Vascular access support teams: A multi-disciplinary response to optimise patient care during the COVID-19 pandemic

Global emergencies like the coronavirus disease 2019 (COVID-19) pandemic represent a major challenge for healthcare providers. To provide the greatest good for the greatest number of patients, it is often necessary to re-arrange health care provision, including the re- deployment of staff and development of task-oriented teams. During the first COVID-19 wave, our hospital, a tertiary care center in the UK expanded its critical care capacity from the usual 54 to 150 beds and re-purposed non-critical care areas. At peak, the team cared for 151 critically ill patients. To help offload procedural tasks from the critical care team, a Vascular Access Support Team (VAST) consisting of senior surgical and non-surgical staff was established. Between 6 April - 10 May 2020, they inserted 190 catheters (central venous lines n = 182, arterial lines n = 8) in 122 patients (mean age 52.1 ± 13 years, 73% male, mean body mass index 30.2 ± 6.3), including 35 patients receiv- ing support with Extracorporeal membrane oxygenation (ECMO). The median number of lines placed by the VAST was 5 per day (range 0–17); 89 lines (46.8%) were inserted following an urgent referral. Complication rates were low compared to reports in the literature, despite the constraints related to limited space, personal protective equipment, practicing in remote areas and complex patient comorbidities. They included minor bleeding from the insertion site (n = 19), ar- terial puncture (n = 2) and line malposition requiring repositioning or re-siting (n = 6). Anonymous feedback from critical care staff via an online survey confirmed a high level of satisfaction. (Fig. 1) 98% agreed that the VAST service had met the requirements during a period of clinical urgency and the critical care team had been freed up to focus on other aspects of patient management. Most respondents estimated that between 2 and 3 h of critical care consultant time had been saved per unit per shift. The VAST team was considered to add value with regardsto a) expert line placement (47% respondents); ii) saving precious time and allowing teams to focus on other important jobs (92%); and iii) supporting junior medical and nursing colleague morale (63%). Our experience adds to reports from non-UK centers that procedure- oriented teams like VAST have a crucial role in a pandemic. Our thoughts relating to the opportunities and challenges when considering a VAST during a healthcare crisis are summarised in Table 1. Importantly, services like VAST represent a valuable resource in case of similar emergencies in the future.