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Objective To analyze the influencing factors of unplanned extubation(UE)occurrence of peripherally inserted central catheter(PICC)in the patients with hematological diseases.Methods A retro-spective cohort study method was adopted.The data of 7 298 patients with hematological diseases implanted with PICC catheter and followed up to its removal from January 1,2016 to December 31,2020 in the Hematol-ogy Hospital of Chinese Academy of Medical Sciences were collected,including the demographic information,catheterization records,maintenance and extubation records.According to whether UE occurring,they were divided into the UE group(n=262)and normal extubation group(n=7 036).The general data were com-pared between the two groups.The COX regression was used to analyze the influencing factors of UE in pa-tients with hematological diseases.The dose-effect relationship between age and PICC UE occurrence risk was studied by the restrictive cubic spline method.Results The incidence rate of UE was 3.6％(262/7 298).The COX regression analysis results showed that the gender,disease diagnosis,fibrinogen,prothrombin time,PLT,catheter material,number of punctures during catheterization,positioning method of catheter tip,num-ber of catheter-related complications occurrence were related to PICC UE occurrence in the patients with he-matological diseases(P＜0.05).The results of restricted cubic spline showed that there was a"U"-type non-linear relationship between age and UE risk(X2=17.710,P＜0.05),and the risk of UE was the lowest when the age was 30 years old.Conclusion In PICC,the emphasis should be paid to the male patients with hemato-logical malignancies who have repeated punctures during catheterization,no intracardiac electrocardiographic positioning during catheterization,bleeding tendency,indwelling polyurethane catheters and repeated catheter-related complications in order to decrease the UC occurrence probability.
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Objective To compare the incidence of catheter-related venous thrombosis between midline catheters and peripherally inserted central catheters.Methods Randomized controlled trials and cohort studies on the incidence of venous thrombosis associated with midline catheters and PICC catheters were searched from CNKI,Wanfang database,VIP database,Web of Science,PubMed,Embase and Cochrane Library from inception to December 31,2022.Review Manager 5.4 software and Stata 14.0 software were used to analyse and describe the outcome indicators.Results A total of 16 studies were included,including 12 cohort studies and 4 randomized controlled studies,with 21853 subjects.The results of the Meta-analysis showed that the incidence of catheter-related venous thrombosis per thousand catheter days of midline catheters was statistically significant compared with PICC[RR=2.74,95％CI(1.21,6.21),P=0.016].There was no significant difference in the incidence of catheter-related venous thrombosis compared with PICC[RR=0.85,95％CI=(0.70,1.03),P=0.101].In the subgroups,the incidence of superficial vein thrombosis in the midline catheter was significantly different from that in the PICC[RR=2.36,95％C/=(1.56,3.58),P＜0.001].Conclusion The current evidence shows that the incidence rate of catheter-related venous thrombosis per thousand catheter days and superficial vein thrombosis was higher for midline catheters than PICCs.Therefore,in clinical practice,vascular access devices should be selected reasonably,and the occurrence and development of catheter-related superficial venous thrombosis should be paid attention to,and clinical screening should be effectively carried out on the basis of a full evaluation.
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@#Objective To explore the application of painless diagnosis and treatment technology in children's peripherally inserted central catheter(PICC)guided by ultrasound.Methods Totally 82 children who planned to undergo PICC in the hospital from January 2021 to January 2023 were selected and randomly divided into a control group and an observation group using a random number table method,with 41 cases in each group;The control group underwent conventional ultrasound guided PICC catheterization,while the observation group underwent painless diagnostic and therapeutic techniques using ultrasound guided PICC catheterization;Compare the success rate of catheterization,completion time of catheterization,degree of pain in the child pain[children's pain behavior scale(FLACC)],tolerance[Houpt behavior scale(HBS)],compliance[Frankl scale(FCS)],and family satisfaction between the two groups.Results The success rate of catheterization in the observation group was higher than that in the control group,and the catheterization time was shorter than that in the control group,with a statistically significant difference(P<0.05).The FLACC score of the observation group was lower than that of the control group,while the HBS score and FCS score were higher than those of the control group,with a statistically significant difference(P<0.05);The total satisfaction of family members in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The use of painless diagnosis and treatment technology in ultrasound-guided PICC catheterization in children can improve the success rate of catheterization,shorten the catheterization time,reduce the degree of pain in children,enhance tolerance and compliance,and improve family satisfaction.
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Objective:To analyze and compare the incidence of catheter related complications between midline catheter (MC) and peripherally inserted central catheter(PICC) within 30 days. Provide guidance and basis for medical staff to choose appropriate intravenous infusion tools to prevent catheter related complications.Methods:The randomized controlled trials, clinical controlled trials and cohort studies about MC and PICC related complications were searched in PubMed, Web of Science, Cochrane Library, Embase, EBSCO, Ovid, CNKI, VIP, Wanfang database and CBM, which were published at home and abroad up to December 31, 2021. After screening the literatures, extracting data and quality evaluation according to the inclusion and exclusion criteria, RevMan5.4 software was used for statistical analysis.Results:A total of ten articles were included in this study, including two randomized controlled trials, a clinical controlled trials, a prospective cohort study and six retrospective cohort studies, with 12 765 cases in MC group and 33 783 cases in PICC group. The results of Meta-analysis showed that the incidences of catheter-related bloodstream infection and catheter displacement in MC group were significantly lower than those in PICC group ( RR=0.37, 95% CI 0.18-0.76, P<0.05; RR=0.49, 95% CI 0.25-0.97, P<0.05). Conclusions:Compared with PICC in the early stage of intravenous infusion, MC is safer and more effective. When continuous infusion of isotonic or near-isotonic medications is required, and there is no need for continuous vesicant medications, MC can be preferred. However, more large-sample and high-quality studies are still needed to provide a basis for the popularization of MC in China.
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Objective:To construct a virtual simulation training platform for peripheral inserted central catheter (PICC) catheterization and discuss its application in clinical training.Methods:A total of 118 nurses who attended the PICC professional and technical advanced training courses in a province in 2020 and 2021 were enrolled in this study. In 2020, the training was conducted in the form of theoretical teaching combined with practical training ( n=51), and in 2021, virtual simulation platform was introduced as a supplement on the basis of the original training ( n=67). SPSS 23.0 was used for independent-samples t-test to compare the theoretical and operational assessment results of the two years and evaluate the application effect of the platform. Through the satisfaction survey and learning log, the nurses' experience of using the platform was understood. Results:The theoretical performance and the operational performance of nurses who participated in the training in 2021 were (96.56±3.17) and (94.06±2.16) respectively, and the operational performance was better than that of nurses who participated in the training in 2020 ( t=-11.37, P<0.001), and the difference in theoretical performance was not statistically significant ( t=0.17, P=0.853). In 2021, 63 nurses (94.0%) who used the virtual simulation platform believed that the platform could assist to improve the training effect; 61 nurses (91.0%) expected the application of virtual simulation technology in the teaching and training of other knowledges. Conclusion:As a new teaching form, virtual simulation technology can significantly improve the training effect and satisfaction, and provide reference for the development of relevant teaching and training.
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Objective:In order to investigate the status quo of central line-associated bloodstream infections (CLABSI) prevention among ICU nurses and analyze its influencing factors.Methods:A total of 245 ICU nurses from Harbin Medical University Affiliated First, Second, and Cancer Hospitals from December 2021 to January 2022 were selected by convenience sampling method. To evaluate the status quo of CLABSI prevention among ICU nurses by using Central Line-associated Bloodstream Infections Prevention Knowledge and Practice Scale, a cross-sectional survey was conducted among ICU nurses by using General Data Questionnaire and ICU Nurse Alarm Fatigue Scale, and the influencing factors of CLABSI prevention were evaluated.Results:The knowledge, attitude, behavior dimensions and alarm fatigue scores of ICU nurses on CLABSI prevention were (13.74 ± 2.87), (50.92 ± 4.10), (85.44 ± 8.52), and (31.35 ± 5.06), respectively. The score of ICU nurses′ alarm fatigue was negatively correlated with the score of knowledge, attitude and behavior dimensions in CLABSI prevention knowledge and practice ( r=-0.360, -0.378, -0.408, all P<0.01). The results of multiple regression analysis showed that alarm fatigue, CLABSI training and first education degree were the main influencing factors of ICU nurses′ knowledge and attitude to CLABSI prevention ( P<0.01). Alarm fatigue, CLABSI training and the highest education degree were the main influencing factors of ICU nurses ′ CLABSI prevention ( P<0.01). Conclusions:ICU nurses′ knowledge and practice of CLABSI prevention were at the middle level. Alarm fatigue, participation in CLABSI training, and educational background (first and highest) are the influencing factors for the prevention of CLABSI among ICU nurses in terms of knowledge, belief, and behavior. The administrators should pay more attention to CLABSI prevention, provide more opportunities and ways to train and examine ICU nurses, strengthen the weak links of CLABSI prevention, and make ICU nurses master the Knowledge System of CLABSI prevention as soon as possible.
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Objective To investigate the clinical effects of two methods of compressive coverage with aseptic gauze dressing and alginate dressing on haemostasis in placement of peripherally inserted central catheter(PICC)so as to provide a new dressing method for clinical application.Methods A total of 416 breast cancer patients undergoing PICC were randomly divided into two groups,with 208 per group.In the control group,the puncture sites for PICC were dressed with aseptic gauze immediately after the placement of PICC,with a daily aseptic gauze dressing change once per 24 hours.In the trial group,the puncture sites were dressed with alginate dressing immediately after the placement of PICC,with a weekly dressing change at the 7th day after PICC placement,while no local bleeding on the puncture site.The incidence,within 24 hours,of bleeding,degree of comfort,frequency and cost of dressing change as well as the infection rate within 7 days after the PICC placement were monitored and compared between the groups.Results A total of 205 patients in the control group and 208 in the observation group had completed the study.In the trial group,the incidence of bleeding at puncture sites within 24 hours after placement of PICC was significantly lower than that of the control group(27.88%vs.38.05%,χ2=4.829,P=0.028).The frequency of dressing change within 24 hours in the observation group was significantly less than that of the control group(Z=205.235,P<0.001).The cost of dressing change in the observed groups was also significantly less than that of the control group(56.94 vs.10.20 yuan in average,Z=-8.990,P<0.001).The incidence rates of local pain and itche reported by the patients in the observation group were significantly lower than those in the control group(Z=-12.079,P<0.001;Z=-12.194,P<0.001).No infection at the puncture site was observed in both groups.Conclusions Application of alginate dressing immediately after PICC placement in breast cancer patients can extend the time for initial dressing change up to 7 days in the patient without bleeding at the puncture site within 24 hours after the placement of PICC.An alginate dressing can reduce the incidence of bleeding at the puncture site,increase the comfort of patients,lower the frequency and cost of dressing change hence the nursing workload.
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Objectives@#To determine the efficacy of low-dose heparin in preventing central catheter occlusion and its safety among neonates.@*Materials and Methods@#A randomized controlled trial was conducted among 42 neonates requiring peripherally inserted central catheter (PICC) lines. The neonates were divided into two groups: low dose heparin (0.5 units/kg/hr =0.2 units/ml) and control group (0.5 units/ml). The efficacy outcomes were duration of catheter patency, completion of catheter use, and the presence of catheter occlusion or thrombosis. The safety outcomes include heparin complications.@*Results@#The study participants had a mean age of 17 days old at 35 weeks gestational age and mean weight of 1.97 kg. The participants given low dose heparin were 36% more likely to complete the use of central line and 12% less likely to develop catheter occlusion. Analyses showed non-statistically significant risk ratio of active bleeding, thrombocytopenia, and deranged prothrombin time in the low dose heparin group.@*Conclusion@#The use of low dose heparin (0.5 units/kg/hr = 0.2 units/ml) appears as effective as the control dose in completion of catheter use and prevention of catheter occlusion. There was also no significant difference in the adverse effects. Low dose heparin can be used as continuous infusion for preventing central line occlusion; however, it has no advantage in lowering the risk of complications.
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HemorragiaRESUMEN
OBJECTIVE To compare the safety of high-dose methotrexate （HD-MTX） via peripherally inserted central catheter （PICC） and totally implantable venous access port （TIVAP） in pediatric patients with malignant brain tumors. METHODS Patients with malignant brain tumors who received HD-MTX via PICCs or TIVAPs in our hospital from July 2018 to April 2022 were retrospectively analyzed. Clinical data were collected to compare differences in blood concentration of methotrexate （MTX），the incidence of adverse events （including adverse drug reactions and catheter-related complications） and length of stay in hospital. Multivariate linear regression was applied to analyze the factors that influenced the blood concentration of MTX. RESULTS A total of 107 patients were included in the study，with 65 patients in the PICC group and 42 patients in the TIVAP group. Blood concentration of MTX at 24 h （C24 h） in TIVAP group was significantly higher than PICC group （[ 126.87±61.99） μmol/L vs. （102.45±48.77） μmol/L，P＜0.05）. There was no significant difference in blood concentration of MTX at 42 h （C42 h），compared with PICC group （P＞0.05）. Results of multivariate linear regression analysis showed that TIVAP was associated with the increase of C24 h（P＜0.05）. No significant differences were observed in the incidence of adverse events and the length of stay in the hospital between 2 groups （P＞0.05）. CONCLUSIONS Risk of adverse events is not increased，although the MTX C24 h level is elevated after administration of TIVAP. TIVAP is a safe choice for HD-MTX therapy with implementing therapeutic drug monitoring.
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Objective:To evaluate the clinical effectiveness of the standardized peripherally inserted central catheter (PICC) implantation procedure in the management of parenteral nutrition infusion routes.Methods:Patients were enrolled from January 2018 to January 2020 and were divided into the study and control groups, receiving standard operating procedures of PICC or insertion through below elbow with or without ultrasonic guidance. The differences in the success rate of PICC insertion, catheter indwelling time, incidence rate of complications, and patient satisfaction were compared.Results:A total of 943 subjects were included. The study group and the control group were comparable in terms of baseline characteristics such as disease type, body mass index and prevalence of nutritional risk. The overall success rate was 100% in both groups. The first-attempt success rate in the study group was higher compared with the control group (92.6% vs 72.2%, χ 2 = 66.229, P < 0.001), and the catheter indwelling time was longer ([25.4 ± 2.3] d vs [21.6 ± 3.1] d, t = 21.271, P < 0.001). The incidence rate of short-term complications in the study group was significantly lower than that in the control group (3.50% vs 11.52%, χ 2 = 21.490, P <0.001), while there was no significant difference in the incidence rate of long-term complications between the two groups (6.78% vs 8.85%, χ 2 = 1.388, P = 0.239). Conclusion:Establishing and implementing the standardized operating procedure of PICC is an effective method to improve the management of parenteral nutrition infusion routes.
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Objective:To explore the risk factors and event characteristics of unplanned removal of peripherally inserted central catheters (PICCs) in patients with chest tumors.Methods:The convenience sampling method was used to select chest cancer patients treated in a hospital in Shanghai between March 2018 and December 2021. Logistic regression analysis was used to identify the risk factors of unplanned removal in these patients.Results:A total of 242 patients were included in this study, of whom 42 (17.3%) experienced unplanned removal. The most common causes of unplanned removal in descending order were catheter related dermatitis, catheter slippage, catheter occlusion, catheter related thrombosis, and local or catheter related infections. Logistic multivariate regression analysis showed that a history of radiation therapy ( OR=0.295, 95% CI: 0.108 to 0.806, P=0.017) and a history of surgery ( OR=0.247, 95% CI: 0.076 to 0.799, P=0.020) were protective factors for preventing unplanned removal. Catheterization during spring or autumn ( OR=8.771, 95% CI: 2.828 to 27.204, P<0.001), catheter-related dermatitis ( OR=12.404, 95% CI: 4.176 to 36.845, P<0.001), catheter slippage ( OR=25.105, 95% CI: 7.040 to 89.523, P<0.001), occlusion ( OR=6.155, 95% CI: 1.713 to 22.111, P=0.005), and catheter related thrombosis ( OR=17.817, 95% CI: 2.848 to 111.479, P=0.002) were independent risk factors of unplanned removal. Unplanned removal may occur anytime when the patient had the catheter inserted, but is less likely to happen in the early stage and more likely in the first month after catheterization. Besides, catheter related complications demonstrated seasonality, with catheter related thrombosis and occlusion more frequent in autumn and winter, compared with dermatitis and catheter slippage showing no difference in incidence around the year. Conclusions:The incidence of unplanned removal is high in chest tumor patients with PICC. Nursing staff should familiarize themselves with the risk factors, event characteristics, and the seasonality of catheter related complications, and improve the evaluation and early intervention of complications, to reduce the incidence of unplanned removal and improve the patient's experience of living with catheters.
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Objective To evaluate the effect of LEARNS[listen(L),establish(E),adopt(A),reinforce(R),name(N),strengthen(S)]model health education for patients with peripherally inserted central catheter(PICC)after discharge.Methods From June 2020 to June 2021,193 discharged patients with PICC were selected as the study objects.They were divided into observation group(95 cases)and control group(98 cases)according to random number table method.The control group received routine health education and continued follow-up for 3 months.In the observation group,health education was constructed and implemented at 2,4,8 and 12 weeks after discharge based on the control group and the basis of LEARNS model.The incidence of PICC-related complications and PICC-related adverse events were compared between the two groups,and self-management ability was evaluated using cancer patients PICC self-management scale(CPPSMS)score,strategies used by people to promote health(SUPPH)were used to evaluate self-efficacy.Results The incidence of PICC-related complications and adverse events in the observation group were significantly lower than those in the control group[11.58%(11/95)vs.40.82%(40/98)and 6.32%(6/95)vs.22.45%(22/98),both P＜0.05].There were no statistically significant differences in CPPSMS scores(daily catheter observation,maintenance compliance,management confidence,anomaly handling,information acquisition,tubeed exercise,and tubeed daily life)and SUPPH scores(positive attitude,self-stress reduction,and self-decision-making)in the two groups before intervention,and the above scores were higher than those before intervention.After intervention,the above scores in the observation group were significantly higher than those in the control group(CPPSMS total score was 131.37±27.20 vs.92.41±23.89,daily catheter observation score was 26.02±6.04 vs.18.27±5.43,maintenance compliance score was 18.45±4.36 vs.13.28±3.12,and management confidence score was 17.69±3.37 vs.13.81±3.65,anomaly processing score was 15.01±3.46 vs.10.25±2.74,information acquisition score was 11.98±2.56 vs.7.84±2.07,tube motion score was 15.94±3.46 vs.10.28±2.78,daily life with tubes score was 26.28±5.19 vs.18.68±4.46,all P＜0.05;SUPPH total score was 106.54±20.84 vs.93.93±18.50,positive attitude score was 56.89±11.45 vs.49.34±10.56,self-stress reduction score was 38.25±8.73 vs.34.76±6.28,the self-decision-making score was 11.40±2.57 vs.9.83±2.96,all P＜0.05).Conclusion The implementation of health education based on LEARNS model in discharged patients with PICC tube can improve their self-management ability and self-efficacy,and improve clinical prognosis.
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Pediatric kidney transplant recipients differ from adult counterparts in primary disease, physiology, psychology, organ function and immune status and their perioperative treatment and nursing management are different from those of adult kidney transplantation. To standardize holistic perioperative nursing regimens for pediatric kidney transplantation, Surgery Nursing Committee of Shanghai Nursing Association organized national medical and nursing experts in the fields of transplantation to jointly draft "expert consensus on perioperative nursing standards for pediatric kidney transplantation " (abbreviated as "consensus"). After three rounds of online expert inquiry, all revised opinions were jointly discussed combined with literature evidence, and the expert consensus was finally reached. The highlights of perioperative treatment and nursing care for pediatric kidney transplantation were summarized and stated, including preoperative evaluation, preoperative and postoperative nursing care, which were of scientific and practical value.
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Objective: To identify the prevalence and risk factors for damage or removal of fully implanted long-term catheters from patients undergoing antineoplastic chemotherapy. Methods: This is an observational, cross-sectional study that evaluated medical records of patients undergoing placement of a fully implanted catheter for antineoplastic chemotherapy from January 2015 to December 2019. Clinical and sociodemographic data were collected that were associated with catheter survival using Log-Rank Mantel-Cox and Cox Regression tests (SPSS, p<0.05). Results: Of 58 devices evaluated, most patients were higher educated married females, younger than 60 years old. The most frequent side of catheter implantation was the right side, and the most prevalent implantation site was the internal jugular vein. Less than 1/3 of patients (29.3%) had port-a-cath loss due to complications with a five-year follow-up survival of 35.73±3.76 (95% CI = 28.35-43.11). Two patients (4.7%) needed removal due to device exposure, three (7.0%) due to obstruction, and 12 (27.9%) due to infection. Female patients (p=0.019) and patients with breast tumors (p=0.049) had a shorter mean survival time. The women showed port-a-cath survival 9.25 times (95% CI = 1.35-50.25) shorter in the multivariate analysis. Conclusion: port-a-cath catheter loss is around 30% and being female is a determining risk factor.
Objetivo: Identificar a prevalência e os fatores de risco para danos ou retirada de cateter de longa permanência totalmente implantado em pacientes submetidos à quimioterapia antineoplásica. Metodos: Trata-se de um estudo observacional transversal que avaliou prontuários de pacientes submetidos à colocação de cateter totalmente implantado para quimioterapia antineoplásica, no período de janeiro de 2015 a dezembro de 2019. Foram coletados dados clínicos e sociodemográficos associados à sobrevida do cateter por meio do Log-Rank testes de Mantel-Cox e Regressão de Cox (SPSS, p<0,005). Resultados: Dos 58 dispositivos avaliados, a maioria dos pacientes era mulheres casadas com nivel superior de escolaridade e com idade inferior a 60 anos. O lado mais frequente de implantação do cateter foi o direito, e o local de implantação mais prevalente foi a veia jugular interna. Pouco menos de 1/3 dos pacientes (29,3%) tiveram perda de port-a-cath devido complicações com uma sobrevida de seguimento de cinco anos de 35,73±3.76 (IC 95% = 28.35-43.11). Dois pacientes (4,7%) necessitaram de remoção por exposição do dispositivo, três (7,0%) por obstrução e 12 (27,9%) por infecção. Pacientes do sexo feminino (p=0,0019) e pacientes com tumores de mama (p=0,049) apresentam menor tempo médio de sobrevida. As mulheres apresentaram sobrevida port-a-cath 9,25 vezes (IC 95%=1,35-50,25) menor na análise multivariada. Conclusão: A perda do cateter port-a-cath foi de aproximadamente 30% e ser do sexo feminino foi um fator de risco importante.
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Dispositivos de Acceso Vascular , Pacientes , Cateterismo Periférico , Factores de Riesgo , Catéteres , AntineoplásicosRESUMEN
Objective:To study the effect of heating skin disinfectant during peripherally inserted central catheter (PICC) in preterm infants.Methods:Premature infants were retrospectively analyzed who received PICC catheterization during hospitalization in the Department of Neonatology of the Affiliated Hospital of Southwest Medical University from April 2020 to March 2021. They were divided into the control and heating groups according to different disinfection methods in two different periods. The skin of premature infants in the heating group was disinfected with disinfectant at 37℃, and the control group was disinfected with room temperature disinfectant. The rate of successful primary catheterization, operation duration, and catheter-associated infection were compared between the two groups.Results:The rate of successful primary catheterization in the heating group was higher than that of the control group [80.2% (65/81) vs. 66.7% (56/84)], and the operation time was shorter than that of the control group [(45.0±9.0) min vs. (48.4±11.9) min] ( P<0.05). There was no statistical difference in catheter keeping time, unplanned extubation rate, the rate of positive catheter tip cultures, and the blood cultures. Conclusions:During PICC puncture in premature infants, heating skin disinfectant can increase the success rate of one-time PICC catheterization, reduce the operation duration, and not increase the risk of catheter-associated infection.
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Peripherally inserted central venous catheter (PICC)-related upper extremity venous thrombosis (UEVT) is defined as upper extremity venous thrombosis within the veins where PICCs were placed or adjacent to and may result in pulmonary embolism. Malignancies, previous history of venous thrombosis and malposition are common risk factors for PICC-UEVT. Once patients demonstrate clinical manifestations of phlebitis and thrombosis, such as swelling, pain and tenderness at the PICC site, venous duplex ultrasonography is the first choice for diagnosing PICC-UEVT. According to American College of Chest Physicians guidelines, it's not recommended to remove PICCs upon detection of PICC-UEVT. The first-line treatment is to administer systemic anticoagulants while keeping the catheter in place, unless any contraindications. PICCs could continue to be used during anticoagulation therapy, suppose that catheter tip remains well placed and functions as normal. With early diagnosis and standard anticoagulant treatment, a better clinical outcome could be achieved. Prophylactic anticoagulation is not routinely recommended per guidelines. Recommendation for asymptomatic PICC-related thrombosis is still absent and warrants further prospective studies with large sample size.
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OBJECTIVE@#To observe the clinical effect of moxibustion combined with plucking technique at Jiquan (HT 1) for preventing peripherally inserted central catheter (PICC)-related venous thrombosis in the upper limbs of malignant tumor patients.@*METHODS@#A total of 80 malignant tumor patients undergoing PICC were randomized into an observation group and a control group, 40 cases in each one. In the control group, the routine care for PICC was exerted. In the observation group, besides the routine care, moxibustion combined with plucking technique at Jiquan (HT 1) was added. Mild moxibustion was exerted along the venous distribution of PICC (avoiding the entry site) for 10 to 15 min, and then, the circling moxibustion was applied to Quchi (LI 11), Xuehai (SP 10) and Tianfu (LU 3), 3 to 5 min at each acupoint. Finally, plucking technique was given at Jiquan (HT 1) for 5 to 10 min. This combined therapy was intervened since the 2nd day of PICC placement, once daily, 5 times a week, for 3 weeks totally. The incidence of the PICC-related venous thrombosis in the upper limbs was compared between the two groups on day 42 of placement. On day 2, 7, 14, 21, 28, 35 and 42 of PICC placement, the peak systolic velocity (PSV) and the end-diastolic velocity (EDV) of the subclavicular vein on the placement side were observed separately in the two groups.@*RESULTS@#The incidence of the PICC-related venous thrombosis in the upper limbs in the observation group was lower than that in the control group (2.5% [1/40] vs 17.5% [7/40], P<0.05). From day 7 to 35 of PICC placement, PSV of the subclavicular vein on the placement side was higher than that on the day 2 of PICC placement in the observation group (P<0.05). On day 28 and 42 of PICC placement, PSV of the subclavicular vein on the placement side was lower than that on the day 2 of PICC placement in the control group (P<0.05). In the observation group, EDV of the subclavicular vein on the placement side was higher than that on the day 2 of PICC placement from day 7 to 28 of PICC placement (P<0.05). In the control group, EDV of the subclavicular vein on the placement side from day 28 to 42 of PICC placement was lower than that on the day 2 of PICC placement (P<0.05). From day 7 to 42 of PICC placement, PSV and EDV of the subclavicular vein on the placement side in the observation group were all higher than those in the control group (P<0.01, P<0.05).@*CONCLUSION@#The combined treatment of moxibustion with plucking technique at Jiquan (HT 1) can effectively prevent PICC-related venous thrombosis in the upper limbs and improve venous blood flow velocity in malignant tumor patients.
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Humanos , Cateterismo Venoso Central/métodos , Cateterismo Periférico/efectos adversos , Moxibustión/efectos adversos , Neoplasias/complicaciones , Extremidad Superior , Trombosis de la Vena/etiologíaRESUMEN
Introdução: O uso do cateter central de inserção periférica na Neonatologia tem contribuídosignificativamente para reduzir a mortalidade neonatal nas Unidades de Terapia IntensivaNeonatais. Essa prática intravenosa segura favorece a estabilização hemodinâmica do recémnascido e possibilita a administração de drogas vesicantes, irritantes e de nutrição parenteral.O objetivo principal deste estudo foi de analisar o efeito da padronização das medidas deprevenção de infecção durante a inserção e o manuseio do cateter venoso central deinserção periférica pelo time de cateteres na incidência da Infecção da Catheter-RelatedBloodstream infection (CRBSI) em recém-nascidos na Unidade de Terapia IntensivaNeonatal. Metodologia: Esta tese está dividida em três estudos. 1) Protocolo de revisãosistemática, em que se aborda a prevalência de complicações associadas ao uso de PICCs emrecém-nascidos (RNs); 2) Coorte prospectiva, em que se avaliaram os fatores de risco para odesenvolvimento de infecção da corrente sanguínea relacionada ao cateter (CRBIS) emrecém-nascidos; 3) Coorte com análise retro e prospectiva, que analisou os efeitos dapadronização das medidas de prevenção de infecção adotadas pelo time de PICC sob onúmero de casos de CRBSI em neonatos na Unidade de Terapia Intensiva Neonatal.Resultados: No artigo 1, observou-se a prevalência de complicações decorrentes do manejoinadequado do PICC nos RNs, informação considerada importante para o aprimoramento daprática clínica. No artigo 2, verificou-se que a maioria da amostra foi composta de prematuros,com peso inadequado, distúrbios respiratórios e cardiopatia, mas não houve associação dessasvariáveis com a CRBSI. Neonatos com PICC nos membros superiores apresentaram maiorrisco de CRBSI (RR=2,84; IC95% 1,02-6,85). No artigo 3, analisaram-se 365 recémnascidos que usaram o PICC e que foram submetidos a 563 procedimentos de inserção decateteres, dos quais 69 apresentaram CRBSI, o que confere uma incidência de CRBSI de12,3%. Na análise das características relacionadas ao procedimento de inserção do PICC nosneonatos em função da notificação de CRBSI, as variáveis significativamente associadas àocorrência de CRBSI foram o vaso acessado (p=0,002) e a posição do cateter(p=0,005). Naanálise estatística das variáveis relacionadas à terapêutica infusional, observou-sesignificância estatística na associação entre a ocorrência da CRBSI e o uso de dois ATBdurante o primeiro esquema de antibioticoterapia, o qual apresentou o valor de p<0,05. 7Efeito da padronização das medidas de prevenção de infecção da corrente sanguíneaTambém se constatou que foram descritos oito grupos de patógenos envolvidos nos 69 casosde CRBSI - os mais comuns foram relacionados à CRBSI em recém-nascidos com PICC,como as Enterobactérias (5,2%), Staphylococcus coagulase negativa(3,4%) eStaphylococcus coagulase positiva (2,0%). Conclusão: O estudo indicou que os times decateteres são importantes nas unidades de terapia intensiva neonatais, sobretudo quandoadotam condutas baseadas em evidências científicas que fundamentam a sistematização doprocesso de trabalho para o devido monitoramento dos fatores de risco relacionados àincidência de CRBSI em RN, a vigilância durante realização do procedimento e a terapêuticainfusional. Contudo, o efeito da padronização das medidas de prevenção adotadas pelotime de cateteres na UTIN tem impactado a redução do desenvolvimento de infecção dacorrente sanguínea relacionada ao cateter (AU).
Introduction: The use of peripherally inserted central catheter in neonatology hassignificantly contributed to the reduction of neonatal mortality in neonatal intensive care units.It is safe intravenous practice favors the hemodynamic stabilization of the newborn, allowsthe administration of vesicant drugs, irritants and parenteral nutrition. Therefore, this studyhas as main objective to analyze the effect of the standardization of infection preventionmeasures during the insertion and handling of the peripherally inserted central venouscatheter by the catheter team on the incidence of CRBSI in newborns in the NeonatalIntensive Care Unit. Methodology: The thesis is divided into three studies. 1) Systematicreview protocol, which addresses the prevalence of complications associated with the use ofPICCs in newborns (NBs); 2) prospective cohort that evaluated risk factors for thedevelopment of catheter-related bloodstream infection (CRBIS) in newborns; 3) cohort withretro and prospective analysis, which analyzed the effect of the standardization of infectionprevention measures adopted by the PICC team on the number of CRBSI cases in neonates inthe Neonatal Intensive Care Unit. Results: in article 1 it was observed the prevalence ofcomplications resulting from inadequate management of the PICC in NBs, informationconsidered important for the improvement of clinical practice. In article 2, it was found thatthe majority of the sample was composed of premature infants, with inadequate weight,respiratory disorders and heart disease, but there was no association of these variables withthe CRBSI. Neonates with PICC in the upper limbs had a higher risk of CRBSI(RR=2.84;95%CI 1.02-6.85). At article 3 analyzed 365 newborns who used the PICC, who underwent563 catheter insertion procedures, of which 69 had CRBSI, giving an incidence of CRBSI of12.3%. In the analysis of the characteristics related to the PICC insertion procedure inneonates due to the CRBSI notification, the variables significantly associated with theoccurrence of CRBSI were the vessel accessed (p=0.002) and catheter position(p=0.005). Inthe statistical analysis of the variables related to infusion therapy, a statistical significance wasobserved in the association between the occurrence of CRBSI and the use of two ATBduring the first antibiotic therapy regimen, which presented a value of p<0.05. There wasalso a description of 8 groups of pathogens involved in the 69 cases of CRBSI, the most 9Efeito da padronização das medidas de prevenção de infecção da corrente sanguíneacommon pathogens related to CRBSI in newborns with PICC being Enterobacteriaceae(5.2%), coagulase-negative Staphylococcus (3.4%) and Coagulase positive Staphylococcus(2.0%). Conclusion: it was observed In the statistical analysis of the variables related toinfusion therapy, especially when they adopt procedures based on scientific evidence, whichunderlie thesystematization of the work process for the proper monitoring of risk factorsrelated to the incidence of CRBSI in newborns, surveillance during the procedure, andinfusion therapy. However, it is observed that effect of standardization of preventionmeasures adopted by the catheter team in the UTIN have had an impact on thereduction of development of cateter related bloodstream infection (AU).
Asunto(s)
Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Infecciones Relacionadas con Catéteres , Unidades de Cuidados Intensivos , Cateterismo Periférico/instrumentación , Factores de Riesgo , Interpretación Estadística de DatosRESUMEN
Objective:To explore a new method of ultrasound-guided positioning of the tip of neonatal peri-pherally inserted central catheter (PICC).Methods:Clinical data of 174 newborn infants hospitalized in the Neonatal Intensive Care Unit (NICU) of Beijing Chaoyang District Maternal and Child Healthcare Hospital from January 2019 to April 2021 receiving PICC catheter intubated under the guidance of ultrasound for positioning the tip were retrospectively analyzed to explore the accuracy, reliability and feasibility of the improved ultrasound-guided positioning technique.Before lower extremity catheterization, ultrasound was performed to monitor the vascular pattern and catheterization of PICC was conducted under the guidance of ultrasound.Results:(1) Among 174 infants intubated with ultrasound-guided positioning of the PICC tip, 172(98.9%) of them had the ideal position, and 2(1.1%) did not achieve the ideal position, but achieved the ideal position after ultrasound-guided correction.(2) Lower extremity venous catheterization was successfully performed at 100.0% after ultrasound-guided monitoring of blood vessels.The time-consuming of lower extremity venous catheterization was significantly shorter than that of the previous method [(31.50±2.58) min vs.(56.10 ±5.30 min)]( t=46.84, P<0.001). The total success rate of catheterization and catheterization of lower limb vein increased by 7.0% and 17.5%, respectively.(3) Only 1 (0.57%) case reported the complication of catheter tip thrombosis, the complication rate of which decreased from the previous 79.00% to 2.70%(2/112 cases). Conclusions:The improved ultrasound-guided positioning of the PICC tip is convenient, simple, faster and accurate, which enhances the success rate and is worthy to be applied in clinical practice.
RESUMEN
OBJECTIVES@#To determine efficacy of continuous heparin infusion vs placebo on maintenance of peripherally inserted central catheter line among neonates admitted at the NICU.@*METHODS@#This is a meta-analysis of randomized controlled trials reported in accordance with PRISMA checklist. Cochrane Risk-of-bias tool was used in assessment of reporting biases. Pooled risk ratios were estimated using random- or fixed-effects model.@*RESULTS@#Of 4519 studies identified, 4 studies were included, and all have low risk of bias. Meta-analysis showed that continuous heparin infusion on PICCs had significantly higher duration of catheter patency compared to the placebo group (MD=2.22, 95%CI=1.03-3.14, pvalue<0.00001). Heparin group also had decreased risk of occlusion (RR=0.47, 95%CI=0.94, pvalues=0.03) compared to control. The risk for other adverse events such as thrombosis, infection, IVH progression, and mortality was comparable between the two groups. @*CONCLUSION@#Continuous heparin infusion in PICC fluids can prolong duration of catheter patency by 2.2 days and reduce risk of catheter-related occlusion by 50%, without having significant effect on incidence of other adverse events.@*RECOMMENDATIONS@#Continuous heparin infusion on PICC fluids should be part of maintenance and care policy at the NICU, but precautions should be followed to prevent adverse outcomes. Systematic review of intermittent heparin flushing can be a window of opportunity.