Axillary vein thrombosis in COVID positive patient with midline and continuous positive airway pressure Helmet

Vailati, Davide; Fusco, T; Canelli, Antonio; Chiariello, Carmela; Zerla, Pietro Antonio

doi:10.1177/1129729820943424

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…A possible explanation may be the increased upper limb venous stasis due to underarm fastening straps of helmet used during ventilation with continuous positive airway pressure (CPAP). 10 As a consequence, the use of alternative strategies to reduce CRT such as intermediate (50-70 units/ kg/12 h) or therapeutic dose of low-molecular weight heparin (100 units/kg/12 h or 150 units/kg/24 h) should be 11,12 This could be due to the large use of parenteral nutrition (PN) through VADs during pandemic. PN was found to be an independent risk factor for catheter infection.…”

Section: Discussionmentioning

confidence: 99%

Retrospective survey from vascular access team Lombardy net in COVID-19 era

et al. 2021

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Background: Venous Access Devices (VADs) are the most used devices in COVID-19 patients. Objective: Identify VADs implanted, catheter related thrombosis (CRT), catheter-related bloodstream infection (CRBSI), and accidental remove of VADs in both COVID-19 positive and COVID-19 free patients. Successive analysis was conducted comparing COVID-19 positive patients with COVID-19 free with inverse probability propensity score weights using simple regression to account for these two confounders (peripheral tip as central/peripheral and hospitalization as no/yes). Methods: This multicenter, retrospective cohort study collected data from seven hospitals in Lombardy during the pandemic period from February 21st to May 31st 2020. Results: A total of 2206 VADs were evaluated, 1107 (50.2%) of which were inserted in COVID-19 patients. In COVID-19 cohort the first choice was Long Peripheral Cannula in 388 patients (35.1%) followed by Midline Catheter in 385 (34.8%). The number of “central tip” VADs inserted in COVID-free inpatients and COVID-19 positive were similar (307 vs 334). We recorded 42 (1.9%) CRT; 32 (79.2%) were observed in COVID-19 patients. A total of 19 CRBSI were diagnosed; 15 (78.95%) were observed in COVID-19. Accidental removals were the more represented complication with 123 cases, 85 (69.1%) of them were in COVID-19. COVID-19 significantly predicted occurrence of CRT (OR = 2.00(1.85–5.03); p < 0.001), CRSB (OR = 3.82(1.82–8.97); p < 0.001), and Accidental Removal (OR = 2.39(1.80–3.20); p < 0.001) in our propensity score weighted models. Conclusions: CRT, CRBSI, and accidental removal are significantly more frequent in COVID-19 patients. Accidental removals are the principal complication, for this reason, the use of subcutaneously anchored securement is recommended for a shorter period than usual.

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Section: Discussionmentioning

confidence: 99%

Retrospective survey from vascular access team Lombardy net in COVID-19 era

et al. 2021

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“…Moreover, concerns have recently arisen regarding the possibility of axillary vein thrombosis in patients receiving non-invasive ventilation using Helmet straps attached to the armpits. 13 This event did not occur in our series since our Helmets are fixed with a pneumatic “donut” at the neck without straps.…”

Section: Discussionmentioning

confidence: 82%

Long peripheral cannula in COVID-19 patients: 769 catheter days experience from a semi-intensive respiratory COVID unit

Gilardi

Grandi

Giannuzzi³

et al. 2022

J Vasc Access

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Background: In the daily management of peripheral venous access, the health emergency linked to the COVID-19 pandemic led to re-examining the criteria for choosing, positioning and maintaining the different types of peripheral venous access. Objectives: This study aimed to observe the dwell time of long peripheral cannula (LPC, also known as mini-midline) in patients affected by COVID 19 related pneumonia. The secondary objective is to study any complications due to mini-midline insertion. Materials and methods: We conducted a prospective observational study on COVID19 patients who arrived at our Semi-Intensive Respiratory Unit from territorial ED between January and April 2021, to whom were positioned an LPC at the time of admission following the SIPUA protocol (Safe Insertion of Peripheral Ultrasound-guided Access). We used Vygon™ Leader-Cath© 18G in polyethylene and 8 cm long catheter. Results: We enrolled 53 consecutive patients, reaching 769 catheter days. The procedure was performed without immediate complications in 37 patients out of 53 (69.8%). In 14 patients (26.4%), we observed a local hematoma (no one led to a failure or early removal of the device) and in two patients (3.7%) was not possible to draw blood. The average catheter dwell time was 14.5 days, from 3 to 41 days. In 42 patients (79.2%), the device was removed at the end of use. In 11 patients out of 53 (20.8%), the device was removed early due to complications: seven accidental removals, one obstruction, two vein thrombosis, and one superficial thrombophlebitis. Conclusions: The ultrasound-guided implantation of an 18G LPC in COVID19 patients, regardless of the state of their venous heritage, would seem to be an excellent strategy for these patients, reducing the number of venipunctures and CVC implantation, as well as allowing multiple and high pressure (contrast) infusions.

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“…28 Another indication to SFV was respiratory failure in two septic patients with helmet, both with severe coagulopathy. The presence of the rubber collar of the helmet is associated with difficult CICC insertion and the underarm straps tight around the axilla may increase the risk of thrombosis, in particular after cannulation of arm 29 The use of FICC has been advocated in COVID patients with helmet for non-invasive ventilation, 30 but to our knowledge we are the first to report a SFV approach in patients with helmet.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided cannulation of the superficial femoral vein for central venous access

et al. 2021

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Background: In some clinical conditions, central venous access is preferably or necessarily achieved by threading the catheter into the inferior vena cava. This can be obtained not only by puncture of the common femoral vein at the groin, but also—as suggested by few recent studies—by puncture of the superficial femoral vein at mid-thigh. Methods: We have retrospectively reviewed our experience with central catheters inserted by ultrasound-guided puncture and cannulation of the superficial femoral vein, focusing mainly on indications, technique of venipuncture, and incidence of immediate/early complications. Results: From June 2020 to December 2020, we have inserted 98 non-tunneled central venous catheters (tip in inferior vena cava or right atrium) by ultrasound-guided puncture of the superficial femoral vein at mid-thigh or in the lower third of the thigh, all of them secured by subcutaneous anchorage. The success of the maneuver was 100% and immediate/early complications were negligible. Follow-up of hospitalized patients (72.5% of all cases) showed only one episode of catheter dislodgment, no episode of infection and no episode of catheter related thrombosis. Conclusions: The ultrasound approach to the superficial femoral vein is an absolutely safe technique of central venous access. In our experience, it was not associated with any risk of severe insertion-related complications, even in patients with low platelet count or coagulation disorders. Also, the exit site of the catheter at mid-thigh may have advantages if compare to the exit site in the inguinal area.

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Axillary vein thrombosis in COVID positive patient with midline and continuous positive airway pressure Helmet

Cited by 8 publications

References 5 publications

Retrospective survey from vascular access team Lombardy net in COVID-19 era

Retrospective survey from vascular access team Lombardy net in COVID-19 era

Long peripheral cannula in COVID-19 patients: 769 catheter days experience from a semi-intensive respiratory COVID unit

Ultrasound-guided cannulation of the superficial femoral vein for central venous access

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