Complex COVID patient needs more access describes how the Vascular Access clinician evaluated a COVID patient, advocated a creative and clinically appropriate solution for multiple points of access, and created such access achieving the best outcome feasible, and is the focus of this Nurse Clinicians in Action. Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases generally involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA-compliant communication app. Our extensive training program and diverse client base including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities provide our clinicians a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.
Complex COVID Patient Needs More Access
– Clinical Case
This complex COVID patient case occurred in an acute care hospital Intensive Care Unit (ICU). A 35 year-old male patient diagnosed with COVID was intubated for respiratory support and additionally required multiple critical care medications including vasopressors. Prior to Vascular Wellness being consulted, a left jugular line was attempted without success, possibly related to the patient’s obesity. To further complicate matters, after intubation, a left-sided neck cellulitis developed, the patient’s condition worsened, and he went into renal failure requiring hemodialysis.
Complex Covid Patient Needs More Vascular Access
– Diagnosis and Treatment
The Vascular Wellness clinician was consulted to place a temporary dialysis catheter (aka, a Vas Cath for Dialysis) and upon arrival, the ICU Nurse informed the clinician that she was concerned about the vasopressors running through the Peripheral IVs as they “didn’t look good”. Upon assessment and medical history review, the Vascular Wellness clinician concluded that in addition to the Trialysis catheter (a specialty dialysis catheter that has two lumens dedicated for hemodialysis and one for general infusion), this patient required additional central access that would preserve vasculature in case the renal issues required ongoing dialysis and possible fistula formation. This complex COVID patient needed more access promptly and creating this additional access now would be more efficient and best for the patient and client as it would be available for immediate use. Left-sided jugular insertion was not possible due to the cellulitis and the right jugular would be used for the temporary dialysis catheter. After careful assessment, the clinician decided to “double stick” the right internal jugular vein as it was large enough via ultrasound assessment to accommodate two separate central lines safely. The clinician proceeded to place a 14 French Trialysis low in the right internal jugular and a 5 French triple lumen catheter slightly higher in the same vein. This gave the clinical team caring for the patient the availability of 4 separate access points for infusion of critical medications and the ability to remove the Peripheral IVs that “didn’t look good”. The Peripheral IV sites were reddened with early phlebitis from the harsh nature of the vasopressor medication. Additionally, each catheter was independently dressed providing the flexibility for the removal of either catheter when clinically indicated while maintaining the other catheter.
Vascular Access Specialists
– Key Points
Vascular Wellness clinicians have placed hundreds of thousands of lines and this experience enables us to assess a situation and patient properly. Vascular Wellness prides itself on being Vascular Access Specialists and using advanced vascular access procedures and techniques to create access even in difficult situations enabling clinical teams to treat their patients back to health. Although “double sticking” is not common, it is exactly the type of “outside the box” clinical solution that some patients with complex vascular access requirements need and how an outstanding clinical outcome was achieved. This case exemplifies how the Vascular Wellness clinicians truly are Vascular Access Specialists and how they rely on their training, expertise, and experience to provide the best patient outcome.
By having the tools of US Guided PIVs, Midlines, PICCs, Small Bore lines such as Internal Jugular lines (IJs) and Femoral lines (Fems), and Large Bore lines including Vas Caths and Quad Lumens, Vascular Wellness is able to create clinically appropriate access in virtually all patients, while minimizing multiple needle sticks trying to create access. The ability to minimize sticks and place the right line at the right time, the first time, or multiple lines as in this case, is incredibly important as the placement of a Central Venous Catheter is an invasive medical procedure that comes with risks. These factors, along with a consultative approach with the treating physician, are just a few reasons why Vascular Wellness improves patient outcomes, reduces costs, and strengthens infection control. We are Vascular Access Specialists.
If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today. For the latest articles and insights, follow us on LinkedIn, Facebook, Twitter, YouTube, and Instagram.
Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, South Carolina, Virginia, and West Virginia;
(2) Customized vascular access services to Tennessee and Georgia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky