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Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey

Received: 15 August 2020     Accepted: 27 August 2020     Published: 3 September 2020
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Abstract

INTRODUCTION: PPE for contact protection is an integral component of the management of critically ill COVID-19 patients. It causes restrictions in mobility and impaired touch perception. This is further impaired by additional standard barrier precautions taken for sterility. In an era where the point of care ultrasound (POCUS) has become an everyday practice, ultrasound guidance is recommended to overcome some of these difficulties. OBJECTIVE: The objective was to find and evaluate the techniques practiced, the difficulties faced and complications while performing a central venous catheter and arterial cannula insertion. MATERIALS AND METHODS: The study was conducted through an online survey. The questionnaire included questions about the practices followed, the problems faced, and complications during performing such procedures. RESULT: 66.66% of the Senior residents and 16.6% of the Consultants attempted the CVC insertions. Arterial cannulation was attempted by 78.37% senior residents and 14.42% Consultants. Majority of intensivists used USG for CVC insertions (86.48%) and for arterial cannulation (81%). The various difficulties faced were impaired vision due to fogging (100%), impaired body movement. 66% complained of suboptimal patient positioning and 33% complained of difficulty in communication during CVC insertion. We found that there were no immediate complications. CONCLUSION: To access central and arterial cannulation in a COVID ICU, Senior intensivist should perform the procedure using USG guided techniques so as to improve success rate and minimize complication amidst difficulties like fogging of vision and improper procedural positioning. Standardized equipment for “standard” maximal barrier precautions should be available before performing these procedures in addition to PPE.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 8, Issue 2)
DOI 10.11648/j.ijacm.20200802.15
Page(s) 55-61
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Central Venous Catheter, Arterial Cannula, COVID-19, ICU, USG

References
[1] CDC Updated protocol on airborne precautions, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html.
[2] Maki DG, Ringer M, Alvarado CJ: Prospective randomized trial of povidone-iodine, alcohol, and Chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991; 338: 339–4313.
[3] Practice Guidelines for Central Venous Access 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology 2020; 132 (1): 8-43.
[4] Lamperti, M, Bodenham, AR, Pittiruti, M, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 2012; 38 (7): 1105–1117.
[5] Grebenik CR, Boyce A, Sinclair ME, Evans RD, Mason DG, Martin B: NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? Br J Anaesth 2004; 92: 827–30.
[6] White L, Halpin A, Turner M, Wallace L. Ultrasound-guided radial artery cannulation in adult and pediatric populations: a systematic review and meta-analysis. Br J Anaesth. 2016; 116 (5): 610-617.
[7] Gu WJ, Tie HT, Liu JC, Zeng XT. Efficacy of ultrasound-guided radial artery catheterization: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2014; 18 (3).
[8] Kiberenge RK, Ueda K, Rosauer B. Ultrasound-Guided Dynamic Needle Tip Positioning Technique Versus Palpation Technique for Radial Arterial Cannulation in Adult Surgical Patients: A Randomized Controlled Trial. Anesth Analg. 2018; 126 (1): 120-126.
[9] Merrer J., De Jonghe B., Golliot F., Lefrant J. Y., Raffy B., Barre E. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001; 286: 700–707.
[10] Parienti J. J., du Cheyron D., Timsit J. F., Traoré O., Kalfon P., Mimoz O. Meta-analysis of subclavian insertion and nontunneled central venous catheter-associated infection risk reduction in critically ill adults. Crit Care Med. 2012; 40: 1627–1634.
[11] O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011; 39: S1.
[12] Armstrong PJ, Sutherland R, Scott DH: The effect of position and different maneuvers on the internal jugular vein diameter size. Acta Anaesth Scand 1994; 38: 229–31.
[13] Sayin MM, Mercan A, Koner O, Ture H, Celebi S, Sozubir S, Aykac B: Internal jugular vein diameter in pediatric patients: Are the J-shaped guidewire diameters bigger than internal jugular vein? An evaluation with ultrasound PaediatrAnaesth 2008; 18: 745–51.
[14] Brass P., Hellmich M., Kolodziej L., Schick G., Smith A. F. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev. 2015; Jan 9; 1.
[15] Saugel B., Scheeren T., Teboul J. Ultrasound-guided central venous catheter placement: A structured review and recommendations for clinical practice. Crit Care. 2017; 21: 225.
[16] McGhee B. H. & Bridges M. E. (2002) Monitoring arterial blood pressure: What you may not know. Critical Care Nurse. 22 (2): 60-78.
Cite This Article
  • APA Style

    Neha Rawat, Jijo Francis, Goverdhan Dutt Puri, Amarjyoti Hazarika, Naveen Naik, et al. (2020). Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey. International Journal of Anesthesia and Clinical Medicine, 8(2), 55-61. https://doi.org/10.11648/j.ijacm.20200802.15

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    ACS Style

    Neha Rawat; Jijo Francis; Goverdhan Dutt Puri; Amarjyoti Hazarika; Naveen Naik, et al. Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey. Int. J. Anesth. Clin. Med. 2020, 8(2), 55-61. doi: 10.11648/j.ijacm.20200802.15

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    AMA Style

    Neha Rawat, Jijo Francis, Goverdhan Dutt Puri, Amarjyoti Hazarika, Naveen Naik, et al. Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey. Int J Anesth Clin Med. 2020;8(2):55-61. doi: 10.11648/j.ijacm.20200802.15

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  • @article{10.11648/j.ijacm.20200802.15,
      author = {Neha Rawat and Jijo Francis and Goverdhan Dutt Puri and Amarjyoti Hazarika and Naveen Naik and Kulbhusan Saini},
      title = {Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {8},
      number = {2},
      pages = {55-61},
      doi = {10.11648/j.ijacm.20200802.15},
      url = {https://doi.org/10.11648/j.ijacm.20200802.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20200802.15},
      abstract = {INTRODUCTION: PPE for contact protection is an integral component of the management of critically ill COVID-19 patients. It causes restrictions in mobility and impaired touch perception. This is further impaired by additional standard barrier precautions taken for sterility. In an era where the point of care ultrasound (POCUS) has become an everyday practice, ultrasound guidance is recommended to overcome some of these difficulties. OBJECTIVE: The objective was to find and evaluate the techniques practiced, the difficulties faced and complications while performing a central venous catheter and arterial cannula insertion. MATERIALS AND METHODS: The study was conducted through an online survey. The questionnaire included questions about the practices followed, the problems faced, and complications during performing such procedures. RESULT: 66.66% of the Senior residents and 16.6% of the Consultants attempted the CVC insertions. Arterial cannulation was attempted by 78.37% senior residents and 14.42% Consultants. Majority of intensivists used USG for CVC insertions (86.48%) and for arterial cannulation (81%). The various difficulties faced were impaired vision due to fogging (100%), impaired body movement. 66% complained of suboptimal patient positioning and 33% complained of difficulty in communication during CVC insertion. We found that there were no immediate complications. CONCLUSION: To access central and arterial cannulation in a COVID ICU, Senior intensivist should perform the procedure using USG guided techniques so as to improve success rate and minimize complication amidst difficulties like fogging of vision and improper procedural positioning. Standardized equipment for “standard” maximal barrier precautions should be available before performing these procedures in addition to PPE.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey
    AU  - Neha Rawat
    AU  - Jijo Francis
    AU  - Goverdhan Dutt Puri
    AU  - Amarjyoti Hazarika
    AU  - Naveen Naik
    AU  - Kulbhusan Saini
    Y1  - 2020/09/03
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijacm.20200802.15
    DO  - 10.11648/j.ijacm.20200802.15
    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 55
    EP  - 61
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/j.ijacm.20200802.15
    AB  - INTRODUCTION: PPE for contact protection is an integral component of the management of critically ill COVID-19 patients. It causes restrictions in mobility and impaired touch perception. This is further impaired by additional standard barrier precautions taken for sterility. In an era where the point of care ultrasound (POCUS) has become an everyday practice, ultrasound guidance is recommended to overcome some of these difficulties. OBJECTIVE: The objective was to find and evaluate the techniques practiced, the difficulties faced and complications while performing a central venous catheter and arterial cannula insertion. MATERIALS AND METHODS: The study was conducted through an online survey. The questionnaire included questions about the practices followed, the problems faced, and complications during performing such procedures. RESULT: 66.66% of the Senior residents and 16.6% of the Consultants attempted the CVC insertions. Arterial cannulation was attempted by 78.37% senior residents and 14.42% Consultants. Majority of intensivists used USG for CVC insertions (86.48%) and for arterial cannulation (81%). The various difficulties faced were impaired vision due to fogging (100%), impaired body movement. 66% complained of suboptimal patient positioning and 33% complained of difficulty in communication during CVC insertion. We found that there were no immediate complications. CONCLUSION: To access central and arterial cannulation in a COVID ICU, Senior intensivist should perform the procedure using USG guided techniques so as to improve success rate and minimize complication amidst difficulties like fogging of vision and improper procedural positioning. Standardized equipment for “standard” maximal barrier precautions should be available before performing these procedures in addition to PPE.
    VL  - 8
    IS  - 2
    ER  - 

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Author Information
  • Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

  • Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

  • Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

  • Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

  • Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

  • Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

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