Home vascular access device insertion during covid-19 pandemic
Abstract:
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.
Reference:
Grassi O, Oleari F, Citterio C, Bontini S, Gozzo C, Premoli J, Mezzi MP, Roscio S, Muroni M, Cremona G, Biasini C, Mordenti P, Cavanna L. 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 [Home care: home venous access device insertion during covid-19 pandemic in not autonomous patients. From an emergency activity to a daily work practice.]. Recenti Prog Med. 2022 Nov;113(11):669-673. Italian. doi: 10.1701/3907.38894. PMID: 36318170.