Managing central venous access during a health care crisis

Abstract

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.

Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

“…Our low complication rates underscore the effectiveness of the VAST service. Our findings are similar to the recent multi-centre report by Chun et al [18], highlighting the important contribution of a similar service in centres outside of the UK and adds weight to their findings.…”

“…The COVID-19 pandemic and the severity of infection [10,11] with the SARS-CoV-2 has resulted in extreme pressures on health services across the world with reports describing war-like circumstances necessitating rapid innovation to provide emergency care [12]. The urgency for these developments were most evident in ICU settings with several reports highlighting the need for a rapid increase in ICU capacity including beds, vital equipment and personnel [13][14][15][16][17][18]. It is, however, well recognised that a rapid increase in ICU workload may result in adverse patient outcomes [12,19] and that specific COVID-19 protocols and interventions are needed to reduce strains on available ICU resources [13,15,16,18].…”

Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

“…Our low complication rates underscore the effectiveness of the VAST service. Our ndings are similar to the recent multi-centre report by Chun et al [18], highlighting the important contribution of a similar service in centres outside of the UK and adds weight to their ndings.…”

“…The COVID-19 pandemic and the severity of infection [10,11] with the SARS-CoV-2 has resulted in extreme pressures on health services across the world with reports describing war-like circumstances necessitating rapid innovation to provide emergency care [12]. The urgency for these developments were most evident in ICU settings with several reports highlighting the need for a rapid increase in ICU capacity including beds, vital equipment and personnel [13][14][15][16][17][18]. It is, however, well recognised that a rapid increase in ICU workload may result in adverse patient outcomes [12,19] and that speci c COVID-19 protocols and interventions are needed to reduce strains on available ICU resources [13,15,16,18].…”

Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams

“…Owing to COVID-19, the landscape of healthcare worldwide has been transformed [25] with many medical procedures being updated and adapted to a situation that was characterized by high risk of contamination to HCPs [26]. The pandemic exposed a lack of disaster preparedness in many hospitals worldwide [27]. To better manage the sudden large influx of patients, many organizations saw a redeployment of staff, and in some hospitals as part of this, VATs were implemented [27].…”