[Home care: home venous access device insertion during covid-19 pandemic in not autonomous patients. From an emergency activity to a daily work practice.] / Cure a casa: posizionamento di dispositivo venoso a domicilio per pazienti non autonomi durante la pandemia covid-19. Da attività in emergenza a pratica routinaria.

INTRODUCTION: Reliable venous access is essential in providing effective care for many patients. Various vascular access devices (VAD) are available, and are placed by a specialized team using ultrasound guidance in a dedicated room of the hospital; however, during the pandemic covid-19 many not autonomous or bedridden patients were unable to reach the hospital for VAD insertion, because the unavailability of ambulance for the transport. For this reason the specialized team organized a modality for positioning the VAD at bedside at home. METHODS: In 2012 a VAD-team was established by the health authority in the oncology-hematology Department at the hospital of Piacenza. This team was dedicated in positioning ultrasound-guided vascular access. During the covid-19 pandemic the VAD-team modified its organization to reach patients at home to position VAD, initially for oncologic people unable to go to the hospital; this procedure was subsequently extended to other bedridden patients with non-oncologic disease. The positioning of the VAD was performed under ultrasound guidance, according to the same modalities used in hospital. The primary endpoin was the suitability of the VAD to allow the planned treatment. The secondary endpoint was complications of the use of VADs. RESULTS: Between March 2020 to December 2020 and January 2021 to December 2021, VAD were positioned in 118 and 134 patients respectively. The VAD utilized were midlines for each patient. The mean age of the patients was 88 years, the majority were female (>60%). The majority of the patients had neurodegenerative disease (>60%) or advanced cancers (>25%). The VAD allowed the planned treatment in 94% of the patients. The complications were infrequent: VAD dislocation (<1%), thrombosis (<2%). No infection was registered. DISCUSSION AND CONCLUSION: During covid-19 pandemic, the VAD-team demonstrated the feasibility of VADs home positioning, for patients that need to be transported by ambulance to the hospital for a venous catheter insertion. This procedure allows saving of economic and human resources both for patients and caregivers, in addiction can leave the ambulance free for other use. Due to this study, this procedure has become routine practice in our health district for patients bedridden or not autonomous.

Bedside Peripheral Ultrasound-Guided Vascular Access in 253 Patients Hospitalized With COVID-19 Pneumonia: A Retrospective Italian Study.

Background Several studies have recommended the use of vascular access in the treatment of COVID-19 patients. However, little is known about the utility and safety of using a peripheral ultrasound-guided vascular access device (UGVAD) at the bedside of hospitalized COVID-19 patients. To examine this, a retrospective monocenter study was carried out at the oncology-hematology department of Azienda Sanitaria di Piacenza, Italy. Methods We retrospectively analyzed data from three general hospitals in a district in North Italy on the positioning of UGVADs used with hospitalized COVID-19 patients. The positioning of the VAD was performed by a dedicated team using ultrasound guidance. The primary endpoint was the duration of VAD until the patient's recovery or death. The secondary endpoints were complications of the use of VADs, which included vein thrombosis, infections, device malfunction, and viral contamination of the operators. Results Between February 21, 2020, and April 30, 2020, 253 consecutive hospitalized patients with COVID-19 pneumonia underwent UGVAD positioning. A midline was inserted in 88.53% of the patients, while peripheral central venous catheters and femoral central catheters were inserted in 9.88% and 1.59% of the patients, respectively. The mean lifespan of the VADs was 10.36±9.96 days (range: 1-73). Primary endpoint: The use of the VAD allowed the planned treatment in 92.88% of the patients; in the remaining 7.12%, the VAD was repositioned. Secondary endpoints: Complications of VAD were registered in 15.02% of the patients (dislocation, 9.49%; infection, 1.98%; thrombosis, 1.58%; occlusion, 1.19%; and malfunction, 0.79%). No contamination of the operators was registered. Discussion and conclusion With the limitation of being a retrospective study, our report suggests that ultrasound-guided positioning of VAD may allow the safe clinical management (drug infusion, hydration, parenteral nutrition, and phlebotomy) of hospitalized COVID-19 patients. The observance of recommended procedures protected all operators from infection.