Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey
International Journal of Anesthesia and Clinical Medicine
Volume 8, Issue 2, December 2020, Pages: 55-61
Received: Aug. 15, 2020;
Accepted: Aug. 27, 2020;
Published: Sep. 3, 2020
Views 253 Downloads 50
Neha Rawat, Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Jijo Francis, Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Goverdhan Dutt Puri, Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Amarjyoti Hazarika, Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Naveen Naik, Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Kulbhusan Saini, Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Follow on us
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.
Central Venous Catheter, Arterial Cannula, COVID-19, ICU, USG
To cite this article
Goverdhan Dutt Puri,
Securing Central Venous Access and Arterial Cannulation in a COVID ICU- Our Experience Questionnaire Based Survey, International Journal of Anesthesia and Clinical Medicine.
Vol. 8, No. 2,
2020, pp. 55-61.
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
CDC Updated protocol on airborne precautions, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
McGhee B. H. & Bridges M. E. (2002) Monitoring arterial blood pressure: What you may not know. Critical Care Nurse. 22 (2): 60-78.