Oleari Francesco, Citterio Chiara, Bontini Salvatore, Grassi Oriella, Gozzo Corrado, Premoli Jessica, Mezzi Maria Pia, Roscio Stefano, Muroni Monica, Cremona Gabriele, Biasini Claudia, Mordenti Patrizia, Cavanna Luigi
Onco-hematology, Hospital Piacenza, Piacenza, ITA.
Cureus. 2022 Apr 15;14(4):e24157. doi: 10.7759/cureus.24157. eCollection 2022 Apr.
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.
背景 多项研究建议在治疗新冠肺炎患者时使用血管通路。然而，对于在住院新冠肺炎患者床边使用外周超声引导血管通路装置（UGVAD）的效用和安全性知之甚少。为了研究这一点，在意大利皮亚琴察市立卫生机构的肿瘤血液科进行了一项回顾性单中心研究。方法 我们回顾性分析了意大利北部一个地区三家综合医院中与住院新冠肺炎患者使用UGVAD相关的定位数据。VAD的定位由一个专业团队在超声引导下进行。主要终点是VAD直至患者康复或死亡的持续时间。次要终点是VAD使用的并发症，包括静脉血栓形成、感染、装置故障以及操作人员的病毒污染。结果 在2020年2月21日至2020年4月30日期间，253例连续住院的新冠肺炎肺炎患者接受了UGVAD定位。88.53%的患者插入了中线导管，而外周中心静脉导管和股静脉中心导管分别插入了9.88%和1.59%的患者。VAD的平均使用寿命为10.36±9.96天（范围：1 - 73天）。主要终点：VAD的使用使92.88%的患者能够接受计划治疗；在其余7.12%的患者中，VAD进行了重新定位。次要终点：15.02%的患者出现了VAD并发症（移位，9.49%；感染，1.98%；血栓形成，1.58%；堵塞，1.19%；故障，0.79%）。未记录到操作人员的污染情况。讨论与结论 由于本研究为回顾性研究存在局限性，我们的报告表明超声引导下VAD定位可能使住院新冠肺炎患者能够得到安全的临床管理（药物输注、补液、肠外营养和静脉放血）。遵守推荐程序可保护所有操作人员免受感染。
