macrodrip and microdrip set, extension tubings, pressure monitoring kit, arm boards: long and short, three-way adapter, micro- and macro-blood transfusion set., ABG analysis kit, heparinized aspirators, needles, alcohol swabs, and syringes. |
| Medication drive or box | All emergency medication such as Inj. hydrocortisone, Inj. sodium bicarbonate, Inj. dexamethasone, Inj. aminophylline, Inj. dobutamine, Inj. ranitidine, Inj. Lasix, Inj. diazepam, Inj. nitroglycerine (NTG), Inj. 50% dextrose, Inj. ephedrine, Inj. 25% dextrose, Inj. dopamine, Inj. adenosine, Inj. amiodarone, Inj. epinephrine, Inj. magnesium sulfate, Inj. atropine, Inj. adrenaline, Inj. calcium gluconate, Inj. midazolam, Inj. deriphyllin, and Inj. potassium chloride (KCI). |
| Miscellaneous cupboard | Restraints, ECG electrodes, jelly, sterile gloves, torch light, masks with face shields or masks and eye protection, pressure cuff, blood collection tubes, gauze pads, IV splint gloves, kidney tray, tourniquets, spirit swab. |
| Procedure trays on bottom of cart | Scalpels with blades, dressings, drain sponge, povidone-iodine solution, suture material, cardiac needle, sterile towels, three-lumen central venous pressure catheter kit, chest tubes suction catheter, open method of intravenous line (cut down), tracheostomy, and central line insertion trays. |
Roles of a Nurse
- A staff nurse in charge of the particular ward is responsible for checking the crash cart, oxygen cylinder levels, working condition of the defibrillator, and documenting compliance on crash cart checklist.
- Emergency cart is usually checked during each shift and kept under lock when not in use. If the lock is not intact, the cart is to be checked by the unit personnel and any missing supplies must be replaced.
- Defibrillator load checks should be performed every shift with the defibrillator plugged in and unplugged.
- All carts should be opened and checked for contents once monthly and following each use. Separate indent book should be maintained.
- Sterile trays should be checked for package integrity and expiry date. Items expiring within the month should be replaced.
- The medication compartment should not be opened if it is sealed and intact.
- Laryngoscopes, number of batteries, and their working condition should be checked every day.
- Oxygen cylinders are replaced when they are empty.
- Compartments of crash carts are to be clearly labeled to identify contents.
- Special procedure trays are kept on the bottom shelf.
- Check the expiry date of medication and replace with fresh ones.
- Ensure that all the compartments are completely filled with supplies.
Special Considerations
Setting up an emergency trolley (or crash cart) requires careful organization to ensure quick access to life-saving equipment and medications. Here are some special considerations to keep in mind:
1. Standardized Organization
- Arrange items in a consistent manner across all units to avoid confusion.
- Label drawers clearly for quick identification.
- Keep frequently used items in the top drawers.
2. Essential Equipment
- Airway management tools (endotracheal tubes, laryngoscope, Ambu bag).
- Circulation support (IV fluids, syringes, defibrillator).
- Emergency medications (epinephrine, atropine, naloxone).
- Monitoring devices (BP cuff, pulse oximeter, ECG leads).
3. Accessibility & Location
- Place the trolley in a central, easily accessible area.
- Ensure it is near a power source for equipment charging.
- Keep pathways clear for rapid movement during emergencies.
4. Regular Maintenance & Checks
- Perform daily inventory checks to ensure all supplies are stocked.
- Replace expired medications immediately.
- Test electronic equipment (defibrillator, suction machine) regularly.
5. Compliance with Protocols
- Follow Advanced Cardiac Life Support (ACLS) guidelines.
- Train staff on proper usage and emergency response procedures.
- Maintain documentation of crash cart inspections.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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