key: cord-0895597-jcvt3ain authors: Sinha, Manish D.; Saha, Prakash; Melhem, Nabil; Kessaris, Nicos; Biasi, Lukla; Booth, Caroline; Callaghan, Chris J.; Donati, Tommaso; Ostermann, Marlies; Patel, Sanjay; Ware, Nick; Zayed, Hany; Drage, Martin; Sallam, Morad title: Vascular access support teams: A multi-disciplinary response to optimise patient care during the COVID-19 pandemic date: 2021-06-25 journal: J Crit Care DOI: 10.1016/j.jcrc.2021.06.011 sha: 02b3a7d7d207857319dad3f849a48d4491629eb5 doc_id: 895597 cord_uid: jcvt3ain nan Global emergencies like the coronavirus disease 2019 (COVID-19) pandemic represent a major challenge for healthcare providers [1] [2] [3] . To provide the greatest good for the greatest number of patients, it is often necessary to re-arrange health care provision, including the redeployment 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 receiving 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 [4] , 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), arterial 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 regards to 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 procedureoriented teams like VAST have a crucial role in a pandemic [5] . 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. Not applicable. Not applicable. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. No funding was received. The crucible of war: innovation in a pandemic Intensive care during the coronavirus epidemic Expanding ICU facilities in an epidemic: recommendations based on experience from the SARS epidemic in Hong Kong and Singapore Complications of intravascular catheters in ICU: definitions, incidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation dressings (the ADVANCED study) Managing central venous access during a health care crisis All authors contributed to the data collection. MDS wrote the first draft. All authors revised the draft and approved the final version.Abbreviations: VAST, vascular access support team.