Just as important as having all of your necessary supplies available during a code is knowing where your supplies are located. Navigating your way through a hectic code is much easier when you have an organized system for storing your crash cart supplies.
Keep the Big Things Outside and Accessible
Both literally and figuratively, the “big things” are often the equipment you may utilize first, and you want to be able to grab them easily.
- Portable Defibrillator/Monitor - You can make quick decisions on how to proceed with the code when you are able to assess your patient’s cardiac rhythm and respiratory status .If you determine that your patient is in a lethal cardiac rhythm, you will be ready to go. Make certain to have pediatric pads available as well.
- Portable suction machine- This will allow you to clear your patient’s airway quickly and prepare for possible intubation or other advanced airway placement.
- Oxygen tank- Once the airway is patent, you can crank open your oxygen tank and deliver oxygen by the appropriate means.
Additionally, consider placing a basket on the outside of the crash cart to store other first-line items, such as gloves, extra electrodes, and various sized adult and pediatric bag-valve masks.
Keep Your Drawers Stocked According to Function
Crash carts will vary from hospital to hospital depending on individual facility requirements and patient population. However, the best practice is to keep supplies that are frequently used together in the same drawer, and separate your drawers based on function. Make sure each drawer is clearly labelled on the outside.
Here is a general guideline for how to stock a typical 6- drawer adult crash cart:
- Drawer 1: Medications - This will include your emergency medications such as epinephrine and sodium bicarbonate, normal saline and sterile water vials, and medication labels.
- Drawer 2: IV start and blood draw equipment - Store your angiocaths, butterflies, tape, and collection tubes here.
- Drawer 3: IV fluids and tubing - This will house your dextrose solutions, sodium chloride, and extension tubing.
- Drawer 4: Adult airway management supplies - Stock ET tubes, laryngoscopes, blades, airway adjuncts, and supraglottic airways here.
- Drawer 5: Pediatric supplies - Stocking pediatric-appropriate medication, IV and airway supplies in a separate drawer will make it easier to find in an emergency.
- Drawer 6: Procedure trays and miscellaneous equipment - Chest tube trays, central line kits and other extra supplies are often stored in the bottom drawers.
Keep Supplies Inventoried and InspectedThis is a crucial element. You don’t want to be in an emergency and find that your cart is missing the appropriate size endotracheal tube or that the epinephrine is expired.
To avoid this, keep a list hanging on the outside of the cart that specifies every item that is stocked. Make sure IV fluids and medications have their expiration dates listed next to them as well. Have a system for double-checking inventory at least monthly to make sure that all items are present and that no expired items are left in the cart. Document this. Additionally, consider placing a lock on the crash cart to ensure its integrity in between checks.
Regularly inspect all your big items to make sure they are functioning as they should. Check your defibrillator daily, and verify the joules discharged on schedule specified by your hospital. Make sure your oxygen tank is sufficiently full. Ensure that your portable suction machine is properly charged. Document appropriately that these checks have been performed.
Following these suggestions will help ensure that your code cart will always be properly stocked and that everything is right where you expect it to be. And when that code comes, you will be thankful.