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Background: SARS-Cov-2(covid-19) infection is associated with Systemic Hyercoagulability and Thrombo-Embolic Complications. Anticoagulants play a key role in their management. Despite anticoagulants we have observed five case of RBBB MI in our ICU which co-relates with the thrombotic complication. And hence, Efficacy of the anticoagulants is debatable and requires meticulous APTT monitoring. Efficacy of thrombolysis is also not clear. A current guideline gives more emphasis on PCI over thrombolysis in RBBB MI patients. BUT unfortunate turn of events into catastrophe happened in these cases due to non-feasibility of cathlab interventions in covid-19 pandemic scenario. Material and Methods: This is A case series of five patients that were COVID-19 positive admitted to the ICU and Developed RBBB MI during their ICU stay despite on anticoagulant therapy. Data was collected retrospectively from hospital indoor records. Positive case of COVID-19 was confirmed by RT-PCR assay of nasopharyngeal or oropharyngeal swab specimen. Conclusion: Development of RBBB MI in covid-19 patients on anticoagulants co-relates with the thrombotic complication of SARS-CoV-2 infection and failure of the therapeutic management. PCI can be considered as a gold standard intervention compared to thrombolysis. BUT unfortunate turn of events into catastrophe happened in these cases due to non-feasibility of cathlab interventions in covid-19 pandemic scenario. [ABSTRACT FROM AUTHOR]

Introduction: The use of ultrasound imaging before or during vascular cannulation greatly improves first-pass success and reduces complications, but this skill must then be combined with manual dexterity to perform the three dimensional (3D) procedure of placing a catheter into the deep veins while analyzing the 2D images. Hence this study is an attempt to still decrease the above mentioned limitation of guided deep vein cannulation by slight modification in the insertion technique. Aims and objectives: Aims to compare the ultrasound guided deep vein cannulation by conventional insertion technique(CIT) v/s ultrasound guided perpendicular insertion technique (PIT). Main comparison parameters here are number of attempts required, time taken for successful insertion, vessel counter puncture, arterial puncture and other known mechanical complications of deep venous cannulation. Material and method: Prospective, non randomized cross sectional study, done over 200 patients in two arms. Data-analysed by epi2k and state-9 software. Results: Total number of insertions were 64 by CIT v/s 136 by the PIT. Mean of number of attempts required were 1.918 with the CIT v/s 1.106 for the PIT method. Mean of time of cannulation was 78.62 + 18 sec with CIT while it was 66.98 + 12 sec for PIT and this was statistically significant(P = 0.041). Incidence of vessel counter-puncture was much lower in PIT as compared to CIT (6.1 % v/s 16.2%). 5.9% cannulation done by CIT had arterial puncture v/s 0.8% with the PIT. Not a single episode of any other mechanical complications with either of the method. Conclusion: USG guided perpendicular method is less time consuming, less number of attempts are required and there are less chances of arterial picture or vessel counter puncture. [ABSTRACT FROM AUTHOR]