Crash cart is a lifesaving trolley which contains essential medicines, instruments and equipment that can be used to save life of a patient (or a person), in case of medical emergency such as heart attack. In hospital there is always a risk of a patient undergoing cardiac arrest and hence it is important to have crash cart trolleys stationed at appropriate places for the code blue team to use it on the patient, whenever required. (Code blue team is a dedicated trained team of doctors and nurses, who can perform basic and advanced life support function on patient who has undergone a cardiac arrest).
In-order to ensure that crash
cart is usable whenever required some policies and practices needs to be put
into place. It is also important that crash cart contains all things that may
be required during a medical emergency. The checklist below can be used for
this purpose.
Checklist of items in crash cart (Source: UC DAVIS Health System, Centre for professional Practices of Nursing)
Top Basket
Adult BVM with Adult Large & Medium Masks
Pediatric BVM with #2, 3, 4 Masks
5 in1 Connector & 02 Tubing
Bottom Basket
Large Gloves
Defibrillator Pads
Adult Multi-function Electrodes
Pediatric Multi-function Electrodes
Surgical Cone Mask
Right side of
the cart
Sharp container
First Drawer –
Medications
Amiodarone 150 mg/3ml vial
Atropine 1mg/10 ml syringe
Calcium Chloride 1gm/10 ml syringe
Dextrose 50% 0.5 mg/ml 50 ml syringe
Dopamine 400 mg/250 ml IV bag
Epinephrine 1 mg/10 ml (1:10,000) syringe
Lidocaine 100 mg 5ml syringes
Lidocaine 2 gm/250 ml IV bag
Sodium Bicarbonate 50mEq/50 ml syringe
Sodium Chloride 0.9% 10 ml vial
Sterile Water Inj. 20 ml vial
Vasopressin 20 units/ml 1 ml vial
Povidone-Iodine Swabstick
Alcohol Swabs
Pharmacy Pre-printed Labels
Blank Labels
Drawer 2 – IV
solutions and paediatric medications
Atropine 0.5 mg/ 5 ml syringe
Sodium Bicarbonate 10 mEq/10 ml (8.4%) syringe
Saline Flush Syringes
Sodium Chloride 0.9% 10 ml flush syringe
Sodium Chloride 0.9% 100 ml IV bag
Dextrose 5% 250 ml IV bag
Sodium Chloride 0.9% 1000 ml IV bag
Drawer 3 –
Adult Intubation Supplies
Adult Microcuff ET Tube (6.0, 7.0, 8.0 and 9.0)
Black Locks
Twill Tape
Lubafax
Bite Block
Nasopharyngeal Airways, Size 26 Fr, 30 Fr, 32 Fr
Batteries: Size C & D
Tongue Depressor
Kelly Clamp with Rubber Tip
Adult Stylet 14 Fr
CO2 Colorimetric Indicator
Flashlight with Batteries
35 cc Syringe (LL)
Magill Forceps (Adult)
Laryngoscope Blade
Laryngoscope Handle
Airway (Plastic) Size 90 mm, 100 mm
Drawer 4 – Paediatric
Intubation Supplies
2.5 mm Uncuffed ET Tube
Microcuff ET Tube (3.0, 3.5, 4.0, 4.5 & 5.5)
Stylet (8 Fr and 6 Fr)
Laryngoscope Blades
Disposable Miller Blade
Disposable Macintosh Blade
Batteries, size AA
Laryngoscope Handle, Small
Magill Forceps (Pediatric)
Airway Size 40 mm, 60 mm
Nasopharyngeal Airways, Size 12 Fr, 14 Fr, 16 Fr, 20 Fr
Huggable ECG Electrode
BP Cuff with Sphygmomanometer & BP Bulb
Armboards (3" x 1", 3" x 2" & 5' x
2")
BD Vacutainers Push Button Blood Collection Set
Spinal Needle
Skin Protectant Swabstick
Infant Feeding Tube, 5 Fr
Umbilical Vessel Catheter 5 Fr
Suction Catheter Kit (6, 8, 10, 12 Fr Kits)
Drawer 5 – IV
Start supplies
IV Start Kit
Angiocath. 14 G 5.25” 2.1 x 133 mm
Bifuse 4” Ext. Set with MicroClave Connectors
T-Connector Extension Set 6”
10 cc luer lock syringe or 12 cc luer lock syringe
12 cc 20 G x 1½ " with needle
6 cc luer lock syringe
3 cc luer lock syringe
1 cc luer lock syringe
1 ml 25 G 5/8" Syringe (TB)
Tourniquet Tubing 1"
Insyte Autoguard 14 G 1.75in 2.1 x 45 mm
Insyte Autoguard 16 G 1.16in 1.7 x 30 mm
Insyte Autoguard 18 G 1.16in 1.3 x 30 mm
Insyte Autoguard 20 G 1.16in 1.1 x 30 mm
Spinal Needle (18 G x 3½”)
Vacutainers
Cannula
3-Way Stopcock
Dual Luer Lock Cap
Smallbore 7” Ext. Set with MicroClave Connector
MicroClave Clear Connector
Drawer 6 – IV
Supplies and tubings
30 ml or 35 ml Syringe luer lock
20 ml Syringe luer lock
60 cc Catheter Tip Syringe
3 cc Portex Pro-Vent Arterial Blood Sampling Kit
3 cc ABG Syringe Line draw
Adult Armboard
Betadine solution 4 oz
Betadine Prep Pads
Adhesive Tape 1"
Buretrol Add-on-Set
Continu-Flo Solution Set
Continu-Flo Solution Set
Clear Cuff
Multi-lumen
Drawer 7 –
Procedure Trays
ECG Electrodes
Surgeon's Gloves- Sizes 6, 6½, 7, 7½, 8
Surgeon's Gloves- Sizes 6, 6½, 7, 7½, 8
Sutures 3.0 Silk & 3.0 Dermalon
Disp. Needle Holder
Yankauer Suction
Sterile Field
Suction Cath Kit 14 Fr & 18 Fr
Sump 12 Fr, 14 Fr & 16 Fr
10 cc or 12 cc Syringe
10 cc or 12 cc Syringe
Adult Cut Down Pack
Adult Cut Down Pack
Crico Pack
Maintaining crash cart: It is important that the items listed in
the checklist above is available in crash cart all the time. For this purpose,
hospital should have a policy of not
using crash cart medicines or other items for routine patient care purpose.
Also, whenever the crash cart has been used for handling emergency, the used
items should be replenished immediately after that. Hospital should designate a
person to ensure that the crash cart contains all required items and is
replenished whenever used. Periodically the medicines should also be checked
for its expiry date and replaced if required.
Some hospitals seal the crash
cart with a plastic wrap, to prevent its use in routine cases. This is however
not recommended, as it can just increase the time to access its materials in
case of emergency. A small paper tape on edges of drawer can be put which doesn’t
restrict its opening, but tears off, letting others know that the crash cart
was opened.
A copy of checklist should be
kept on the crash cart for monitoring purpose
Number and locations of crash cart: There is no standard
recommendation on how many crash cart to be maintained in a hospital or where
to station the cart. The general principle is that crash cart should be easily
available to all patient care areas and it should not take more that 30-45
seconds to bring crash cart near the patient's bed, where it has to be used. Hence,
depending upon the layout of the hospital, number of crash cart should be
procured. If the wards are big, one crash cart should be kept in every ward. In
floor wise arrangement, one or two crash cart can be kept on each floor
depending upon how big the floor is. One dedicated crash cart should be kept in
areas like emergency, blood donation room, imaging department, day care and OPD
areas.
In case it is difficult to cover
all areas by crash cart, a crash bag can be kept with the code blue team, which
contains some basic essential items out of the list, which they can start using
on patient by the time crash cart is brought in.
Staff training: While code blue team is the main user of crash
cart, all healthcare staff should know about it and should be able to perform
at-least basic life support activities. Policies and procedure of maintaining
crash cart should be known to all.
