evaluate whether hand-grip ball exercises reduce thrombosis and occlusions of Midline catheters in hospitalized patients.

The proposed intervention consists of low-intensity, short-duration, non-invasive, and non-pharmacological exercises, with an expected minimal risk profile. The aim of the study is therefore to systematically evaluate the effectiveness and safety of this practice in patients with Midline catheters, in a context of genuine scientific uncertainty, in order to generate evidence useful for clinical practice.

Primary objective To compare the effectiveness of a structured upper-limb exercise program versus usual care in reducing the incidence of Midline catheter-related thrombosis/occlusions in a population of hospitalized patients.

Associated endpoints

Incidence of Midline thrombosis (%) confirmed by ultrasound.

Inclusion Criteria:

• Midline catheter insertion for planned intravenous therapy lasting ≥ 7 days. Age between 18 and 70 years. Catheter inserted in the upper limb (forearm). Ability to understand and perform hand exercises with the limb bearing the venous catheter.

Written informed consent.

Exclusion Criteria:

• Pre-existing superficial or deep venous thrombosis of the limb used for the Midline catheter.

Limb injuries or amputations. Motor or neurological impairment of the hand. Life expectancy < 7 days. Cognitive impairment/delirium. Medical contraindications to active upper-limb movement.