Jugular Vein Catheterization in Critically Ill Patients with Coronavirus Disease 2019 Can Increase the Surgeon’s Exposure

Dear Editor:

Airborne transmission is a common method of the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [1], and exhalation by infected people or carriers can easily expose healthy people to coronavirus disease 2019 (COVID-19). According to a report by the World Health Organization, the possibility of transmitting the virus through air during some procedures that generate aerosols, such as endotracheal intubation and bronchoscopy, is higher [2]. This report did not mention the possibility of transmitting the virus during the upper body’s vein catheterization. During the COVID-19 outbreak in northern Iran in 2020, in the educational hospitals of Babol University of Medical Sciences, four of the eight surgeons who performed jugular vein catheterization were infected despite wearing personal protective equipment. These physicians were screened for clinical and laboratory symptoms of COVID-19 before starting their duty in the COVID-19 ward, and all of them were confirmed to be healthy. Moreover, they were quarantined for 14 days after completing their work in the hospital and before returning home. All surgeons wore the N95 mask, face shield, glove, and insulated clothing. Therefore, we decided to change medical instructions for catheterization, and for all COVID-19 patients with respiratory system involvement, only femoral vein catheterization was allowed. After 4 weeks, if the patient’s symptoms disappeared and laboratory tests were negative, the jugular catheter replaced the femoral catheter. After notifying surgeons regarding this instruction, in 2 months, implantation was performed for 34 infected patients by ten healthy surgeons with a femoral catheter. Only two surgeons developed gastrointestinal symptoms due to their first-degree relatives’ involvement with COVID-19, and the other eight surgeons were healthy. No catheter-related infections were detected in these patients. This finding indicated that the surgeons who try to install the venous catheter in the upper body veins are at a risk for SARS-CoV-2 infection by airborne transmission. Recently an article published by Jasinski et al. [3] laid down a catheter embedding protocol to prevent doctors and nurses from working in COVID-19 wards during central vein catheterization. They decided to utilize the triple-lumen peripherally inserted central catheters as the preferred means of establishing central vein access. Their findings indicated low staff exposure, similar to our findings. Therefore, personal protection equipment is vital for preventing the infection during jugular catheterization. However, in case full protection is impossible, the jugular catheter can be replaced with the femoral catheter to protect the performing surgeons. In conclusion, awareness of personal protection, sufficient personal protective equipment, and proper preparedness and response play vital roles in lowering the risk of infection.