COVID-19 and vascular access: Evidence and lessons for improving the standard of care, a scoping review

The Coronavirus Disease 2019 (COVID-19) pandemic has significantly impacted intravenous therapy practices, particularly in critically ill patients. Vascular access strategies were adapted to evolving clinical needs, infection control priorities, and resource limitations, with a focus on safety, efficacy, and technological advancements. This scoping review aimed to explore how the COVID-19 pandemic affected vascular access practices and catheter-related complications, with the objective of mapping innovations, identifying emerging trends, and summarizing preventive and therapeutic strategies. The review followed PRISMA-ScR guidelines and was registered in PROSPERO (CRD420251027530). A systematic search was conducted in PubMed®, EMBASE®, EBSCO-CINAHL®, and CENTRAL for English-language studies published between January 2020 and May 2025 addressing catheter-related complications in COVID-19 patients, including catheter-related bloodstream infections (CRBSI), central line-associated bloodstream infections (CLABSI), catheter-related thrombosis (CRT), and accidental catheter removal. Among 521 screened articles, 58 met the inclusion criteria. Most studies reported higher rates of CRBSI, CLABSI, CRT, and accidental removal in COVID-19 patients, especially in critical care settings. Arterial catheters were also associated with elevated risks of thrombosis and infection during the pandemic. Mid-thigh femoral access sites emerged as practical alternatives to reduce central line use and healthcare personnel exposure. Technological advances, including power-injectable catheters, ultrasound-guided insertion, intracavitary ECG for tip confirmation, and securement tools such as cyanoacrylate glue and subcutaneous anchor systems, improved safety and reduced mechanical and infectious complications. Chlorhexidine-based antisepsis, antimicrobial-impregnated devices, and disinfectant caps effectively decreased CRBSI and CLABSI rates. In older, comorbid patients—now representing the majority of COVID-19 hospitalizations—nutritional and anticoagulant therapy must be carefully balanced to minimize bleeding and thrombotic risks. In conclusion, the pandemic catalyzed significant innovation and adaptation in vascular access practices. Integrating portable technologies, infection prevention strategies, and alternative access routes has enhanced patient care and established new standards for managing intravenous therapy in high-risk, resource-constrained settings.