Vascular access in COVID-19 patients: Smart decisions for maximal safety

Scoppettuolo, Giancarlo; Biasucci, Daniele Guerino; Pittiruti, Mauro

doi:10.1177/1129729820923935

Cited by 39 publications

(58 citation statements)

References 10 publications

(12 reference statements)

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“…Wireless ultrasound transducers may be particularly useful in this clinical scenario. 10 Postplacement confirmation. In critically ill patients, reducing complications is paramount, and early identification of complications is a key to survival of the patient.…”

Section: Standard Practicesmentioning

confidence: 97%

“… 7 , 8 The teams often consist of vascular surgeons, general surgeons, interventional radiologists, anesthesiologists, intensivists, and interventional cardiologists who have been trained and have extensive experience in central venous access as well as experience in identifying and managing the complications associated with central venous access procedures. 9 , 10 For example, to meet the increased demand for critical care providers at the University of Massachusetts, vascular surgeons formed a Surgical Workforce Access Team (SWAT) to best leverage the skill sets of vascular surgery division members and to provide the best service to the hospital and to their colleagues. 7 At Mount Sinai Hospital in New York, physicians recognized a dramatic increase in the rate of central line complications and the resulting urgent vascular interventions.…”

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confidence: 99%

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Managing central venous access during a health care crisis

Chun

Judelson

Rigberg

et al. 2020

Journal of Vascular Surgery

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Objective: During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic. Methods: We conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19. Results: Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twentythree of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). Conclusions: Implementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises.

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Section: Standard Practicesmentioning

confidence: 97%

mentioning

confidence: 99%

Managing central venous access during a health care crisis

Chun

Judelson

Rigberg

et al. 2020

Journal of Vascular Surgery

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“…Failure to obtain these needs will eventually lead to patients but also nephrologists to dissatisfaction. Last but not least, efficient cannulation techniques, preferably under ultrasound guidance, 23 are highly dependent on the level of expertise of the dialysis unit medical and nursing staff, representing a barrier to dialysis unit complications avoiding further patient dissatisfaction when successful.…”

Section: High Surgical and Endovascu-lar Vascular Access Standardsmentioning

confidence: 99%

Optimizing Best Vascular Access Practice in Patients on Dialysis during the COVID-19 Pandemic Period

Georgiadis

Argyriou

Kantartzi

et al. 2021

Annals of Vascular Surgery

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The COVID-19 crisis has opened the Pandora's box of interconnected challenges where, vascular access (VA) and renal physicians must confront with and adapt to deliver the maximum desired health care service for their patients on dialysis. Raising the bar for quality means that high surgical and endovascular standards are becoming the cornerstone of treatment option and dedicated experienced medical staff is the sine qua non for achieving this goal. An operative team checklist should be developed to accomplish maximum safety with optimal results coupled with larger patient volume and a rapid turnover, at the same time focusing on reducing the potential risk of COVID-19 transmission. The recommendations recently proposed by the European and American Vascular Societies in this new ''COVID-19'' era, regarding the deferral of VA creation in incident predialysis patients, or revision for VA malfunction/steal in prevalent dialysis patients aims to protect them, the medical staff, and the community from uncontrolled spread of the virus and consequently from possible avoidable mortality. 1,2 Fortunately, the coronavirus pandemic will not last forever, and even though there will be a second intense wave of the epidemic in some countries, many things will, and must change, after the quarantine is permanently lifted, especially the safely care of high-risk patients, like those on maintenance hemodialysis. However, this global pandemic crisis really unmasked the general rule that if these potentially noninfected hemodialysis patients are handled appropriately, by dialysis clinicians and VA surgeon teams, this can be turned into a high opportunity to avoid COVID-19 infection. We will describe in this letter our strategies and proposals for optimum VA surgery results in the pandemic period establishing the lowest risk of COVID-19 transmission.

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“…Ultrasound also allows to check the correct position of the catheter tip in the axillary vein just before the clavicle, the ideal position for enabling smooth blood sampling. 7,8 Our hospital does not have wireless ultrasound probes, thus a portable ultrasound device with battery was used instead. All the procedures were performed in compliance with the international sterility precautions guidelines and all involved operators wore FFP2/N95 masks without valve, with a surgical mask above it and a face shield, impermeable gowns, goggles, double pair of gloves and shoe covers.…”

mentioning

confidence: 99%

“…All the procedures were performed in compliance with the international sterility precautions guidelines and all involved operators wore FFP2/N95 masks without valve, with a surgical mask above it and a face shield, impermeable gowns, goggles, double pair of gloves and shoe covers. 7 Moreover, we adopted additional equipment for the COVID patients, including sterile drapes with an adhesive border to stable the puncture field even in the patient who was not fully collaborative. As tourniquet we adopted sterile, single-use silicon Penrose tube drain, that could be loosened or tightened by the operator without any additional assistance, in order to reduce the team's exposure to the patient.…”

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confidence: 99%