Our study suggests that SAS is a highly effective and cost-effective method for securement of medium- to long-term PICCs with expected duration longer than 30 days. The introduction of SAS had a positive impact on our healthcare organization.

Background: Venous Access Devices (VADs) are the most used devices 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 collected data from seven hospitals in Lombardy during the pandemic period from February 21st to May 31st 2020. Results: A total of 2206 VADs were evaluated, 1107 (50.2%) of which 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 (307 vs 334). We recorded 42 (1.9%) CRT; 32 (79.2%) were observed in COVID-19 patients. A total of 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, the use of subcutaneously anchored securement is recommended for a shorter period than usual.

Today's patients are more complex in terms of comorbidities and other conditions requiring multiple, long-lasting therapies such as chemotherapy, total parenteral nutrition, blood transfusion or blood component infusions, and frequent blood sampling. The use of central venous catheters represents an important aspect of care for many patients. It is essential to inform health care workers of the risks associated with central venous catheters such as systemic and infectious complications, mechanical complications, and/or thrombotic complications. To maintain monitoring of our peripherally inserted central catheter team's activity, we developed and adopted a database in which all the data regarding each catheter are recorded. By doing that, we have improved catheter management, clinical efficiency, as well as achieved a cost reduction. We implanted 1416 vascular access devices in 1341 patients of both sexes (632 male and 709 female) for a total of 135,778 vascular access device-implant days between March 2010 and December 2013 for several indications. We have followed-up total complications and we correlated them with the need for catheter removal. The results were that open-tipped catheters resulted in both more complications and a greater need for removal.

We describe the case of a coronavirus disease patient with midline who, during ventilation with continuous positive airway pressure helmet with underarm fastening straps, presented thrombosis of the axillary vein in the armpit. The tip of the midline ended in the armpit. The thrombosis has been resolved with anticoagulant therapy with low molecular weight heparin of 100 IU/kg bid without giving pulmonary embolism. In an emergency context like this, the need to resort to ventilation strategies even in departments generally not accustomed to the use of these devices and to the management of this type of patients, the need to use and adapt the available material (e.g. being unable to renounce to use underarm fastening straps) obliges us to consider the use of alternative strategies also in the field of vascular access. After this case, we began to consider techniques that allow us to prevent the catheter from ending in the armpit, with benefit. It is essential to continue to observe this patient.

Background: Venous Access Devices (VADs) are the most used device in COVID-19 patients. To the best of our knowledge this is first survey on VADs in COVID-19 era. Objective: Identify 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 21st to May 31st 2020. Results: In the observation period 2206 VADs were evaluated, of which 1107 (50.2%) were inserted in COVID-19 patients. We recorded 42 (1.9%) CRT; 32 (79.2%) were observed in COVID-19 patients. 19 CRBSI were diagnosed. 15 were observed in COVID-19 group (78.95%). Accidental removals were the more represented complication with 123 registered cases, 85 of them (69.1%) 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, but with a rate similar to the literature reports. Accidental removals are the principal complication, for this reason use of subcutaneously anchored securement is recommended for shorter period than usual.