Retrospective survey from vascular access team Lombardy net in COVID-19 era

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

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Abstract

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.

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  1. Version published to 10.1177/1129729821997252
  2. ScreenIT

    SciScore for 10.1101/2020.11.03.20222810: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: Ethical approval: The study (“REGISTRO DELLE INFEZIONI SOSPETTE E ACCERTATE COVID-19/Studio Sacco COVID-19)” was approved by the local ethical committee Milan Area 1 in ASST Fatebenefratelli Sacco, University Hospital Luigi Sacco with the registration number 2020/16088.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First of all, we compared the rate of VADs complications in two populations (COVID 19 positive and COVID free patients) which are probably different in terms of risk factors for CRT, CRBSI and AR. We reduced the effects of selection biases by using inverse probability propensity score weights to account for two confounders which significantly differed among the two populations (peripheral tip as central/peripheral and hospitalization as no/yes). However other potential demographic and clinical confounders should probably be taken into account when comparing such different populations. In our study we did not collect demographic and clinical data that could potentially represent risk factors for VADs complications; this is definitely another limitation of this investigation. Finally, our study is retrospective: the used VADs were chosen by the clinician for each patient and subsequently changed on the basis of clinical experience and data emerging from literature.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.03.20222810v1 on medRxiv