Recommendations for the use of vascular access in the COVID-19 patients: an Italian perspective

Abstract

Due to their longer dwell time, midline catheters will reduce the number of peripheral venous insertions required (thus saving resources and reducing risks for the operator); they will allow high flow infusions and easy blood sampling; if indicated, they might be easily replaced over guidewire with a peripherally inserted central catheter (PICC). Choose an exit site at mid-thigh, away from the groin, either by puncturing the common femoral vein and then tunneling to mid-thigh or by directly puncturing the superficial femoral vein at mid-thigh. * When inserting a CICC, prefer an infraclavicular approach (ultrasound-guided puncture and cannulation of the axillary vein) rather than a supraclavicular approach, so to provide greater protection and stability of the catheter at the exit site. * In the absence of contraindications, give low molecular weight heparin at prophylactic (100 units/kg/24 h) or even therapeutic (100 units/kg/12 h or 150 units/kg/24 h) dose in all COVID-19 patients with central lines, so to reduce the thrombotic risk. 3. 4) Recommendations on the appropriate precautions to avoid operator contamination: * For patient protection, adopt the standard barrier precautions (hand hygiene, skin antisepsis with 2% chlorhexidine in 70% isopropyl alcohol, non-sterile surgical mask, non-sterile cap, sterile gloves, waterproof sterile gown, wide sterile field on the patient, sterile probe cover of appropriate length). * For protection of the operator, adopt the standard personal protective equipment for contact protection (double glove, full suit, goggles or face shield, footwear); use both a surgical mask and a protective mask with N95 filter (equivalent to FFP2 of the European nomenclature), considering the high risk of aerosol in the environment, especially in the extubated and symptomatic COVID patient on NIV.