Background: During the COVID-19 pandemic, Poland saw a surge in interest in midline catheters (MCs) and Long Peripheral Catheters (LPCs) for intravenous therapy. Before this, MCs were not extensively utilised in the country, and there was no formally established Polish vascular access team. MCs, which have been used for years in many countries, are now becoming increasingly common in Poland. This study aimed to analyse the use of MCs in a 3-year perspective of their introduction in daily clinical practice based on a nurse-led Vascular Access Team (VAT). Methods: The records of adult patients who received intravenous therapy with 727 MCs and 293 LPCs from January 2021 to December 2023 at the University Clinical Centre of the Medical University of Warsaw were analysed. Results: The main indication for cannulation was expected intravenous therapy over 5 days (81.66%, n = 833), of which 71.37% ( n = 728) of patients in this group had concomitant difficult intravenous access (DIVA). Over 6 years, centrally inserted central catheters (CICCs) inserted due to DIVA were reduced from n = 108 in 2017 to n = 18 in 2023. The end of intravenous therapy was the reason for the removal of 64.6% of catheters ( n = 659), including death and switch to CICCs as well. Complications leading to premature removal accounted for 31.2%, such as: occlusion (14.6%), patient self-removal (7.1%) and thrombosis (3.43%). Conclusions: The introduction of MCs as a possible option for peripheral venous access reduces the use of CVCs. Developing MCs programmes should be based on investing in staff competencies, which increases success rates. The nurses and physicians should be trained in infusion care to achieve better results in the use of MCs and LPCs. Increasing the competence of nurses in Poland is necessary for the implementation of full-service and top-level functioning of VAT.

Introduction. Midline catheters (MCs) are an option for vascular access alongside the commonly used short peripheral intravenous catheters, centrally and peripherally inserted central catheters. Aim. The aim of this study was to evaluate the solution implemented during the COVID-19 pandemic in a centre where MC access had not been used before. Material and method. It was an observational retrospective evaluation of the 98 medical registries of adult patients. Results. The mean time from hospital admission to midline catheter insertion was 15 days. The most common indications for the catheter implementation were: difficult intravenous access (83%) and expected time hospital stay >6 days (17%). The mean dwell time of the catheters was 9 days. The most common reasons for removal were: the end of intravenous therapy (44%) and catheter blockages (36%). Conclusions. A high level of prematurely removed catheters was observed, despite the existence of a hospital protocol. The high percentage of MCs removed before the end of intravenous therapy may be indicative of the poor quality of care and the need for continuous education of medical staff. The results obtained should be confi rmed in a prospective study planned on their basis in order to identify interventions which are necessary to improve the quality of vascular access care.

Aim. The aim of the study was to conduct a retrospective analysis of cannulations done under ultrasound guidance by the Vascular Access and Infusion Team using the Seldinger technique. Material and methods. This observational study was retrospective in nature. Analysis was carried out of 82 cannulation charts reporting procedures from March to August 2022 at the University Clinical Centre of the Medical University of Warsaw. Results. Midline access was gained in 86 patients with a success rate of 95.3% (n=82). Cannulation by nurses was performed in 93% (n=80) of the patients. The procedure required an average of 1.62 attempts. The most frequently cannulated veins were the basilic (72%, n=59) and brachial (14.6%, n=12) ones. MC removal in 40.2% (n=33) of the cases was due to the termination of intravenous therapy, and in 23.4% (n=19) was caused by complications related to infusion management. Conclusions. Implantation of midline catheters in patients, including those with difficult intravenous access, can be done eff ectively with a minimum number of cannulation attempts. Maintaining midline catheters for the entire duration of therapy is challenging due to potential complications and requires rigorous care during their use. A detailed analysis of possible complications distinguishing between diff erent types of complications and continuous improvement of observation protocols and appropriate management is advisable. It is also advisable to plan and conduct an observational study in the area of retrospective analysis.

These guidelines provide evidence-based recommendations for central venous cannulation in critically ill patients in the intensive care unit. The document was developed by the Working Group of the Polish Society of Anaesthesiology and Intensive Therapy (Polskie Towarzystwo Anestezjologii i Intensywnej Terapii – PTAiIT) based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, which encompasses systematic reviews of the literature, meta-analyses, and – in the absence of sufficient data – expert consensus. These guidelines aim to standardise the approach to central venous cannulation, increase the effectiveness of procedures, and minimise the risk of complications. The guidelines address pre-procedural ultrasound assessment, selection of the optimal vascular access site, comparison of ultrasound-guided versus landmark cannulation at different access sites, confirmation of catheter position after cannulation, and the role of positional manoeuvres.

The use of midline catheters (MCs), alongside Long Peripheral Catheters (LPCs) and Peripherally Inserted Central Catheters (PICCs) is one option to reduce multiple cannulations for Difficult Intravenous Access (DIVA) and multiple insertions of Short Peripheral Catheters (SPCs). In some patients, a larger catheter may need to be inserted, but this is not possible due to limitations in the availability of appropriate veins. Benvenuti et al. described a simple, safe and effective ‚pseudo-tunneling’ technique that is worth using in clinical practice to achieve the best possible therapeutic outcome despite unfavourable anatomical conditions. In clinical situations that require a larger size than the vein available at the site of the planned puncture, it is not always necessary to give up the most suitable midline catheter. Pseudo-tunneling is easy to apply and is an effective solution for small-diameter veins.

Intravenous therapy is a common procedure performed in hospitals. Patients in surgical departments usually require intravenous access due to a planned surgical procedure, and therefore anaesthesia, pain, antibiotic, and fluid therapy. Problems in obtaining intravenous access, even by experienced...