Patterns of vascular access device use and thrombosis outcomes in patients with COVID-19: a pilot multi-site study of Michigan hospitals

Abstract

Venous thromboembolism (VTE) is an important complication of coronavirus disease 2019 (COVID-19). To date, few studies have described vascular access device use and VTE risk in this cohort. To examine the use of vascular access devices and incidence of VTE in patients hospitalized with COVID-19. We performed a retrospective, multi-center cohort study of patients hospitalized with COVID-19 who received a midline catheter, peripherally inserted central catheter (PICCs), tunneled or non-tunneled central venous catheter (CVC), hemodialysis (HD) catheter or a port during hospitalization. Mixed-effects multivariable logit models adjusting for VTE risk factors in the Caprini risk score were fit to understand the incremental risk of VTE in patients with vascular access devices vs. those that did not receive devices. Management of VTE was determined by examining anticoagulant use pre- vs. post-thrombosis. Results were expressed using odds ratios (ORs) and associated 95% confidence intervals (CI). A total of 1228 hospitalized COVID-19 patients in 40 hospitals, of which 261 (21.3%) received at least one vascular access device of interest, were included. The prevalence of acute, non-tunneled CVCs was 42.2%, acute HD catheters 18.4%, midline catheters 15.6%, PICCs 15.6%, tunneled CVCs 6.8%, and implanted ports 1.4%. The prevalence of VTE was 6.0% in the study cohort, and 10.0% among patients with vascular access devices. After adjusting for known VTE risk factors, patients that had a vascular access device placed were observed to have a four-fold greater odds of VTE than those that did not (OR 4.17, 95% CI 2.33–7.46). Patients who received multiple different catheters experienced more VTE events compared with patients that received only one type (21.5% vs. 6.1%, p < .001). Among the 26 patients with VTE, only 8 (30.8%) survived to discharge and among these, only 5 were discharged on therapeutic doses of anticoagulation. Hospitalized patients with COVID-19 that receive vascular access devices experienced higher rates of VTE than those that do not. Future studies to evaluate the nexus between COVID-19, vascular device use, and thrombosis appear are warranted.

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

“…Many studies have made recommendations on the type of positioning and management of VADs in COVID-19 patients [ 5 , 6 , 10 - 12 ]. However, data on the efficacy and safety of VAD positioning in hospitalized COVID-19 patients are fragmentary and poor [ 13 , 14 ]. In this study, 253 patients hospitalized with COVID-19 underwent VAD positioning.…”

“…It is well known that SARS-CoV-2 promotes a hypercoagulative state in infected patients. Recently, Sebolt et al [ 13 ] performed a retrospective multi-center cohort study of patients hospitalized with COVID-19 who received VADs (midline, PICC, non-tunneled CVC, hemodialysis catheter, or port catheter); 261 COVID-19 patients from 40 hospitals were included in this study. The authors reported a higher rate of venous thromboembolism (VTE) (10.0%) in patients who underwent VAD positioning than in those who did not.…”

“…Several papers have included recommendations for the use of vascular access in COVID-19 patients [ 5 , 6 , 10 - 12 ]. However, data on the results of positioning vascular devices in COVID-19 patients are fragmentary and poor [ 13 , 14 ]. In this retrospective study, we report the results of consecutive insertional procedures in 253 hospitalized COVID-19-infected patients in different phases of the disease [ 15 , 16 ].…”

Impact of COVID-19 pandemic on hemodialysis access thrombosis

“… 16 COVID-19 infection is a hypercoagulable condition and causes both arterial and venous thrombosis. 17 One explanation for the higher AVF thrombosis incidence rate in COVID-19 group could be the delay in intervention for stenosis diagnosis and management. Prompt monitoring and surveillance of dialysis access can detect stenosis and prevent AVF thrombosis.…”

Risk Assessment of Venous Thromboembolism among Septic Shock Patients: Single versus Concurrent Insertion of Central Venous Catheters

“…The Caprini risk score, first published in 1991, is a thrombotic risk assessment tool validated in over 250,000 surgical patients [11]. Its usefulness was proven in multiple clinical scenarios, including plastic surgery and perioperative care [12,13], but numerous studies utilized the Caprini score also in non-surgical patients to quantify the mortality risk in hospitalized patients [14], including in those with SARS-CoV-2 infection [15][16][17].…”