Patients with difficult intravenous access (DIVA) are at increased risk of delays, discomfort and complications due to multiple failed intravenous access attempts. However, evidence comparing commonly used alternatives, short midline catheters (SMLs) and central venous catheters (CVCs) in this population is limited.

To evaluate the feasibility of a larger randomised controlled trial comparing SMLs with CVCs in DIVA patients using predefined feasibility outcomes.

This trial was a pragmatic, open-label, single-centre, randomised controlled pilot trial with 1:1 randomisation. Participants were recruited from January to August 2025 with follow-up until September 2025.

Ryhov County Hospital, Jönköping, a teaching county hospital in Sweden.

Adult patients (≥18 years) with DIVA, requiring intravenous therapy for 4–29 days.

Patients received either a 10-cm SML in the upper arm or a single- or double-lumen CVC in the jugular or subclavian vein.

Primary outcomes were feasibility criteria: eligibility, recruitment, retention, adherence, missing data and skin puncture attempts. Secondary outcomes included insertion and dwell time, and catheter complications (infection, thrombosis and malfunction).

Of 73 patients screened, 40 (55%) were eligible and 30 (75%) (15 males (50%); median (IQR) age, 73 (61–82) years) were randomised to receive SML (n=15) or CVC (n=15). Three patients in the SML group were not included in the data analysis due to one failed insertion and two incomplete follow-ups. Retention (93%), adherence (97%) and missing data (0%) fulfilled predefined thresholds. The only criterion not met was the number of skin puncture attempts, with 52% of patients requiring two or more. Median catheter dwell time was 5.5 days for SML and 4.0 days for CVC. Complication rates per 1000 catheter days were 101.4 for SML versus 9.1 for CVC, primarily due to a higher rate of malfunction in SML (58% versus 7%). No infections or thromboses were observed.

This pilot trial met all but one feasibility criterion, demonstrating that a larger randomised controlled trial is achievable. The findings highlight practical challenges, particularly related to puncture attempts and catheter performance, that should be addressed in the design of a definitive trial.

NCT06719869.

This study aimed to investigate the impact of socioeconomic status and country of origin on COVID-19 outcomes in Swedish intensive care units (ICUs), hypothesising that these factors are independently associated with 90-day mortality.

Registry-based cohort study.

Swedish ICUs, from 6 March 2020 to 31 December 2022.

Adults (≥18 years) with confirmed SARS-CoV-2 infection and acute hypoxaemic respiratory failure. A total of 5833 patients were included in the multivariable model.

Not applicable.

The primary outcome was 90-day mortality. Secondary outcomes included 1-year mortality and ventilator and renal replacement therapy-free days within 60 days post-ICU admission.

Non-European country of origin was independently associated with higher 90-day and 1-year mortality adjusted OR (aOR) 1.34 [95% CI 1.13 to 1.61], p=0.001, aOR 1.26 [95% CI 1.01 to 1.5], p=0.01, respectively. Socioeconomic variables did not significantly impact mortality or organ support-free days. Other predictors of 90-day mortality included age, sex, chronic heart and lung disease, Simplified Acute Physiology Score 3 score, immunosuppression, time in hospital prior to ICU admission, pandemic wave and admission Partial pressure of oxygen in arterial blood/Fraction of inspired oxygen-ratio.

The study identified significant disparities in COVID-19 outcomes based on country of origin, with non-European patients facing higher mortality risks. These findings could challenge the notion of equitable healthcare in Sweden and underscore the need for further research into systemic inequalities.