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Objective:To evaluate the effect of blunt separation method on peripherally inserted central venous catheters.Methods:The randomized controlled trials regard to the effect of blunt separation method on peripheral central venous catheters were retrieved from CNKI, Wan fang Data Knowledge Service Platform, CQVIP, CBM, Cochrane, PubMed, EMBASE and Web of science from January 2010 to March 2021, two researchers performed quality assessments and extracted data according to Cochrane evaluation manual standards. RevMan 5. 4 software was used for statistical analysis.Results:A total of 11 randomized controlled trials were analyzed, including 1379 participants. The meta-analysis results showed that there was no statistical difference in the successful rate of one-time sheath delivery ( OR=1.62, 95% CI 0.92-2.86, P>0.05). However, patients in blunt separation group showed lower blood loss ( OR=0.24, 95% CI 0.11-0.50, P<0.05), lower the incidence of seepage at puncture site ( OR=0.18, 95% CI 0.09-0.37, P<0.05) than those in traditional skin expansion group at 24h after catheterization, and less the time of maintenance within 7 days after catheterization ( MD=-0.95, 95% CI-1.78--0.11, respectively, P<0.05). Conclusions:Blunt separation method can significantly reduce the incidence of complications and the time of catheter maintenance. Due to the limited quality of included studies, more high quality studies are needed to verify the conclusions.
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Objective To investigate the effect of modified radiographic position for peripherally inserted central catheter (PICC) on XGray imaging.Methods FiftyGone patients of standard anteriorGposterior radiography (control group)and 50 patients of radiography with the left side of the body tilted 10 to 30 degrees to the right (modified group)were collected retrospectively.The quality of imaging was analyzed between groups.Results The image quality was significantly improved in the modified group (χ2＝ 1 7.27,P＜0.05).Conclusion When the bedside mobile DR is performed on PICC patients,raising the left side of the body and tilting to the right 10 to 30 degrees,known as modified radiographic position,can effectively increase the image quality and improve the identification of PICC,so as to accurately determine the depth of the PICC catheter.
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Objective: To explore the risk of incidence of catheter-related thrombosis in cancer patients receiving chemotherapy using nomogran. Methods: We retrospectively evaluated 286 patients with malignant tumor who needed PICC insertion at the First Affiliated Hospital of Xi'an Jiaotong University between December 2014 and December 2015. Potential risk factors were included in the least absolute shrinkage and selection operator (LASSO) regression analysis to finally build a nomogram to predict the risk of PICC-related thrombosis. Results: A total of 286 patients who needed PICC insertion were analyzed, among whom 72 experienced PICC- related thrombosis. Twenty-seven potential thrombosis-related risk factors were included in the LASSO regression analysis. The results indicated that the use of ultrasound guidance during insertion, previous chemotherapy, other catheter-related complications, and plasma Ddimer were the risk factors of PICC related thrombosis. Thus, these four risk factors were applied to the nomogram model. Further,the nomogram prediction model yielded a C-index of 0.688 and the adjusted fitting curve was located in the error range of 10%. Conclusions:Combined with puncture technology, previous chemotherapy history, complications, and D-dimer level constituted the nomogram prediction model for PICC-related thrombosis which had a good accuracy.
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Objective To study the advantages and disadvantages of two methods(the peripherally inserted central venous catheter (PICC) and the totally implantable venous-access ports (TIVAP) in the chemotherapy of tumor patients. Methods The clinical data of 160 patients treated with PICC or TIVAP from March 2016 to December 2016 were retrospectively reviewed,and the complications of the two groups were compared and reviewed. Results The catheter occlusion rate,catheter infection rate and the incidence of phlebitis in the TIVAP group were lower than that in the PICC group (P<0.05). Conclusions The patents treated with TIVAP have fewer complications and prolonged indwelling time has no impact on the life quality of patients.
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Objective To analyze and summarize the clinical effect of peripherally inserted central catheters (PICC) guided by B-ultrasound,and to discuss the catheterization skills of PICC guided by B ultrasound.Methods Retrospectively analyzed the clinical data of 102 patients recieved PICC guided by ultrasound in neurosurgery department of Chongqing emergency medical center from January 2016 to May 2017.The success rate of one-time puncture, the success rate of one-time catheter delivery and the number of complications were analyzed, and the causes and treatment methods of complications were analyzed.Results Of the 102 cases,94 cases were successfully punctured in one time,6 cases were punctured twice,and 2 cases were punctured more than 2 times.The one-time puncture success rate was 92.16%.Catheter misplacement occurred in 5 patients,and postoperative complications occurred in 2 patients.Conclusion Mastering the related angiotomy and imaging knowledge of PICC and using the B-ultrasound guidance system to insert the catheter can improve the success rate of catheterization and reduce the postoperative complications.
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Objective To explore how to establish and safeguard the peripherally inserted central catheters(PICC) maintenance network for the management and practical activity of PICC,so as to provide continuous high-quality PICC maintenance for discharged patients with PICC. Methods 40 nurses each year from 10 cities and 100 country hospitals affiliated with Shanxi Quality Control Center to train in the 1st and 2nd affiliated hospital of Xi`an Jiaotong University were choosen as 214 PICC maintainers. These maintainers were taken into the inner-net of 1st affiliated hospital of Xi`an Jiaotong University management system complete the PICC maintenance net of Shanxi province. Results After the establishment of maintenance network, the number of patients with PICC increased (from 610 cases in 2008 to 1 434 cases in 2014);A large number of PICC management had been down by the qualified nurses in primary hospitals; Duration of PICC in patients days was prolonged; The PICC related complications including thrombophlebitis, catheter infection,occlusion or dislodgment and unplanned extubate were significantly decreased (P < 0.05 respectively). Conclusions Establishment of PICC maintenance network can provide patients with standardized and convenient PICC maintenance service,decrease the incidence of catheter which related complications and ensure patient safety. The application of PICC maintenance network should be used more and more.
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The PICC application in tumor chemotherapy patients has the advantages of simple operation, long time of implanting catheter, small pain and protect vein. They can ensure the chemotherapy smoothly, and further promotion in the clinical application, but when the patients took the tube back, the complications increased significantly. Health education is the mail channel for patient and family to get the major way to maintain PICC knowledge and skills. Through literature review of PICC health education at home and abroad, in our country, according to the present situation of PICC health education, the health education model, method and effect evaluation were summarized and looked for the problems in the present education of PICC health education. It can provide a basis for exploring new pattern of health education for improving the sevice life of the catheter and the patients’ life quality.
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Objective To assess the application of intracavitary electrocardiography (IC-ECG) during the insertion of the Groshong peripherally inserted central catheters (PICC).Methods A total of 168 patients (aged 20-76 years) with gynecologic tumors who required the insertion of Groshong PICC because of various clinical conditions between January 2013 and December 2014 were selected into this study in Zhongnan Hospital of Wuhan University.During PICC insertion, the P-wave of IC-ECG helped general judgments about the position and direction of the tip of catheters, hence guiding the intubation.Precise position was determined by Xray following the fastening of catheters, based on which the accuracy and sensitivity of IC-ECG in the insertion of Groshong PICC were evaluated.Results All the cases presented typical changes of P-wave.However, 15 cases exhibited no such alternations in the first placement however deep or shallow the catheters were, in whom the typical P-wave was induced after withdrawal and replacement of the catheters with adjustment of patient position.According to the X-ray (gold standard), the accuracy and sensitivity of IC-ECG in diagnosing position of tip in the superior vena cava (SVC) were 98.8％ and 98.8％, respectively.The accuracy of diagnosing the position at the optimum location in the SVC reached 97.0％.Conclusions A high peaked P-wave of similar shape could be observed in IC-ECG in the insertion of Groshong PICC.IC-ECG could remarkably increase the positioning accuracy of PICC tip into the SVC;meanwhile, the optimal inserted length of the catheters could be determined by monitoring the changes of the P-wave with IC-ECG during insertion.
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Objective To compare the effects of venous port access ( VPA ) with peripherally inserted central catheters ( PICC) in patients with breast cancer .Methods 120 cases with breast cancer were divided into 2 groups from Jan.2009 to Dec.2010,among whom 60 cases were with VPA when receiving operation , and the other 60 cases were with PICC after the operation .The success rate of catheterization , duration of catheter in-dwelling and catheter-related complications of the 2 groups were compared .Results The one-time success rate of catheterization was 100%in VPA group and 66.7%in PICC group .The catheters were retained for more than 12 months in 59 cases in VPA group,while only 4 cases in PICC group retained catheter for more than 12 months. The complications occurred to 1 case in VPA group ( 1.7%) and 9 cases in PICC group ( 15%) .Conclusion VPA is an ideal pathway for chemotherapy of patients with breast cancer , which can reduce nursing work and is worth to be promoted in clinical practice .
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Objective To investigate training of the ultrasound-guided modified Seldinger technique(MST)for cannulation of PICC.Method Twenty-nine nurses trained with the traditional training on ultrasound-guided MST during December 2009 to December 2011 were set as control group and another 29 nurses trained with the systematic training during December 2011 to December 2013 were as experiment group.The training effect were compared between the two groups after 2 months training.Results The theoretical knowledge in the experiment group was improved significantly compared with the control group. Moreover, the success rate of catheterization in the experiment group was 100.0%,significantly higher than that in the control group(both P<0.01).Conclusion Systematic training system is more effective than the traditional training.It can improve the nurses’technical and theoretical knowledge on ultrasound-guided MST for PICC.
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The peripherally inserted central catheter occlusion is not rare in adults.Its occurence is related with the catheter's tip position,catheter type and the skills of medical staff.Personnel training is particularly important in the prevention of occlusion.Urokinase and heparin can be used for thrombolysis.
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Objective To investigate the clinical effectiveness of peripherally inserted central catheters(PICC) and peripheral intravenous catheters(PIV) in tumor chemotherapy. Methods A total of 180 patients with intravenous chemotherapy were randomly divided into two groups. 108 patients in the PICC group, 72 patients in the PIV group. The holding time and complications were observed and compared. Results The rate of complication in the PICC group were much lower than the PIV group, however was much longer than the PIV group in holding time. But there was no statistical difference in the positive culture rate of bacteria of two groups. Conclusions It is very safe to use PICC which can reduce the rate of complication of catheters and venipuncture times and is worthy of spreading in practice.
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Objective To assess the clinical application value of color Doppler ultrasound guided puncture in peripherally inserted central catheter (PICC). Methods Thirty-two patients needed long-term intravenous infusion underwent PICC. Color Doppler ultrasound was used to select the puncture vascular,the best puncture point and angle, and the entire process was monitored and guided dynamically, and the initial position of the catheter tip was located. Results Color Doppler ultrasound-guided puncture was successful in all 32 patients, and the successful rate was 100%. The guided puncture time was 22 s to 19 min, and the first puncture succeeded in 30 patients (93.75%). Conclusion Color Doppler ultrasound-guided puncture in PICC can obviously raise the success rate of puncture, shorten puncture time and reduce the complications. It is an easy, safe and certain method.
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Objective To investigate the induced-factors levels of venous thrombosis associated with the placement of peripherally inserted central catheters (PICC) in patients with malignant tumor,and establish intervention model accordingly. Methods 40 patients complicated with venous thrombosis after PICC were set as the thrombosis group, 40 patients without venous thrombosis were selected as the no-thrombosis group, 30 healthy cases were selected as the control group. All cases' serum samples were ob-tained to measure the levels of molecular biomarkers of the coagulation system, platelet parameters and molecular biomarkers of the fibrinolysis system. The results of the three groups were assessed. Results Patients in the thrombosis group were reported significantly higher levels of vWF, GMP140,TAT than those in both two other groups, but lower levels of ATⅢ. Higher levels of MPV and PCT were found in the throm-bosis group than those in both two other groups.Tthe data also showed higher PLG and PAI levels and lower levels of PLM in the thrombosis group. Conclusions From this study it shows that patients with malig-nant tumors during the placement of PICC have evident hypercoagnlahility, high- activated platelet and se-vere pre- thrombosis state caused by PICC. In treatment of malignant tumor patients with PICC, the level of coag-ulation system molecular markers, platelet parameters,fibrinolysis molecular markers shoud be used as a clinical routine and as the index of early intervention and evaluation of the PICC.