I had such high hopes for 2020. We started the year at the National Infusion and Vascular Access Society (NIVAS) with plans to produce practical, national guidelines for vascular access and IV therapy practice and develop a nationally accredited qualification for vascular access. Sadly, our best laid plans were not to be and these projects are on hold.
COVID-19 has affected all of us in many different ways. As the chair of NIVAS and as an IVAS service lead in my own hospital, my focus has been the same: what can we do in vascular access differently to adapt and cope with the pandemic? As it turned out, vascular access was at the forefront of our COVID-19 strategy, and we have learned some valuable lessons. We found that peripherally inserted central catheters (PICCs) were not the most suitable catheter for our critical care COVID-19 patients. Acute non-tunnelled neck central venous catheters (CVCs) were more reliable, short midlines placed with ultrasound scan were invaluable and the use of arterial catheters increased as the need for regular blood gas analysis became more relevant.
My team quickly became competent in ultrasound-guided arterial cannulation and acute neck CVC placement, finding new techniques for inserting vascular access devices for patients in the prone position, and placing devices wearing full personal protective equipment (PPE).
Nationally, the need for additional critical care beds was planned for early on in the pandemic and all hospitals found that it was not just a shortage of ventilators that became a problem, a shortage of infusion pumps also caused additional pressure. NIVAS was asked to produce some national guidance to support the use of gravity infusions and what to do in the event of an infusion pump shortage. Behind the scenes, NIVAS was supporting the NHS Supply Chain, which was working hard to ensure the NHS did not run out of vital IV and vascular access equipment, and it was successful because we did not. It is only since this national emergency that I realise how important IV therapy and vascular access is in the delivery of care in our health service, and how valuable vascular access teams have been and will be in the future.
I caught the dreaded virus myself at the beginning of April and was hospitalised for nearly a week. Having COVID-19 was awful and utterly terrifying. I was not alone, three other members of my team also contracted the virus despite all wearing full PPE. Luckily, we all made a full recovery. My experience was profound and being a healthcare provider probably made the experience worse because I had already seen the worst the virus could do to patients in intensive care before I became sick.
When I got back to work, I made some changes to our vascular access practice. We started using respirators instead of FFP3 masks and visors to place devices. The respirator hoods had been ordered at the beginning of March, and luckily they arrived just as we were experiencing the peak of our COVID-19 admissions in April. These hoods filter the air that is pumped into the hood. They made a world of difference in placing devices, mainly because the air was cool, and our vision was not obscured by sweat or steamed-up glasses. We also stripped down our ultrasound equipment and ECG technology to the bear minimum and used a plastic box to carry the equipment into isolation areas. This made cleaning the equipment and doffing our PPE much easier.
Being an optimist, I have tried to see a positive in all this heartache and mayhem. The pandemic has meant that I was able to increase my vascular access team from four to seven nurses, who now deliver a 7-day service, 8am to 8pm, across two acute hospital sites. This has always been a dream for me and the reality is that, since this new service model has been running, it has been extremely busy, even in recent days when our COVID-19 inpatients are virtually down to zero. It is my hope that other hospitals have taken similar opportunities to expand and grow their vascular access teams. It is clear to me that a modern and dynamic healthcare system should have a specialist vascular access team, one which is able to offer a tailored catheter insertion service, depending on the requirements of the service user.
Reading the comments from my Twitter feed and having recently joined an international vascular access Facebook group, I am not alone in my assumptions. Across the globe, the pandemic seems to have affected healthcare workers providing vascular access services in the same way.
As for me, I have strong COVID-19 antibodies now, which it seems are in high demand. I am donating plasma regularly for the COVID-19 convalescent plasma trial. NHS Blood and Transplant staff are wonderful and luckily very skilled at placing a 14-gauge cannula successfully every time.