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Crisis management during anaesthesia: vascular access problems
R J Singleton1, S B Kinnear, M Currie
1Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia.
Insights
A structured approach effectively manages vascular access problems during anesthesia. This method systematically checks the entire vascular access system, aiding early crisis resolution.
Area of Science:
- Anesthesiology
- Patient Safety
- Clinical Algorithms
Background:
- Vascular catheters are potential causes of anesthetic crises.
- Assumptions about device placement and function can be dangerous.
Purpose of the Study:
- To evaluate a core algorithm, "COVER ABCD-A SWIFT CHECK," with a vascular access sub-algorithm.
- To assess its role in managing anesthesia-related crises.
Main Methods:
- A structured approach was tested on 4000 incidents from the Australian Incident Monitoring Study (AIMS).
- The evaluation focused on problems related to vascular access.
Main Results:
- 128 incidents involved vascular access issues.
- The structured approach systematically addressed problems from distal to proximal, including infusion devices, lines, catheter-skin interface, vascular tree, central venous space, and staff interface.
- The algorithm successfully managed all identified vascular access problems.
Conclusions:
- The structured approach is a valuable clinical tool for anesthesia.
- It is easily remembered and applied for prompt resolution of vascular access issues.
Background:
In confronting an evolving crisis, the anaesthetist should consider the vascular catheter as a potential cause, abandoning assumptions that the device has been satisfactorily placed and is functioning correctly.
Objectives:
To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for vascular access problems, in the management of crises occurring in association with anaesthesia.
Methods:
The potential performance of a structured approach was evaluated for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS).
Results:
There were 128 incidents involving problems related to vascular access. The structured approach begins distally, checking the infusion device or fluid (12 incidents), moving proximally by way of the fluid giving line (10), the line deadspace (8), then the catheter/skin interface (65), and on to the peripheral vascular tree (3) and central venous space (23), and finally, the interface of the vascular access system and the attending staff (7). The approach was able to accommodate all the vascular access problems among the first 4000 incidents reported to AIMS.
Conclusion:
The approach has potential as an easily remembered and applied clinical tool to lead to early resolution of vascular access problems occurring during anaesthesia.
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