Introduction <p>Vascular access devices (VADs) play a critical role in clinical practice, facilitating the administration of medications, fluid therapy, and parenteral nutrition. Nevertheless, improper selection of VADs can result in various complications, escalate healthcare costs, and significantly impact patients’ experience. This study seeks to evaluate the appropriateness of VAD selection in contemporary clinical practice.</p> Methods <p>A prospective observational pilot study was conducted between September 1st and December 31st, 2023, in two medical wards at Careggi University Hospital, Florence, Italy. Data on VAD type, insertion, maintenance, and complications were collected. The primary outcome was the appropriate selection of central VADs (CVADs) and peripheral VADs (PVADs) as recommended by the most recent international guidelines and consensus documents.</p> Results <p>A total of 322 VADs were inserted in the considered period, out of which 23 (7.1%) were CVADs and 299 (92.9%) were PVADs. Peripherally Inserted Central Catheter (PICC, <i>n</i> = 10; 43.5%) was the most represented CVAD, followed by ports (<i>n</i> = 6; 26%), Centrally Inserted Central Catheters (CICC, <i>n</i> = 4; 17.4%), and Femorally Inserted Central Catheters (FICC, <i>n</i> = 3; 13%). Short peripheral cannulas (SPC) were the most represented PVADs (<i>n</i> = 257; 86%), followed by long peripheral cannulas (LPC) (32; 10.7%), and midline (MC) (<i>n</i> = 10; 3.3%). CVADs were appropriate in 82.6% of cases, whereas PVADs’ appropriateness fell to 43.1%. Overall, 47 VAD failures were observed: 6 (26.1%) CVADs and 41 (13.7%) PVADs.</p> Conclusion <p>This study found a high prevalence of inappropriate VAD selection in hospitalised patients, especially among PVADs, although with no increased risk of complications. Further studies are needed to address effective strategies for improving the selection of VADs.</p>