Vascular specialists at Cedars-Sinai Medical Center in Los Angeles have developed a care system that markedly relieves the COVID-19 burden for regular ICU staff.
When the COVID-19 pandemic hit, some 20 interventionalists volunteered to be the go-to clinicians to insert invasive lines — both central venous catheters and arterial lines — so that ICU personnel could better focus on patient care.
They called themselves the COVID Line Team and have continued to provide their services through the most recent second peak of cases this winter. Last week, the team published a report in the Journal of Vascular Access on their experience in the first COVID surge in Los Angeles last March.
During that initial wave, Cedars had postponed elective surgeries to focus on critically ill patients. That left physicians like Evan Zahn, MD, a pediatric cardiologist at Cedars-Sinai’s Smidt Heart Institute, with little work during a time that felt more urgent than ever.
“I have a unique skill set,” Zahn told MedPage Today. Normally, he would spend most of his time on duty placing catheters in small, premature infants. “I didn’t really see what kind of role, if any, I would be playing [in the COVID-19 crisis] and that felt … wrong.”
He approached his boss, Eduardo Marban, MD, executive director of the Smidt Heart Institute, to see if his expertise could help.
“He said he’d do anything, ‘I’ll act as an intern if I need to’,” Marban said of Zahn. “And I was looking at a guy who could get a line into a rock.”
Knowing Zahn was highly proficient in placing invasive lines into the smallest patients, Marban sensed that he could easily transition to working with adult veins and arteries. He suggested that specialists like Zahn could relieve some of the load on ICU staff.
Leading the charge, Zahn fired off an email to other physicians with experience placing lines — such as anesthesiologists and other interventionalists — to see who might be willing to volunteer their unique skillset to the ICU. Within a day, almost 20 doctors had offered assistance.
Throughout the first COVID surge, the team of volunteers provided their services 24 hours a day, 7 days a week, until infection rates in Los Angeles started dwindling during the summer months.
Around the end of December, however, cases in the region began surging again, and the city would soon become the U.S. epicenter for COVID-19. But this time, with Cedars open again for elective surgery, members of the team have had to balance their full-time work with their volunteer shifts at the ICU.
Anesthesiologist Robert Wong, MD, who coordinates logistics for the COVID Line Team, noted that in the past two months — when the ICU was at its highest volume of COVID patients — specialists were consistently placing 8-10 lines a day.
“If the ICU team had to do it, I think their days would be four, six hours longer,” Wong told MedPage Today.
He said the vast majority of COVID patients in the ICU need invasive lines placed. Placing lines on non-COVID patients is challenging enough; add the donning and doffing of PPE and the meticulous sterilization protocols that are necessary when dealing with an infectious disease, and the placement of an invasive line can take ICU staff up to 90 minutes per patient. A specialist, ready to go in full PPE, could do it in under 30 minutes.
Their work not only gives ICU doctors and nurses more time to tend to other sick patients, but, by halving the time spent in contaminated rooms, it also lowers the overall risk of both team members contracting COVID themselves. So far, none of the COVID Line Team members have become infected.
At first, the Line Team members were making up the system’s standard operating procedures as they went, in order to meet the needs of the first wave. And while the physicians can no longer provide around-the-clock line placement services, the team had streamlined their practices well before the second wave hit.
“They didn’t need to reinvent the system from scratch,” said Dr. Marban. “Having already had all the physicians ready became a true godsend to the primary care team staff.”
Source: MedicalNewsToday.com
