Retrospective survey from Vascular Access Team Lombardy Net in COVID-19 era

  1. Gidaro Antonio
  2. Vailati Davide
  3. Gemma Marco
  4. Lugli Francesca
  5. Casella Francesco
  6. Cogliati Chiara
  7. Canelli Antonio
  8. Nadia Cremonesi
  9. Monolo Davide
  10. Cordio Giuseppe
  11. Frosi Chiara
  12. Destefanis Riccardo
  13. Rossi Anna
  14. Alemanno Maria Chiara
  15. Valenza Franco
  16. Elli Stefano
  17. Caldarini Andrea
  18. Lucchini Alberto
  19. Paglia Stefano
  20. Baroni Monica
  21. Giustivi Davide
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Abstract

Background

Venous Access Devices (VADs) are the most used device in COVID-19 patients.

Objective

Identify VADs implanted, catheter related thrombosis (CRT), catheter-related bloodstream infection (CRBSI), and accidental remove of VADs in both COVID-19 positive and COVID-19 free patients. Successive analysis was conducted comparing COVID-19 positive patients with COVID-19 free with inverse probability propensity score weights using simple regression to account for these two confounders (peripheral tip as central/peripheral and hospitalization as no/yes).

Methods

This multicenter, retrospective cohort study was conducted using data from 7 hospitals in Lombardy during the pandemic period from February 21 st to May 31 st 2020.

Results

2206 VADs were evaluated, of which 1107 (50.2%) were inserted in COVID-19 patients. In COVID-19 cohort the first choice was Long Peripheral Cannula in 388 patients (35.1%) followed by Midline Catheter in 385 (34.8%). The number of “central tip” VADs inserted in COVID-free inpatients and COVID-19 positive were similar (307vs334). We recorded 42 (1.9%) CRT; 32 (79.2%) were observed in COVID-19 patients. 19 CRBSI were diagnosed; 15 (78.95%) were observed in COVID-19. Accidental removals were the more represented complication with 123 cases, 85 (69.1%) of them were in COVID-19. COVID-19 significantly predicted occurrence of CRT (OR = 2.00(1.85-5.03); P<0.001), CRSB (OR = 3.82(1.82-8.97); P<0.001), and Accidental Removal (OR = 2.39(1.80-3.20); P<0.001) in our propensity score weighted models.

Conclusions

CRT, CRBSI, and accidental removal are significantly more frequent in COVID-19 patients. Accidental removals are the principal complication, for this reason use of subcutaneously anchored securement is recommended for shorter period than usual.

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