Crisis management during anaesthesia: vascular access problems

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.