Quality Standards: Acute care equipment and drug listsAuthorsResuscitation Council UKoriginally published November 2013. Last updated May 2020.
Introduction
Healthcare organisations have an obligation to provide a high-qualityresuscitation service, and to ensure that staff are trained and updated regularlyto a level of proficiency appropriate to each individual’s expected role.
As part of the quality standards for cardiopulmonary resuscitation practice andtraining this document provides lists of the minimum equipment and drugsrequired for cardiopulmonary resuscitation. These lists are categorised accordingto the clinical setting.
The equipment and drug lists on this page are in reference to the Acute Care Quality Standards.
The core standards for the provision of cardiopulmonary resuscitation across allhealthcare settings are described in the Introduction and Overview to Quality Standards.
Drug tables for cardiac arrest are highlighted in the text with the symbol !
General points
1. All clinical service providers must ensure that their staff have immediateaccess to appropriate resuscitation equipment and drugs to facilitate rapidresuscitation of the patient in cardiorespiratory arrest. The standarddefibrillator sign should be used in order to reduce delay in locating a
defibrillator in an emergency. The sign can be downloaded here.2. All settings must have a means of calling for help (e.g. landline telephone
[internal or external], mobile telephone with reliable signal, or alarm bell).3. Standardisation of the equipment used for cardiopulmonary resuscitation
(including defibrillators and emergency suction equipment), and the layoutof equipment and drugs throughout an organisation is recommended.
4. It is recognised that planning for every eventuality is complex; therefore,organisations must undertake a risk assessment to determine whatresources are required given their local circumstances. Risk factors toconsider include patient group (e.g. adults, children), incidence of cardiacarrest, training of staff, and access to expert help.
a. For example, in secondary or tertiary care specific locations mayneed special provisions (e.g. for failed intubation, tracheostomy care,cardiac arrest in pregnancy etc).b. Some settings need a wide range of equipment immediatelyavailable (e.g. resuscitation room in emergency department).Suggested options include having basic equipment (and possiblydrugs) available immediately (on a resuscitation trolley), and furtherequipment and drugs arriving with a resuscitation team (in a ‘grab-bag’), or in some settings as part of an ambulance response.c. Staff should be trained to use the available equipment according totheir expected roles.
5. Depending on the organisation, this risk assessment must be overseen by aResuscitation Committee or a designated resuscitation lead. Expert adviceshould also be sought locally from those commonly involved in resuscitation(e.g. resuscitation officers, emergency physicians, cardiac care unit staff,intensivists, anaesthetists, prehospital care physicians).
6. Resuscitation equipment should be single-patient-use and latex-free,whenever possible and appropriate. Where non-disposable equipment isused, a clear policy for decontamination after each use must be availableand must be followed.
7. Personal protective equipment (e.g. gloves, aprons, eye protection) andsharps boxes must be available, based on a local risk assessment and localpolices.
8. A reliable system of equipment checks and replacement must be in place toensure that equipment and drugs are always available for use in a cardiacarrest. The frequency of checks should be determined locally.
9. It is recommended that equipment and drugs are presented in a clear andlogical manner to enable easier use during an emergency.
10. The manufacturer’s instructions must be followed regarding use, storage,
servicing and expiry of equipment and drugs.11. Further equipment and drugs may be needed to manage other types of
emergencies that are likely to be encountered in a particular setting; thismay include:
monitoring equipment (e.g. blood pressure, pulse oximetry, 3-leadelectrocardiogram [ECG], temperature, waveform capnography),12-lead ECG recorder,difficult airway equipment (e.g. scalpel and bougie forcricothyroidotomy),near-patient tests (e.g. blood glucose, blood gas analysis).
12. A formal procurement process that includes trialling of equipment beforepurchase is recommended. Trialling of resuscitation equipment can takeplace in actual care settings or in simulated clinical scenarios.
13. The precise availability of equipment and drugs should be determinedlocally. The equipment lists include a suggestion on the immediacy withwhich equipment and drugs should be available:
a. Immediate - available for use within the first minutes ofcardiorespiratory arrest (i.e. at the start of resuscitation).b. Accessible - available for prompt use when the need is determinedby resuscitation team.
14. These lists are not exhaustive. Local experts should be consulted to ensurethat the appropriate equipment and drugs are available when they areneeded, to enable provision of high-quality attempted resuscitation.
Equipment and drug lists: adult
The equipment and drug lists in this chapter are for adult acute hospital care.
Drug tables for cardiac arrest are highlighted in the text with the symbol !
Airway and Breathing (Adult)
Acute Hospital Care - Adult
Airway and breathing
Item SuggestedAvailability Comments
Pocket mask withoxygen port Immediate According to
local policy
Oxygen maskwith reservoir Immediate
Self-inflating bagwith reservoir Immediate
Clear facemasks, sizes 3, 4,5
Immediate
Oropharyngealairways, sizes 2,3, 4
Immediate
Nasopharyngealairways, sizes 6,7 (andlubrication)
Immediate
Portable suction(battery ormanual) withYankauer suckerand soft suctioncatheters
Immediate
Airway suctionequipment.NPSA Signal.Referencenumber 1309.February 2011
Supraglotticairway devicewith syringes,lubrication andties/tapes/scissorsas appropriate
Immediate/Accessible
Choice ofdevice (e.g.laryngeal maskairway, i-gel®,laryngeal tube)and size willdepend on localpolicy and stafftraining
Item SuggestedAvailability Comments
Oxygen cylinder(with key wherenecessary)
Immediate
Oxygen tubing Immediate
Magill forceps Immediate
Stethoscope Immediate
Tracheal tubes,cuffed, sizes 6, 7,8
Immediate/Accessible
This will dependon local policyand stafftraining. Forexample, thereis notconsensus onthe role of a‘stylet’
Tracheal tubeintroducer(stylet)
Immediate/Accessible
This will dependon local policyand stafftraining. Forexample, thereis notconsensus onthe role of a‘stylet’
Item SuggestedAvailability Comments
Laryngoscopehandles (x 2) andblades (size 3and4)
Spare batteriesfor laryngoscopeand spare bulbs(if applicable)
Immediate/Accessible
This will dependon local policyand stafftraining. Forexample, thereis notconsensus onthe role of a‘stylet’
Syringes,lubrication andties/tapes/scissorsfor tracheal tube
Immediate/Accessible
This will dependon local policyand stafftraining. Forexample, thereis notconsensus onthe role of a‘stylet’
Item SuggestedAvailability Comments
Waveformcapnograph -withappropriatetubing andconnector
Immediate/Accessible
For use withsupraglotticairways ortracheal tube.NAP4 - 4thNational AuditProject of theRoyal College ofAnaesthetistsand the DifficultAirway Society,March 2011.
Standards of monitoring during anaesthesia and recovery.Association ofAnaesthetist ofGreat Britainand Ireland,2011.
EBA Recommendation for the use of Capnography. European BoardofAnaesthesiology,2011.
Circulation (Adult)
Item Suggestedavailability Comments
DefibrillatorManual and/orautomated externaldefibrillatorPacing function ifneeded
Immediate
Type ofdefibrillator,andlocationsdetermined byalocal riskassessment.Available toenable shockwithin 3minutesofcollapse.Pacingfunction isrecommendedfor cardiacunits,cardiaccatheterlaboratories,emergencydepartments,intensive careunits andoperatingtheatres. It mayalso beappropriate forother settings,and this shouldbe determinedlocally
Adhesivedefibrillator pads Immediate
Spare set ofpads alsorecommended.Pads should besuitable forexternal pacingif needed
Razor Immediate
ECG electrodes Immediate
Intravenouscannulae (selectionof sizes) and 2%chlorhexidine/alcoholwipes, tourniquetsand cannuladressings
Immediate/Accessible
Adhesive tape Immediate/Accessible
Intravenous infusionset Immediate/Accessible
0.9% sodiumchloride (1000 ml) Immediate/Accessible
Amountdepends onavailability offurther supplies
Selection of needlesand syringes Immediate/Accessible
Intra-osseousaccess device Accessible
Central venousaccess - Seldingerkit, full barrierprecautions (hat,mask, sterile gloves,gown) and skinpreparation (2%chlorhexidine /alcohol)
Accessible
Placed withultrasoundguidance,where possible
Ultrasound /echocardiography Accessible
To identify andtreat reversiblecauses ofcardiorespiratoryarrest
Item Suggestedavailability Comments
Clock/timer Accessible
Gloves, aprons,eye protection Immediate
Furtherpersonalprotectiveequipmentmay berequiredaccording tolocal policy
Nasogastric tube Accessible
Sharps containerand clinical wastebag
Immediate
Sharpscontainermust beimmediatelyavailablewhereversharps used
Large scissors Accessible
2% chlorhexidine/ alcohol wipes Accessible
Blood sampletubes Accessible
IV extension set Accessible
Types ofconnectors,ports, andcaps to bedeterminedlocally
Pressure bags forinfusion Accessible
Item Suggestedavailability Comments
Blood gas syringe Accessible
Blood glucoseanalyser withappropriate strips
Immediate/Accessible According tolocal policy
Drug labels Accessible
Guidance oncolourcoding forsyringelabels
Manual handlingequipment Accessible
According tosetting. See Guidance for safer handling during resuscitationin healthcare settings
Cardiorespiratoryarrest recordforms for patientrecords, auditforms andDNACPR forms
Accessible
Access toalgorithms,emergency drugdoses
Accessible
CARDIAC ARREST DRUGS - FIRST LINE for intravenous use !
(Adult)
Acute Hospital Care - Adult
CARDIAC ARREST DRUGS - FIRST LINE for intravenous use !
Item Suggestedavailability Comments
Adrenaline 1mg(= 10 ml1:10,000) as aprefilled syringex 3
Immediate
Number of syringesdepends on accessto further syringes.1mg needed foreach 4-5 min of CPR
Amiodarone300mg as aprefilled syringex 1
AccessibleFirst dose requiredafter 3 defibrillationattempts
CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use ! (Adult)
Acute Hospital Care - Adult
CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use !
Item Suggestedavailability Comments
Adenosine 6mgx 5 Accessible
Atropine - 1mgx 3 Accessible
Adrenaline1mg(= 10 ml1:10,000)prefilledsyringe
Accessible
Furthersyringesshould beaccessible forprolongedresuscitationattempts
Amiodarone300mg x 1 Accessible
If decision ismade to givefurther dosesof amiodarone
Calciumchloride 10 ml10% x 1
Accessible
Calciumgluconate canbe used as analternative.Note: 10 ml 10%Calciumchloride = 6.8 mmol Ca2+10 ml 10%Calciumgluconate =2.26 mmolCa2+
Item Suggestedavailability Comments
Chlorphenamine10 mg x 2 Accessible
Second-linetreatment foranaphylaxis,can also begivenintramuscularly
Hydrocortisone100 mg x 2 Accessible
Second-linetreatment foranaphylaxis,can also begivenintramuscularly
Glucose forintravenoususe
Immediate/Accessible
Volume andconcentrationaccording tolocal policy
20% lipidemulsion 500ml
Accessible
For use inareas wherelarge doses oflocalanaestheticare used forregionalblocks,according toAssociation ofAnaesthetistsGuidelines.
Lidocaine 100mg x 1 Accessible
Inclusion to bedeterminedlocally
Item Suggestedavailability Comments
Magnesiumsulphate (2 g =8 mmol) x 1
Accessible
Midazolam 5mg in 5 ml x 1 Accessible NPSA Alert
Naloxone 400microgram x 5 Accessible
Potassiumchloride Accessible
Formulation tobe determinedlocally.
Potassiumchlorideconcentratesolutions.Patient safetyalert. TheNationalPatient SafetyAgency. July2002.
Sodiumbicarbonate8.4% or 1.26%
Accessible
Volume andconcentrationaccording tolocal policy
Other drugs (Adult)
Acute Hospital Care - Adult
Adrenaline 1mg(1ml 1:1000) Immediate
First-line treatmentfor anaphylaxis - 0.5mg intramuscularinjection in adults
Aspirin 300 mgand otherantithromboticagents
AccessibleFor acute coronarysyndrome accordingto local policy
Furosemide 50mgIV x 2 Accessible
Flumazenil 0.5mgIV x 2 Accessible
Glucagon 1 mg IVx 1 Accessible
GTN spray Accessible
Ipratropiumbromide 500microgramnebules x 2 (andnebuliser device)
Accessible
Salbutamol 5mgnebules x 2 (andnebuliser device)and IVpreparationforinfusion
Accessible
0.9% sodiumchloride orHartmann’ssolution 1000 mlx2 cooled to 4°C
Accessible
For induction oftherapeutichypothermia as partof post-cardiorespiratoryarrest care
Notes and supporting information (Adult)
Notes
1. Portable monitoring and other equipment for patient transfer should bereadily available.
2. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors,anaesthetic agents, antibiotics) should be available readily, according tolocal critical care policies.
3. Keeping resuscitation drugs locked away - this problem was addressed indetail in 2005 by the Royal Pharmaceutical Society of Great Britain in arevision of the Duthie Report (1988) ‘The Safe and Secure Handling ofMedicines’. Resuscitation Council UK responded with a statement, alongwith an accompanying letter written to the CQC explaining the position.
Supporting information
1. Association of Anaesthetists of Great Britain and Ireland (AAGBI) SafetyGuideline - Interhospital Transfer. 2009. http://www.aagbi.org
2. Intensive Care Society. Guidelines for the Transport of the Critically Ill Adult(3rd Edition 2011). http://www.ics.ac.uk
3. The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus https://www.diabetes.org.uk/Documents/About%20Us/Our%20views/Care%20recs/JBDS%20hypoglycaemia%20position%20(2013).pdf
Equipment and drug lists: paediatric
The equipment and drug lists in this chapter are for paediatric acute hospitalcare.
Drug tables for cardiac arrest are highlighted in the text with the symbol !
Airway and Breathing (Paediatric)
Item Suggestedavailability Comments
Pocket mask withoxygen port -paediatric and adult
Immediate According tolocal policy
Oxygen mask withreservoir - paediatricand adult
Immediate
Self-inflating bag withreservoir - paediatricand adult
Immediate
Clear face masks, size00, 0, 1, 2, 3, 4, 5 Immediate
Oropharyngealairways, sizes 00, 0,1,2, 3, 4
Immediate
Nasopharyngealairways, sizes 4.0,4.5,5.0, 5.5, 6.0, 7.0(andlubrication)
Immediate
Uncuffedtracheal tubes ofappropriatelength may beused as analternativeaccording tolocalpolicy
Portable suction(battery or manual)with Yankauer sucker(paediatric and adult)and soft suctioncatheters, sizes 5, 6,8, 10, 12, 14
Immediate
Oxygen cylinder (withkey if necessary) Immediate
Item Suggestedavailability Comments
Oxygen tubing Immediate
Magill forceps (adultand paediatric sizes) Immediate
Stethoscope Immediate
Supraglottic airwaydevice with syringes,lubrication andties/tapes/scissors asappropriate
Accessible
Choice of deviceand size willdepend on localpolicy and stafftraining
Tracheal tubes,uncuffed sizes 2, 2.5,3, 3.5, 4, 4.5, 5, 5.5, 6
Accessible
Cuffedpaediatric tubesaccording tolocal policy
Tracheal tubes, cuffedsizes 6, 7, 8, Accessible
Croup tube (uncuffed,longer than standardtracheal tube), sizes2, 2.5, 3, 3.5
Accessible
Alternativedevices may besubstitutedaccording tolocal policy (e.g.Cole's® tubes)
Tracheal tubeintroducer (stylet)small and medium
Accessible
Intubating bougie - 5Ch & 10 Ch Accessible
Item Suggestedavailability Comments
Laryngoscope handles(x 2) and blades(sizes-straight 0, 1,curved2, 3, 4)Spare batteries forlaryngoscope andspare bulbs (ifapplicable)
Accessible
Syringes, lubricationand ties/tapes (e.g.Elastoplast® / Hypofix® /ribbon gauze/tape)and scissors
Accessible
Waveformcapnograph - withappropriate tubingand connector(battery-operated)
Accessible
NAP4 - 4thNational AuditProject of theRoyal College ofAnaesthetistsand the DifficultAirway Society,March 2011
Circulation (Paediatric)
Acute Hospital Care - Paediatric
Circulation
Item Suggestedavailability Comments
Defibrillator- Manual and/orautomatedexternaldefibrillator (AED)
Immediate
Type of defibrillator andlocations decided by a localrisk assessment. AEDs are notintended for use in infants(less than 12 months old) andthis should be considered atrisk assessment
Availability of pacing functionaccording to local policy
Adhesivedefibrillator pads -paediatric andadult sizes
Immediate
Spare set of pads alsorecommended. Pads shouldbe suitable for externalpacing if needed
ECG electrodes(paediatric &adult sizes)
Accessible
Intravenouscannulae (sizes14, 16, 18, 20,22, 24G) and 2%chlorhexidine /alcohol wipes,tourniquets anddressings
Immediate
Adhesive tape Immediate
Intravenousinfusion sets(with and withoutincorporatedburette)
Accessible
Item Suggestedavailability Comments
IV extension setwith 3-way tapsand bungs
Accessible
0.9% sodiumchloride¹ Accessible Amount depends on access to
further fluids
10% Dextrose¹ Accessible
Selection ofneedles andsyringes
Immediate
Intra-osseousaccess devicewith needlessuitable forneonates,children andadults
Immediate
Colloid solutionfor IV infusion¹ Accessible According to local policy
Central venousaccess -Seldinger kit, fullbarrierprecautions (hat,mask, sterilegloves, gown)and skinpreparation (2%chlorhexidine /alcohol)
Immediate
Sizes and type according tolocal policy. Placed withultrasound guidance, wherepossible
Item Suggestedavailability Comments
Ultrasound /echocardiography Immediate
To identify and treatreversiblecauses ofcardiorespiratoryarrest
Other items (Paediatric)
Acute Hospital Care - Paediatric
Other items
Item Suggestedavailability Comments
Clock / timer Accessible
Gloves, aprons,eye protection Immediate
Urinary catheter,sizes 6-14 Accessible
Nasogastric tube,sizes 6-14 Accessible
Sharps containerand clinical wastebag
Immediate
Sharpscontainermust beimmediatelyavailablewhereversharps areused
Large scissors Accessible
2% chlorhexidine/alcohol wipes Accessible
Blood sampletubes Accessible
Pressure bags forinfusion Accessible
Blood gas syringe Accessible
Blood glucosemonitor withappropriate strips
Immediate/Accessible
Item Suggestedavailability Comments
Drug labels Accessible Guidance onsyringelabels
Manual handlingequipment Accessible
According tosetting. See Guidance for safer handling during resuscitationin healthcare settings
Cardiorespiratoryarrest recordform for patientrecords and auditforms. DNACPRformsappropriate forchildren.
Accessible
Access toalgorithms,emergency drugdoses, paediatricdrug dosecalculators (e.g.Broselow tape)
Immediate According tolocal policy
CARDIAC ARREST DRUGS - FIRST LINE for intravenous use ! (Paediatric)
Acute Hospital Care - Paediatric
CARDIAC ARREST DRUGS - FIRST LINE for intravenous use !
Item Suggestedavailability Comments
Adrenaline 1mg(= 10 ml1:10,000)prefilledsyringe(s)¹
Immediate
Number of syringesdepends on ease ofaccess to furthersyringes if needed
Amiodarone300mg prefilledsyringe(s)¹
Accessible
CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use ! (Paediatric)
Acute Hospital Care - Paediatric
CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use !
Item Suggestedavailability Comments
Adenosine 6 mg¹ Accessible
Atropine 1mg¹ AccessibleALERT: Atropine isavailable in variousconcentrations
Adrenaline 1mg(= 10 ml1:10,000)
Accessible
Amiodarone300mg¹ Accessible
Calcium chloride10 ml 10%¹ Accessible
Calcium gluconatemay be used as analternative. Note:10 ml 10% Calciumchloride = 6.8 mmolCa2+10 ml 10% Calciumgluconate = 2.26mmol Ca2+
Chlorphenamine10 mg¹ Accessible
Second-linetreatment foranaphylaxis, canalso giveintramuscular
Diazepam and/orLorazepam Accessible
For treatment ofstatus epilepticus.Agent, dose androute ofadministrationaccording to localpolicy
Item Suggestedavailability Comments
Hydrocortisone100 mg¹ Accessible
Second-linetreatment foranaphylaxis, canalsobe givenintramuscularly
Glucose¹ AccessibleConcentrationaccording to localpolicy
20% Lipidemulsion¹ Accessible For local anaesthetic
toxicity
Lidocaine 100mg¹ Accessible
Magnesiumsulfate (2 g = 8mmol)¹
Accessible
Midazolam 5 mgin 5 ml¹ Accessible NPSA Alert
Morphine¹ Accessible According to localpolicy
Naloxone 400microgram¹ Accessible
Potassiumchloride¹ Accessible
Potassium chlorideconcentratesolutions. Patientsafety alert. TheNational PatientSafety Agency. July2002.
Item Suggestedavailability Comments
Sodiumbicarbonate 8.4%or 1.26%¹
Accessible
Concentration andpreparationaccording to localpolicy
OTHER EMERGENCY DRUGS (Paediatric)
Acute Hospital Care - Paediatric
OTHER EMERGENCY DRUGS
Item Suggestedavailability Comments
Adrenaline1mg(1 ml1:1000)¹ Immediate
First-line treatment foranaphylaxis.Can be part of an‘anaphylaxis kit’ sothat it is not mixed /confused withcardiorespiratoryarrestdrugs
Furosemide 50mg IV¹ Accessible
Flumazenil 0.5mg IV¹ Accessible
Glucagon 1 mgIV¹ Accessible
Ipratropiumbromide 500microgramnebules (andnebuliserdevice)¹
Accessible
Salbutamol5mg nebules(and nebuliserdevice)¹
Accessible
Salbutamol1mg/ml for IVinfusion¹
Accessible
Notes (Paediatric)
1. The volume and/or quantities of the listed fluids and drugs stored and their
location should be determined by local policy. This should ensure that thereis sufficient availability to manage a paediatric resuscitation according toResuscitation Council UK resuscitation guidelines without undue delay.
2. Portable monitoring and other equipment for patient transfer should bereadily available.
3. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors,anaesthetic agents, antibiotics) should be readily available according tolocal critical care policies.
4. All interventions (e.g. drug therapy, practical procedures, discussions withother staff or relatives) should be documented with date and time andsigned by an identifiable member of staff.
5. Keeping resuscitation drugs locked away - this problem was addressed indetail in 2005 by the Royal Pharmaceutical Society of Great Britain in arevision of the Duthie Report (1988) ‘The Safe and Secure Handling ofMedicines’. Resuscitation Council UK responded with a statement, alongwith an accompanying letter written to the CQC explaining the position.
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