From our single tertiary-center experience, many patients who develop COVID-19 infection 23 require rapid escalation of care with mechanical ventilation, multi-agent sedation and 24 vasopressor support. Early on over 430 patients were hospitalized with ~25% requiring 25 mechanical ventilation and Intensive care unit (ICU) care. These patients require central venous access catheters (CVC), hence increasing significantly the exposure time for both physicians and nurses. After discussion between ICU physicians and the vascular surgery team, a decision was made to utilize triple-lumen peripherally inserted central catheters (PICC) as the preferred means of establishing central vein access. A protocol for modified-PICC insertion (Figure 1) was designed to meet the high demand for access.
Reference:Jasinski, P. T., Tzavellas, G., Rubano, J. A., Rutigliano, D. N., Skripochnik, E. and Tassiopoulos, A. K. (2020) A protocol for central venous access in patients with coronavirus disease 2019 (COVID-19). Journal of Vascular Surgery. July 1st. https://doi.org/10.1016/j.jvs.2020.06.052 (epub ahead of print).