Prediction of extended period of vasopressor infusion requiring central venous catheterisation: A burning issue in critical care

Advanced critical care practitioners are a new and growing component of the critical care multidisciplinary team in the United Kingdom. This audit considers the safety profile of advanced critical care practitioners in the provision of central venous catheterisation and transfer of ventilated critical care patients without direct supervision and supervised drug assisted intubation of critically ill patients. The audit showed that advanced critical care practitioners can perform central venous cannulation, transfer of critically ill ventilated patients and intubation with parity to published UK literature.

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Axillary vein cannulation for central venous access in critical care

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0036-1587959 ◽

2016 ◽

Vol 37 (S 01) ◽

Author(s):

M Algaba Montes ◽

AÁ Oviedo García ◽

M Patricio Bordomás

Keyword(s):

Critical Care ◽

Central Venous Access ◽

Venous Access ◽

Axillary Vein ◽

Central Venous ◽

Vein Cannulation

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Impact of Critical Care Consultation Requests for Avoidable Central Venous Catheters on Medical-Surgical Units

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.822 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s258-s258

Author(s):

Madhuri Tirumandas ◽

Theresa Madaline ◽

Gregory David Weston ◽

Ruchika Jain ◽

Jamie Figueredo

Keyword(s):

Critical Care ◽

High Risk ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

High Risk Population ◽

Central Venous

Background: Although central-line–associated bloodstream infections (CLABSI) in US hospitals have improved in the last decade, ~30,100 CLABSIs occur annually.1,2 Central venous catheters (CVC) carry a high risk of infections and should be limited to appropriate clinical indications.6,7 Montefiore Medical Center, a large, urban, academic medical center in the Bronx, serves a high-risk population with multiple comobidities.8–11 Despite this, the critical care medicine (CCM) team is often consulted to place a CVC when a peripheral intravenous line (PIV) cannot be obtained by nurses or primary providers. We evaluated the volume of CCM consultation requests for avoidable CVCs and related CLABSIs. Methods: Retrospective chart review was performed for patients with CCM consultation requests for CVC placement between July and October 2019. The indication for CVC, type of catheter inserted or recommended, and NHSN data were used to identify CLABSIs. CVCs were considered avoidable if a PIV was used for the stated indication and duration of therapy, with no anatomical contraindications to PIV in nonemergencies, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).6Results: Of 229 total CCM consults, 4 (18%) requests were for CVC placement; 21 consultations (9%) were requested for avoidable CVCs. Of 40 CVC requests, 18 (45%) resulted in CVC placement by the CCM team, 4 (10%) were deferred for nonurgent PICC by interventional radiology, and 18 (45%) were deferred in favor of PIV or no IV. Indications for CVC insertion included emergent chemotherapy (n = 8, 44%) and dialysis (n = 3, 16%), vasopressors (n = 3, 16%), antibiotics (n = 2, 11%) and blood transfusion (n = 2, 11%). Of 18 CVCs, 9 (50%) were potentially avoidable: 2 short-term antibiotics and rest for nonemergent indications; 2 blood transfusions, 1 dialysis, 2 chemotherapy and 2 vasopressors. Between July and October 2019, 6 CLABSIs occurred in CVCs placed by the CCM team; in 3 of 6 CLABSI events (50%), the CVC was avoidable. Conclusions: More than half of consultation requests to the CCM team for CVCs are avoidable, and they disproportionately contribute to CLABSI events. Alternatives for intravenous access could potentially avoid 9% of CCM consultations and 50% of CLABSIs in CCM-inserted CVCs on medical-surgical wards.Funding: NoneDisclosures: None

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Central venous pressure monitoring in critical care settings

British Journal of Nursing ◽

10.12968/bjon.2021.30.4.230 ◽

2021 ◽

Vol 30 (4) ◽

pp. 230-236

Author(s):

Barry Hill ◽

Catherine Smith

Keyword(s):

Critical Care ◽

Central Venous Pressure ◽

Right Atrium ◽

Venous Pressure ◽

Vena Cava ◽

Alternative Methods ◽

Haemodynamic Monitoring ◽

Haemodynamic Instability ◽

Central Venous ◽

The Right

Patients who present with acute cardiovascular compromise require haemodynamic monitoring in a critical care unit. Central venous pressure (CVP) is the most frequently used measure to guide fluid resuscitation in critically ill patients. It is most often done via a central venous catheter (CVC) positioned in the right atrium or superior or inferior vena cava as close to the right atrium as possible. The CVC is inserted via the internal jugular vein, subclavian vein or via the femoral vein, depending on the patient and their condition. Complications of CVC placement can be serious, so its risks and benefits need to be considered. Alternative methods to CVC use include transpulmonary thermodilution and transoesophageal Doppler ultrasound. Despite its widespread use, CVP has been challenged in many studies, which have reported it to be a poor predictor of haemodynamic responsiveness. However, it is argued that CVP monitoring provides important physiologic information for the evaluation of haemodynamic instability. Nurses have central roles during catheter insertion and in CVP monitoring, as well as in managing these patients and assessing risks.

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