Adapting a Vascular Access Service (VAS) to Meet the Needs of the COVID-19 Pandemic

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Abstract

The novel coronavirus 2019 (COVID-19) pandemic has placed an unprecedented strain on healthcare systems and frontline workers worldwide. The large influx of these high acuity patients has placed pressure on services to modify their operations to meet this increased need. We describe how the Vascular Access Service (VAS) at a New York City academic hospital adopted a team-based approach to efficiently meet increased demand for vascular access devices, while ensuring safety and conserving personal protective equipment.

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The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method.

Vineet Chopra, Scott A Flanders, Sanjay Saint … (2015)

Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use has led to the realization that PICCs are associated with important complications, including thrombosis and infection. Moreover, some PICCs may not be placed for clinically valid reasons. Defining appropriate indications for insertion, maintenance, and care of PICCs is thus important for patient safety. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate. For peripherally compatible infusions, PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days. In critically ill patients, nontunneled central venous catheters were preferred over PICCs when 14 or fewer days of use were likely. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration. The panel of experts used a validated method to develop appropriate indications for PICC use across patient populations. These criteria can be used to improve care, inform quality improvement efforts, and advance the safety of medical patients.

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Bloodstream infections in critically ill patients with COVID‐19

Daniele Roberto Giacobbe, Denise Battaglini, Lorenzo Ball … (2020)

Abstract Background Little is known about the incidence and risk of intensive care unit (ICU)‐acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID‐19). Material and methods This retrospective, single‐centre study was conducted in Northern Italy. The primary study objectives were: (i) to assess the incidence rate of ICU‐acquired BSI; (ii) to assess the cumulative risk of developing ICU‐acquired BSI. Results Overall 78 critically ill patients with COVID‐19 were included in the study. Forty‐five episodes of ICU‐acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35‐63) per 1000 patient‐days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk, and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti‐inflammatory treatment was independently associated with the development of BSI (cause‐specific hazard ratio [csHR] 1.07 with 95% CI 0.38‐3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20‐13.03 for methylprednisolone, and csHR 10.69 with 95% CI 2.71‐42.17 for methylprednisolone plus tocilizumab, with no anti‐inflammatory treatment as the reference group; overall p for the dummy variable = 0.003). Conclusions The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID‐19 patients treated with anti‐inflammatory drugs is outweighed by the benefits of reducing any possible proinflammatory dysregulation induced by SARS‐CoV‐2.

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Risk of self-contamination during doffing of personal protective equipment

Abrar Ahmad Chughtai, Xin CHEN, Chandini MacIntyre (2018)

The aim of this study was to describe the risk of self-contamination associated with doffing of personal protective equipment (PPE) and to compare self-contamination with various PPE protocols.

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Author and article information

Journal

Journal ID (nlm-ta): Am J Infect Control

Journal ID (iso-abbrev): Am J Infect Control

Title: American Journal of Infection Control

Publisher: Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.

ISSN (Print): 0196-6553

ISSN (Electronic): 1527-3296

Publication date PMC-release: 16 February 2021

Publication date (Electronic): 16 February 2021

Affiliations

[1 ]Icahn School of Medicine at Mount Sinai, Institute for Critical Care Medicine

[2 ]Icahn School of Medicine at Mount Sinai, Department of Nursing

[3 ]Icahn School of Medicine at Mount Sinai, Department of Infectious Diseases

Author notes

[* ]Corresponding Author: Roopa Kohli-Seth, MD, The Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, New York 10029, T: (212) 241-8867, F: (212) 860-3669.

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Publisher Item ID: S0196-6553(21)00085-7

DOI: 10.1016/j.ajic.2021.02.008

PMC ID: 7884228

SO-VID: aa2f1261-ac54-4e93-adde-c83d96fbfd8e

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Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Adapting a Vascular Access Service (VAS) to Meet the Needs of the COVID-19 Pandemic

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Abstract

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Novel Coronavirus Disease COVID-19

Most cited references 9

The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method.

Bloodstream infections in critically ill patients with COVID‐19

Risk of self-contamination during doffing of personal protective equipment

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