Vascular Access During COVID

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Harman Gill
I am a proud Indian by ethnicity and Sikh by religion who lives in the lovely upper valley here in New Hampshire. I love to host, cook and engage in health conversations and loud debates where decibels can be raised but respect is never lost! Talk to you soon!

The Pre-brief

As discussed in our airway post, our practice patterns around central lines and arterial lines have also had to be refined in these pandemic times.  So in this edition of our COVID-19 procedural mini-series, I will share four pearls for safe & successful placement of central venous and arterial lines.

Preparation

  • Use an IO or peripheral vasopressors to temporize & support your patient
  • Switch to portable/disposable bags in replacement of ‘line carts’. Everything that goes into the room should be considered contaminated
  • Wear a sterile gown, gloves, and caps OVER PPE…it gets hot & sweaty real quick!
  • If the COVID team is available then ask them to be a one-stop-shop and place airway, central line, arterial line ALL at the same time.

 

Location

  • May select to choose femoral over conventional IJ/SC site owing to distance from airway secretions…esp in awake & non-intubated patients
  • If placing IJ, SC in awake pt, then place level II mask on the patient

 

Ergonomics

  • Think about whether you are going to use a portable handheld US or a conventional US machine.  
  • Handheld US’s are great but have limited resolutions, small screens AND you need an assistant to hold the screen close enough so you can see it
  • De-contaminate both devices per institutional policy prior to using them again.

 

Confirmation

  • Getting confirmatory chest films for placement may be a challenge while pt is under COVID precautions… another reason to use the femoral site.
  • Get comfortable confirming IJ/SC lines with agitated saline & US as opposed to relying on x-rays.

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