Intensive Care Vascular Access Cases

Intensive Care Vascular Access Cases: A hospital patient with a history of strokes coded, received CPR, return of spontaneous circulation was achieved and was immediately transported to the ICU. A vascular Wellness clinician was nearby when this patient coded, and knowing that the patient might need additional vascular access and was likely a DIVA case due to his medical condition, she stayed close in case her advanced vascular access services were needed. The patient coded again, ROSC was achieved, and fluids and vasopressors were ordered. The nursing staff was unable to secure a secondary PIV, and shortly after, the care team looked for central access but were unsuccessful due to a collapsed internal jugular. The physicians were considering an IO and other surgical options, so the Vascular Wellness clinician introduced herself and offered to place a PICC. They agreed and the PICC was placed quickly on the first attempt, and ECG tip confirmation enabled the medications to be administered immediately. The medical team was extremely grateful.

Intensive Care Vascular Access Cases: An intubated patient in the ICU required multiple critical care medications including vasopressors. Prior to Vascular Wellness being consulted, a left jugular line was attempted without success, and after intubation, a left-sided neck cellulitis developed. The patient’s condition worsened and he went into renal failure, requiring hemodialysis. Vascular Wellness was consulted to place a temporary dialysis catheter (Vascath) and upon arrival, the ICU nurse stated the PIVs where vasopressors were being administered “didn’t look good.”  Upon assessment and medical history review, the Vascular Wellness clinician determined additional central access not only afford the vascular access needed, but also would preserve vasculature in case ongoing dialysis and possible fistula formation were required.  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 in this complex case. This gave the care team 4 separate access points for infusion and the ability to remove the PIVs, as the insertion sites were reddened with early phlebitis from the harsh nature of the vasopressor medication.