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Managing central venous access during a health care crisis.
Chun, Tristen T; Judelson, Dejah R; Rigberg, David; Lawrence, Peter F; Cuff, Robert; Shalhub, Sherene; Wohlauer, Max; Abularrage, Christopher J; Anastasios, Papapetrou; Arya, Shipra; Aulivola, Bernadette; Baldwin, Melissa; Baril, Donald; Bechara, Carlos F; Beckerman, William E; Behrendt, Christian-Alexander; Benedetto, Filippo; Bennett, Lisa F; Charlton-Ouw, Kristofer M; Chawla, Amit; Chia, Matthew C; Cho, Sungsin; Choong, Andrew M T L; Chou, Elizabeth L; Christiana, Anastasiadou; Coscas, Raphael; De Caridi, Giovanni; Ellozy, Sharif; Etkin, Yana; Faries, Peter; Fung, Adrian T; Gonzalez, Andrew; Griffin, Claire L; Guidry, London; Gunawansa, Nalaka; Gwertzman, Gary; Han, Daniel K; Hicks, Caitlin W; Hinojosa, Carlos A; Hsiang, York; Ilonzo, Nicole; Jayakumar, Lalithapriya; Joh, Jin Hyun; Johnson, Adam P; Kabbani, Loay S; Keller, Melissa R; Khashram, Manar; Koleilat, Issam; Krueger, Bernard; Kumar, Akshay.
  • Chun TT; Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
  • Judelson DR; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, Mass.
  • Rigberg D; Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
  • Lawrence PF; Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
  • Cuff R; Division of Vascular Surgery, Department of Surgery, Spectrum Health/Michigan State University, Grand Rapids, Mich.
  • Shalhub S; Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
  • Wohlauer M; Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colo.
  • Abularrage CJ; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
  • Anastasios P; Department of Vascular Surgery, General Hospital of Athens KAT, Athens, Greece.
  • Arya S; Department of Surgery Stanford University School of Medicine, Palo Alto, Calif.
  • Aulivola B; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, Ill.
  • Baldwin M; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Baril D; Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
  • Bechara CF; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, Ill.
  • Beckerman WE; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Rutgers Robert Wood Johnson, New Brunswick, NJ.
  • Behrendt CA; Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Benedetto F; Division of Vascular Surgery, University of Messina, Messina, Italy.
  • Bennett LF; Rose Medical Center, HealthOne, Denver, Colo.
  • Charlton-Ouw KM; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Tex.
  • Chawla A; Division of Vascular Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, La.
  • Chia MC; Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, Ill.
  • Cho S; Division of Vascular Surgery, Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea.
  • Choong AMTL; Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore.
  • Chou EL; Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
  • Christiana A; Department of Vascular Surgery, General Hospital of Athens KAT, Athens, Greece.
  • Coscas R; Vascular Surgery Department, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, Paris, France.
  • De Caridi G; Division of Vascular Surgery, University of Messina, Messina, Italy.
  • Ellozy S; Division of Vascular and Endovascular Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY.
  • Etkin Y; Division of Vascular and Endovascular Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
  • Faries P; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Fung AT; Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
  • Gonzalez A; Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind.
  • Griffin CL; Vascular Division, Department of Surgery, University of Utah, Salt Lake City, Utah.
  • Guidry L; Division of Vascular Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, La.
  • Gunawansa N; Department of Vascular and Transplant Surgery, National Institute of Nephrology Dialysis and Transplantation, Colombo, Sri Lanka.
  • Gwertzman G; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Han DK; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Hicks CW; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
  • Hinojosa CA; Division of Vascular and Endovascular Surgery, Department of Surgery, Universidad Nacional Autónoma de México, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Hsiang Y; Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
  • Ilonzo N; Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Jayakumar L; Vascular and Endovascular Division, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
  • Joh JH; Division of Vascular Surgery, Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea.
  • Johnson AP; Department of Vascular Surgery, Columbia University Valegos College of Physicians and Surgeons, New York, NY.
  • Kabbani LS; Vascular Division, Department of Surgery, Wayne State University, Detroit, Mich.
  • Keller MR; Department of Surgery, Michigan State University, East Lansing, Mich.
  • Khashram M; Department of Surgery, University of Auckland, Auckland, New Zealand.
  • Koleilat I; Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
  • Krueger B; Institute of Anesthesiology, Intensive Care Unit for Cardiovascular Surgery and Department of Vascular Surgery, University Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
  • Kumar A; Department of Cardiovascular and Thoracic Surgery, Medanta Hospital, Gurgaon, India.
J Vasc Surg ; 72(4): 1184-1195.e3, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-728749
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. Twenty-three 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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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Catheterization, Central Venous / Infection Control / Coronavirus Infections / Delivery of Health Care, Integrated / Health Services Needs and Demand / Iatrogenic Disease Type of study: Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: J Vasc Surg Journal subject: Vascular Diseases Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Catheterization, Central Venous / Infection Control / Coronavirus Infections / Delivery of Health Care, Integrated / Health Services Needs and Demand / Iatrogenic Disease Type of study: Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: J Vasc Surg Journal subject: Vascular Diseases Year: 2020 Document Type: Article