This dedicated COVID-19 support page gives access to vital information about managing patients who require vascular access during their treatment and care. These resources designed to share protocols and practise, come from domestic and international clinicians, hospitals and agencies with direct experience of the virus in a variety of settings.
Learning from the Italian experience
Dr Mauro Pittiruti sharing his first hand account from Rome
Dr Mauro Pittiruti is a surgeon at the Catholic University Hospital in Rome. With Italy at the heart of the COVID-19 healthcare emergency before many other countries in Europe, he and his team have highly valuable experience to share.
A detailed clinical paper Vascular access in COVID-19 patients: smart decisions for maximal safety will shortly be published in Journal of Vascular Access. In the meantime Dr Pittiruti is sharing the recommendations from GAVeCeLT (Italy’s Long Term Vascular Access Group) so that clinicians can benefit from their experience immediately.
In short the GAVeCeLT guidelines state: “Most COVID patients get a midline or a PICC. Typically patients with suspected COVID get a midline (real midline, 20-25cm, not a mini-midline), to reduce the number of short peripheral venous catheters inserted and the number of manoeuvers. Patients with confirmed COVID are preferably treated with PICCs - double lumen and triple lumen PICCs are particularly indicated in the COVID patients in ICU. They have great advantages over CICC, considering the respiratory care of these patients (non-invasive ventilation, CPAP, pronation etc.) During insertion we need maximal barrier protection + maximal protection of the operator (double mask, impermeable gown, etc.) We consistently use wireless ultrasound probes, which makes everything easier when inserting a line in a COVID.”
Access the full GAVeCeLT guidelines:
In his role as a surgeon at the Catholic University Hospital in Rome, Dr Pittiruti is the coordinator of a multi-professional vascular access team that inserts more than 7,000 central venous access devices per year.
In a career spanning more than 40 years, Dr Pittiruti has been at the forefront of advances in venous access. He is the co-founder of the Italian Society of Parenteral and Enteral Nutrition (SINPE), of the Italian Long Term Vascular Access Group (GAVeCeLT) and of the WoCoVA Foundation (World Conference of Vascular Access). He is also the author of more than 100 papers, several book chapters and two books on venous access. He received the Herbst Award for Excellence in Vascular Access in 2009.
Other Support Links
The 2020 COVID-19 pandemic has forced everyone to update the usual medical procedures and adapt them to a new situation characterised by a high risk of contamination of the health operator. The placement of a venous access device is no exception. In the experience of this the vascular access team, hit by the COVID19, the safety of both the patient and the staff can be ensured by an insertion bundle of few smart strategies.
This guidance is aimed at supporting your practice during a time when infusion and syringe pumps are limited, or not available, so that you can continue to administer IV therapy using gravity, or bolus push. NIVAS has written this guidance in partnership with the NHS Specialist Pharmacy Service and Medusa, the online injectable medicines guide, which many of your organisations will be signed up to. The link below contains up to date information about injectable medicines during the COVID-19 outbreak and will be constantly updated.
It is a priority to protect patients with a vascular access device from bloodstream infections. But caring for sick patients with a vascular access device, who also require source isolation for infections - such as COVID-19 - can be an additional challenge. During this time, protecting these patients is even more crucial as developing a bloodstream infection with an existing infection, is potentially devastating. This document contains hints and tips to help you ensure the safety of patients using the I-DECIDED device assessment and decision tool.
This paper documents emerging evidence about systematic clotting problems in severe and critically ill COVID-19 patients. The information provided on this site is related to a number of vascular access topics, such as thrombosis and clotting issues.
The BSH has developed this site to support you and the rest of the community through the uncertainties surrounding COVID-19. This site includes access to the website which includes updated clinical resources and evolving guidance. Their Committees and Specialist Interest Groups have worked hard to ensure consistent advice based on sound medical consensus is provided to their members and other haematology professionals.
This guidance has been developed by the INS in a response to concerns related to COVID-19 and is a useful resource for clinicians working in vascular access settings. It contains some Frequently Asked Questions related to COVID-19 Health Care Challenges. Although the INS is not ‘recommending modifications’ to established standards, the society recognises the challenges being faced and have supplied this response.