Ultrasound-guided central venous access for patients in the Intensive Care Unit in prone position: report of three cases

Abstract The prone position is extensively used to improve oxygenation in patients with severe acute respiratory distress syndrome caused by SARS-CoV-2 pneumonia. Occasionally, these patients exhibit cardiac and respiratory functions so severely compromised they cannot tolerate lying in the supine position, not even for the time required to insert a central venous catheter. The authors describe three cases of successful ultrasound-guided internal jugular vein cannulation in prone position. The alternative approach here described enables greater safety and well-being for the patient, reduces the number of episodes of decompensation, and risk of tracheal extubation and loss of in-situ vascular lines.

Conhecimentos da enfermagem sobre peripherally inserted central catheters: complicações, medidas preventivas e indicações de retirada / Nursing knowledge about peripherally inserted central catheters: complications, preventive measures and indications for removal / Conocimientos de enfermería sobre catéteres centrales de inserción periférica: complicaciones, medidas preventivas e indicaciones de retiro

Objetivo: Discutir as complicações e medidas preventivas, bem como as condições de retirada associadas ao uso do Peripherally Inserted Central Catheters, no contexto intra-hospitalar na perspectiva do conhecimento da equipe de enfermagem. Métodos: Investigação exploratório-descritiva, de método misto, realizada numa instituição hospitalar particular (MGBrasil), de março-maio/2021, com 114 profissionais da enfermagem, por meio do Google Forms. Coletados dados de caracterização profissional, perfil de conhecimento e avaliação das complicações, medidas preventivas e condições de retirada associadas ao uso do cateter. Resultados: O perfil profissional revela indícios de precarização do trabalho de enfermagem e o conhecimento dos participantes demonstra acesso às principais complicações do uso do dispositivo, das medidas de prevenção, bem como das condições que justificam a sua retirada. Conclusão: Há evidências da necessidade de intervenções educativas visando-se melhorias em prol da segurança da prática profissional e do paciente, qualidade da assistência e excelência de cuidados na instituição de saúde. (AU)

Objective: To discuss complications and preventive measures, as well as the removal conditions associated with the use of Peripherally Inserted Central Catheters, in the intra-hospital context from the perspective of the nursing team's knowledge. Methods: Exploratory-descriptive investigation, mixed-method research, carried out in a private hospital (MG-Brazil), from March to May/2021, with 114 nursing professionals, using Google Forms. The following data were collected: Professional's characterization, knowledge's profile and evaluation of complications, preventive measures and removal conditions associated with the use of the catheter. Results: The professional profile reveals signs of how nursing job is precarious and the participants' knowledge demonstrates access to the main complications of using the device, prevention measures, as well as the conditions that justify its removal. Conclusion: There is evidence of the needed educational interventions, aiming an improvement of the safe practice to the professional and to the patient, care quality and excellence of care in the health institution. (AU)

Objectivo: Discutir las complicaciones y medidas preventivas, así como las condiciones de retirada, asociadas al uso de Peripherally Inserted Central Catheters, en el contexto intrahospitalario desde la perspectiva del conocimiento del equipo de enfermería. Métodos: investigación exploratorio-descriptiva, de método mixto, realizada en un hospital particular (MG-Brasil), de marzo hasta mayo/2021, con 114 profesionales de enfermería, utilizando Google Forms. Se recogieron datos de caracterización profesional, perfil del conocimiento y evaluación de complicaciones, medidas preventivas y condiciones de retirada asociadas al uso del catéter. Resultados: El perfil profesional revela indicios de la precariedad del trabajo de enfermería y el conocimiento de los participantes evidencia el acceso a las principales complicaciones del uso del dispositivo, las medidas de prevención, así como las condiciones que justifican su retirada. Conclusiones: Existe evidencia de la necesidad de intervenciones educativas dirigidas a mejorar la seguridad de la práctica profesional y del paciente, la calidad de la asistencia y la excelencia de la atención en la institución de salud. (AU)

A compreensão dos profissionais de uma unidade de terapia intensiva pediátrica acerca do bundle de cateter venoso central / The understanding of professionals in a pediatric intensive care unit about the central venous catheter bundle / La comprensión de los profesionales en una unidad de cuidados intensivos pediátricos sobre el bundle de catéter venoso central

Objetivo: Desvelar a compreensão dos profissionais acerca das recomendações do Bundle de inserção e manutenção do cateter venoso central. Métodos: Estudo descritivo exploratório, quantitativo e realizado em 2020 em uma Unidade de Terapia Intensiva Pediátrica de um hospital referência em Minas Gerais. Resultados: Foram entrevistados 62 profissionais de saúde, sexo feminino (90,3%), idade 25-39 anos (50%), Enfermeiros (Enf) (17,8%), Técnicos de enfermagem TE (58%) e Médicos (Med) (24,2%). Concordam totalmente com as assertivas: Bundle como um instrumento eficaz para a redução de infecção de cateter venoso central, Enf (45,5%), TE (25%) e Med (26,7%); deve-se utilizar barreira máxima de precaução, Enf (81,8%), TE (53%), Med (60%); realizar antissepsia das mãos ao manuseio do cateter, Enf (72,7%), TE (52,5%), Med (53,3%); utilizar de clorexidina alcoólica 0,5%, Enf (72,8%). Indiferente a afirmativa anterior, Med (53,3%); evitar veia femoral como sítio de inserção, concordam Enf (54,5%) e Med (40%). Conclusão: O profissional enfermeiro possui maior conhecimento sobre o Bundle de cateter venoso central. É fundamental que toda a equipe reconheça e utilize este instrumento para às boas práticas de manejo do cateter e redução da infecção. (AU)

Objective: To unveil the professionals' understanding of the recommendations of the central venous catheter insertion and maintenance bundle. Methods: A descriptive, exploratory, quantitative study carried out in 2020 in a Pediatric Intensive Care Unit of a reference hospital in Minas Gerais. Results: 62 health professionals were interviewed, female (90.3%), aged 25-39 years (50%), Nurses (Nurse) (17.8%), Nursing technicians (NT) (58%) and Doctors (Med)(24.2%). Totally agree with the assertions: Bundle as an effective tool for reducing central venous catheter infection, Nurse (45.5%), TE (25%) and Med (26.7%); Maximum precautionary barrier should be used, Nurse (81.8%), TE (53%), Med (60%); Perform hand antisepsis when handling the catheter, Nurse (72.7%), ET (52.5%), Med (53.3%); Use 0.5% alcoholic chlorhexidine, Enf (72.8%). Indifferent to the previous statement, Med(53.3%); Avoid the femoral vein as the insertion site, agree Enf (54.5%) and Med (40%). Conclusion: The professional nurse has greater knowledge about the central venous catheter Bundle. It is essential that the entire team recognize and use this instrument for good catheter management practices and infection reduction. (AU)

Objetivo: Desvelar el conocimiento de los profesionales sobre las recomendaciones del Bundle de inserción y mantenimiento del catéter venoso central. Métodos: Estudio descriptivo, exploratorio y cuantitativo realizado en 2020 en una Unidad de Cuidados Intensivos Pediátricos de un hospital de referencia en Minas Gerais. Resultados: se entrevistaron 62 profesionales de la salud, mujeres (90,3%), 25-39 años (50%), Enfermeros (Enfermera) (17,8%), Técnicos de enfermería (NT) (58%) y Médicos (Med) (24,2%). Totalmente de acuerdo con las afirmaciones: Bundle como herramienta eficaz para reducir la infección catéter venoso central, Nurse (45,5%), TE (25%) y Med (26,7%); Se debe utilizar barrera máxima de precaución, Enfermera (81,8%), TE (53%), Med (60%); Realizar antisepsia de la mano al manipular el catéter, Enfermera (72,7%), ET (52,5%), Med (53,3%); Utilice clorhexidina alcohólica al 0,5%, Enf (72,8%). Indiferente a la afirmación anterior, Med (53,3%); Evite la vena femoral como sitio de inserción, coinciden Enf (54,5%) y Med (40%). Conclusión: La enfermera profesional tiene un mayor conocimiento sobre el Bundle catéter venoso central. Es esencial que todo el equipo reconozca y utilice este instrumento para las buenas prácticas de manejo del catéter y la reducción de infecciones. (AU)

Implantação de time de terapia intravenosa a partir de pesquisa convergente-assistencia / Implementation of an intravenous therapy team based on convergent-assistance research / Implementación de un equipo de terapia intravenosa basado en investigación convergente-asistencial

Objetivo: Implantar um time de terapia intravenosa em um hospital de grande porte. Método: Estudo de abordagem qualitativa realizado a partir de encontros de grupo de convergência, utilizando o referencial metodológico da pesquisa convergente-assistencial. Foram realizadas entrevis-tas semiestruturadas, a apuração dos dados obtidos por meio da análise de conteúdo e a formação de três categorias, que originaram os assuntos para a capacitação dos profissionais. Resultados: Participaram nove enfermeiros e, após a realização de quatro encontros de capacitação, foi implantado um time de terapia intravenosa e desenvolvido documento norteador para a execução do trabalho. Conclusão: O estudo resultou na implantação do time de terapia intravenosa em um hospital de grande porte a partir da pesquisa desenvolvida e da experiência de trabalho dos enfermeiros que atuam na prá-tica assistencial. O referencial metodológico possibilitou aos enfermeiros serem ouvidos enquanto promotores da ação e implementadores da inovação.Palavras-chave: Infecção hospitalar. Cateteres de demora. Infecções relacionadas a cateteres. Segurança do paciente.

Objective: To implement an intravenous therapy team in a large hospital. Method: Qualitative study carried out based on convergence group meetings, using the methodological framework of convergent-assistance research. Semi-structured interviews were carried out, data were collected through content analysis and three categories were formed, which originated the subjects for the training of professionals. Results: Nine nurses par-ticipated in the research and, after four training meetings, an intravenous therapy team was implemented and a guiding document was developed for carrying out the work. Conclusion: The study resulted in the implementation of an intravenous therapy team in a large hospital based on the research developed and the work experience of nurses who work in care practice. The methodological framework allowed nurses to be heard as promoters of action and implementers of innovation.

Objetivo: Implementar un equipo de terapia intravenosa en un gran hospital. Método: Estudio cualitativo realizado a partir de reuniones de grupos de convergencia, utilizando el marco metodológico de investigación convergente-asistencial. Fueron realizadas entrevistas semiestructuradas, reco-gida de datos a través del análisis de contenido y la formación de tres categorías, que originaron los temas para la formación de profesionales. Resultados:Participaron nueve enfermeros y, después de cuatro reuniones de capacitación, se implementó un equipo de terapia intravenosa y se elaboró un docu-mento guía para la realización del trabajo. Conclusión: El estudio resultó en la implementación de un equipo de terapia intravenosa en un hospital de gran porte a partir de la investigación desarrollada y la experiencia laboral de los enfermeros que actúan en la práctica asistencial. El marco metodológico permitió que los enfermeros sean escuchados como promotores de la acción e implementadores de la innovación.

Construção e validação de curso online para enfermeiros sobre cateteres venosos centrais em crianças no domicílio / Construcción y validación de un curso en línea para enfermeros sobre catéteres venosos centrales en niños en el hogar / Construction and validity of an online course for nurses on central venous catheters in children at home

Resumo Objetivo construir um curso online e autoinstrucional para enfermeiros que realizam assistência às crianças em uso de cateter venoso central no domicílio e validar o conteúdo do curso por especialistas. Método estudo metodológico, alicerçado no Design Instrucional pelo modelo ADDIE, desenvolvido em duas etapas entre setembro de 2019 e maio de 2020: construção do curso; e validação do conteúdo por um comitê de oito especialistas, recrutados pelo método bola de neve por meio eletrônico. Utilizou-se o Instrumento de Validação de Conteúdo Educativo em Saúde, com ponto de corte ≥0,8 para a validação de conteúdo. Resultado s: elaboram-se 25 produtos tecnológicos para a produção final do curso: quatro planos de ação pedagógica, seis storyboards, nove recursos educativos em vídeo e 6 módulos do curso em formato Sharable Content Object Reference Model, aplicável em diferentes plataformas. Todos os módulos apresentaram Índice de Validade de Conteúdo ≥0,80 em todos os domínios e na avaliação global. Conclusão e implicações para a prática o conteúdo de todos os módulos foi validado pelos especialistas. O curso contribui para a prática assistencial, permitindo atualização com base em conteúdo atual e validado cientificamente. Ele pode ser utilizado em outras propostas pedagógicas, desde que atendidas as premissas da Licença Creative Commons 4.0 Internacional.

Resumen Objetivo construir un curso en línea y de auto instrucción para enfermeras que brindan atención a niños utilizando un catéter venoso central en el hogar y validar el contenido del curso por especialistas. Método estudio metodológico, basado en Diseño Instruccional por el modelo ADDIE, desarrollado en dos etapas entre septiembre de 2019 y mayo de 2020: construcción del curso; y validación del contenido por un comité de ocho especialistas, reclutados por el método bola de nieve, electrónicamente. Se utilizó el Instrumento de Validación de Contenidos Educativos en Salud y se adoptó el punto de corte ≥0.8 para la validación de contenidos. Resultados en siete meses, se elaboran 25 productos tecnológicos para la producción final del curso: cuatro planes de acción pedagógica, seis storyboards, nueve recursos educativos de video y 6 módulos del curso en formato Sharable Content Object Reference Model, aplicables en diferentes plataformas. Todos los módulos mostraron un Índice de Validez de Contenido ≥0,80 en todos los dominios y en la evaluación general. Conclusión e implicaciones para la práctica el contenido de los módulos ha sido respaldado por especialistas. El curso contribuye a la práctica del cuidado, permitiendo la actualización a partir de contenidos actualizados y científicamente validados. Puede ser utilizado en otras propuestas pedagógicas, siempre que se cumplan las premisas de la Licencia Creative Commons 4.0 Internacional.

Abstract Objective to construct an online, self-instructional course for nurses who provide care to children using a central venous catheter at home and validate the course content by experts. Method this is a methodological study, based on Instructional Design using the ADDIE model, developed in two stages between September 2019 and May 2020: course construction; and content validity by a committee of eight experts, recruited by the snowball method through electronic. The Educational Content Validation Instrument in Health was used, with a cut-off point ≥0.8 for content validity. Results twenty-five technological products are created for the course's final production: four pedagogical action plans, six storyboards, nine educational video resources and 6 course modules in Sharable Content Object Reference Model format, applicable on different platforms. All modules presented a Content Validity Index ≥0.80 in all domains and in the overall assessment. Conclusion and implications for practice the content of all modules has been validated by experts. The course contributes to care practice, allowing updating based on current and scientifically validated content. It can be used in other pedagogical proposals, as long as the Creative Commons Attribution 4.0 International License premises are met.

Clinical experience of REcanalisation and balloon-oriented puncture for Re-insertion of long- term dialysis catheter in nonpatent central veins / 中华肝脏病杂志

It is difficult to insert long-term dialysis catheters after severe stenosis or occlusion of the internal jugular vein and innominate vein. We used REcanalisation and balloon-oriented puncture for Re-insertion of dialysis catheter in nonpatent central veins (REBORN) in seven patients with severe central venous lesions, and all patients were inserted with long-term dialysis catheters successfully. None had severe complications such as pneumothorax, hemothorax, or pulmonary embolism during operation. All catheters functioned well after postoperative follow-up of 2 months. REBORN provides a novel approach to establish difficult dialysis pathways.

Design and application of a B-ultrasound-guided deep vein puncture precise positioning device / 中华危重病急救医学

Deep venipuncture catheterization is a routine and basic operation in the treatment of critically ill patients, and it is the most effective way to quickly correct the shock. Clinical B-ultrasound guided deep vein catheters can improve the success rate of puncture, but in the process of operation, the short axis needs to be replaced by the long axis. In the replacement process, the stability of the novice is insufficient, the positioning is difficult, and the operation time is too long. If only short axis puncture is used, it is impossible to know whether the current position of the puncture needle, and the puncture may be too deep and stray into the artery. The accuracy of the 45 degree angle of the injection point requires a very experienced operator. In view of the above shortcomings, doctors in the department of critical care medicine of Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a B-ultrasound puncture equipment, which has obtained the National Invention Patent of China (ZL 2016 1 0571557.X). The device is composed of B-ultrasound probe fixing frame, sliding scale plate, simulation slide rule, puncture needle, sliding device. By sliding device the angle of the pinhole channel, it is conducive to the accurate positioning of the puncture target, optimizing the operation procedure, improving the puncture speed and accuracy, effectively reducing the occurrence of puncture complications, ensuring patient safety, reducing unnecessary waste of human and material resources. It can reduce the workload of medical staff and is worthy of clinical practice.

Dwelling time and complications of umbilical venous catheterization with different tip positions in preterm infants: a multicenter prospective cohort study / 中华儿科杂志

Objective: To compare the dwelling time and complications of low lying umbilical venous catheterization (UVC) in preterm infants with that of central UVC. Methods: This was a prospective cohort study. A total of 3 020 preterm infants from 44 neonatal intensive care units (NICU) who had UVC inserted from October 2019 to August 2021 were enrolled. Demographic and general baseline data, dwelling time of UVC and reasons for removal, complications and their occurrence time were collected. According to the position of the catheter tip, the preterm infants were divided into low lying UVC group (insertion depth of 3-5 cm) and central UVC group (the catheter tip was close to the entrance of right atrium, or at the 8th-9th thoracic vertebra level). The Mann-Whitney U test was used to compare the dwelling time and incidence of complications (cases/1 000 catheter days), and the independent t test and Chi-square test were used to compare the characteristics between the 2 groups. The receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off value of UVC dwelling time. Results: Among the included 3 020 preterm infants, 1 624 (53.8%) were males, the gestational age was 29.9 (28.4, 31.6) weeks, the birth weight was (1 264±301) g, and 2 172 (71.9%) premature babies had central UVC. There were no significant differences in the proportion of males, the gestational age and the birth weight of neonates between the 2 groups (all P>0.05). There were also no significant differences in the rate of maternal history, PPROM>18 hours, chorioamnionitis, antenatal antibacterial angents exposure and antibacterial angents usage through UVC (all P>0.05). The dwelling time of central UVC was longer than that of low lying UVC (7 (6, 10) vs. 4 (3, 7) days, U=23.42, P<0.001). The complication incidence of central and low lying UVC were 20.0 and 70.8 cases/1 000 catheter days, respectively. The top 3 complications of central UVC were occlusion, catheter tip migration, and CLABSI (9.3, 3.5, 3.0 cases/1 000 catheter days). The top 3 complications of low lying UVC were catheter occlusion, CLABSI, and catheter tip migration (45.8, 6.3, 5.4 cases/1 000 catheter days). The ROC curve of UVC dwelling time and complications showed that the cut-off values ​​of central UVC and low lying UVC were 6.5 and 4.5 days, respectively. The 2 groups both showed a trend of increases in the 3 complications with the prolonged dwelling time. Cox regression analysis showed that the overall difference in the proportion of occlusion between the central UVC and low lying UVC groups was statistically significant (χ2=30.18, P=0.024). There were both no significant differences in catheter tip migration and CLABSI (both P>0.05). Conclusions: The most common UVC complication in preterm infants is occlusion. It is not recommended to keep a low lying UVC for longer than 4.5 days. During the whole dwelling period, a close monitoring for UVC complications is required.

Utilização de Cateter Central de Inserção Periférica para Realização de Transplante de Células-Tronco Hematopoiéticas / Use of Peripherally Inserted Central Catheter to Perform Hematopoietic Stem Cell Transplantation / Uso de Catéter Central de Inserción Periférica para Realizar Trasplante de Células Madre Hematopoyéticas

Introdução: O acesso venoso seguro é indispensável aos pacientes no transplante de células-tronco hematopoiéticas (TCTH), e o enfermeiro participa de todo o seu processo de decisão e manutenção. Objetivo: Sistematizar a experiência de enfermeiros na utilização do cateter central de inserção periférica (CCIP) para a realização de TCTH em um centro de transplante de medula óssea de uma instituição pública, referência nacional em oncologia. Método: Estudo descritivo elaborado a partir da sistematização criada por Oscar Jara Holliday. Resultados: A experiência de utilização do CCIP, para a realização de TCTH, no centro de transplante estudado, teve início em 2017. Durante a implementação da nova rotina, surgiram obstáculos relacionados à resistência da equipe, aceitação dos pacientes, disponibilidade de material adequado e profissionais habilitados. Pensando na assistência terapêutica endovenosa de qualidade e segura para o paciente, registrou-se a marca de 130 CCIP implantados nos últimos seis anos (2017-2022), o que representou 32% do total de cateteres utilizados no último ano para realização de transplantes autólogos, alogênicos aparentados, alogênicos não aparentados e haploidênticos. Outro dado referente ao sucesso desse procedimento nesse centro mostra que 80% dos CCIP foram retirados por motivo de alta e os outros 20% por trombose (2%); obstrução (8%); óbito (5%); e febre (5%). Conclusão: Observa-se que, apesar das dificuldades enfrentadas, a implementação e a utilização de CCIP para infusão de células-tronco hematopoiéticas têm apresentado bons resultados e contribuem para a prática de obtenção de acesso vascular seguro no TCTH

Introduction: Safe venous access is essential for patients undergoing hematopoietic stem cell transplantation (HSCT) and the nurse participates in the entire decision-making process and maintenance. Objective: To systematize the experience of nurses in using the peripherally inserted central catheter (PICC) to perform HSCT in a bone marrow transplant center of a public institution that is a national oncology reference. Method: Descriptive study based in Jara Holliday's systematization. Results: The experience of using PICC to perform HSCT at the transplant center investigated began in 2017. During the implementation of the new routine, obstacles related to the team's resistance, patient acceptance, availability of adequate material and qualified professionals were detected. Regarding quality and safe intravenous therapeutic assistance for the patient, 130 PICC have been implanted in the last six years (2017-2022), accounting for 32% of the total number of catheters used to perform autologous, related allogeneic, unrelated allogeneic and haploidentical transplants in the last year. 80% of PICC was removed due to hospital discharge and 20% due to thrombosis (2%), obstruction (8%), death (5%) and fever (5%) confirming the success of this procedure in the center investigated. Conclusion: Despite the difficulties, the implementation and use of PICC for the infusion of hematopoietic stem cells has shown good results and contributed to obtaining safe vascular access in HSCT

Introducción: El acceso venoso seguro es fundamental para los pacientes sometidos a trasplante de células madre hematopoyéticas (TCMH) y el personal de enfermería participa en todo el proceso de toma de decisiones y mantenimiento de este acceso. Objetivo: Sistematizar la experiencia de enfermeros en el uso del catéter central de inserción periférica (PICC) para realizar trasplante de células madre hematopoyéticas en un centro de trasplante de médula ósea de una institución pública de referencia nacional en oncología. Método: Estudio descriptivo elaborado a partir de la sistematización realizada por Oscar Jara Holliday. Resultados: La experiencia de utilizar el PICC para realizar el TCMH en el centro de trasplante estudiado se inició en 2017. Durante la implementación de la nueva rutina surgieron obstáculos relacionados con la resistencia del equipo, aceptación del paciente, disponibilidad de material adecuado y profesionales calificados. Pensando en una asistencia terapéutica intravenosa de calidad y segura para el paciente, nos lanzamos y elevamos la marca de 130 PICC implantados en los últimos seis años (2017-2022), lo que representó en el último año el 32% del total de catéteres utilizados para realizar trasplantes autólogos, alogénicos relacionados, alogénicos no relacionados y haploidénticos. Otro dato referente al éxito de este procedimiento en nuestro centro muestra que el 80% de los PICC se retiraron por alta y el otro 20% por trombosis (2%); obstrucción (8%); muerte (5%) y fiebre (5%). Conclusión: Al final de este informe, observamos que, a pesar de las dificultades enfrentadas, la implementación y el uso de PICC para la infusión de células madre hematopoyéticas mostró buenos resultados y contribuyó para la práctica de obtener un acceso vascular seguro en el TCMH

Educação permanente em cuidados de enfermagem na manutenção do cateter venoso central de inserção periférica / Permanent education in nursing care in the maintenance of the central venous catheter of peripheral insertion

Objetivo: Relatar uma atividade de educação permanente sobre a manutenção do PICC desenvolvida por enfermeiros e estudantes de enfermagem em um hospital oncológico.Métodos: Trata-se de um estudo do tipo relato de experiência baseado na Problematização seguindo as cinco etapas do Arco de Maguerez. Na observação, constatou-se a utilização do PICC no protocolo de terapia do hospital, e considerou-se a complexidade de sua utilização, incidindo na necessidade de atualização acerca dos cuidados. Para a teorização, foi realizada uma revisão da literatura. Na quarta etapa, definiu-se uma educação permanente como abordagem com os profissionais. A atividade ocorreu com a realização de um Quiz e explanação do conteúdo com o material didático produzido.Resultados: As perguntas do Quiz e o material direcionaram a atividade. A equipe demonstrou saber as respostas, cabendo ao mediador a complementação do assunto. Aatividade oportunizou à padronização de condutas e cuidados com o cateter, além do compartilhamento de experiência entre os profissionais. Conclusão:Na utilização do PICC, aperfeiçoar os cuidados promove a prevenção de intercorrências e efetiva a assistência. A continuidade de se desenvolver a temática é necessária, pois o aperfeiçoamento do profissional precisa ser contínuo.

Objective: To report a continuing education activity on the maintenance of PICC developed by nurses and nursing students in an oncology hospital.Methods: This is a study of the type of experience report based on Problematization following the five stages of the Maguerez Arch. In the observation, the use of PICC was verified in the hospital therapy protocol, and the complexity of its use was considered, focusing on the need for updating on care. For the theorization, a literature review was performed. In the fourth stage, a permanent education was defined as an approach with professionals. The activity occurred with the realization of a Quiz and explanation of the content with the didactic material produced.Results: Quiz questions and material targeted activity. The team demonstrated to know the answers, and it was up to the mediator to complement the subject. The activity has given way to the standardization of catheter procedures and care, in addition to the sharing of experience among professionals.Conclusion: In the use of PICC, improving care promotes the prevention of complications and effective care. The continuity of developing the theme is necessary, because the improvement of the professional needs to be continuous.

Efectividad de un programa de reducción de bacteriemias relacionadas con catéter venoso central en una unidad cardiovascular pediátrica / Effectiveness of a program for the reduction of central venous catheter-related bacteremias in a Pediatric Cardiovascular Unit

Introducción. Las bacteriemias relacionadas con catéteres venosos centrales (CVC) son frecuentes en pacientes pediátricos posquirúrgicos de cardiopatías congénitas complejas internados en la unidad de cuidados intensivos pediátricos cardiovascular (UCIP-CV) y tienen alta morbimortalidad. Objetivo. Analizar la efectividad de un programa interdisciplinario para prevención de bacteriemias relacionadas con CVC en la UCIP-CV. Material y métodos. Estudio de implementación, cuasiexperimental, antes-después, sin grupo control. Período de estudio del 1 de enero de 2008 al 31 de diciembre de 2018. Población: equipo de salud de la UCIP-CV que atiende pacientes posquirúrgicos de cardiopatías complejas de un hospital. Período preintervención del 1 de enero de 2008 al 31 de diciembre de 2008; período de intervención del 1 de enero de 2009 al 1 de enero de 2018. Intervención: implementación de un programa de mejora continua. Se analizaron tasas de bacteriemias CVC/1000 días y de uso de CVC/100 días, puntaje de RACHS, razón estandarizada de infecciones (REI), riesgo relativo (RR), intervalo de confianza del 95 % (IC95%), estimando una p < 0,05 como estadísticamente significativa. La tasa de referencia se estimó como el promedio del período 2008/2009 y se comparó la tasa anual con la tasa de referencia. Resultados. La tasa de referencia de bacteriemia 2008/2009 fue 10,6/1000 días CVC para analizar la REI. El puntaje de RACHS mayor a 3 fue similar en todos los períodos analizados. Se observó una reducción de la REI estadísticamente significativa (p < 0,05) en la comparación anual. Al comparar la tasa de bacteriemia/1000 días de CVC inicial de 11,9 vs. final de 3,8, se observó una reducción significativa (RR: 0,16; IC95%: 0,07-0,35; p < 0,001). Conclusiones. El programa fue efectivo; se observó reducción progresiva y significativa de la tasa de bacteriemias relacionadas con CVC en la UCIP-CV.

Introduction. Central venous catheter (CVC)related bacteremias are common in pediatric patients following surgery for complex congenital heart disease admitted to a pediatric cardiac intensive care unit (PCICU) and have a high morbidity and mortality. Objective.To analyze the effectiveness of an interdisciplinary program for the prevention of CVC-related bacteremias in the PCICU. Material and methods. Quasi-experimental,before and after implementation study without a control group. Study period: 01-01-2008 to 1231-2018. Population: PCICU staff who care for patients following surgery for complex heart disease at a hospital. Pre-intervention period: 0101-2008 to 12-31-2008; intervention period: 01-012009 to 01-01-2018. Intervention: implementation of an ongoing improvement program. The rate of CVC-related bacteremias/1000 days and CVC use/100 days, RACHS score, standardized infection ratio (SIR), relative risk (RR), and 95% confidence interval (CI) were analyzed and a p value < 0.05 was considered statistically significant. The reference rate was estimated as the average for the 2008-2009 period and the annual and reference rates were compared. Results. The bacteremia reference rate for 20082009 was 10.6/1000 days of CVC to analyze the SIR. A RACHS score over 3 was similar across all studied periods. The annual comparison showed a statistically significant reduction (p < 0.05) in the SIR. The comparison between the baseline bacteremia rate/1000 days of CVC (11.9) and the final rate (3.8) showed a significant reduction (RR: 0.16; 95 % CI: 0.07­0.35; p < 0.001). Conclusions. The program was effective; the rate of CVC-related bacteremias in the PCICU showed a progressive, significant reduction.

Experiencia en el uso de ultrasonido en cateterismo venoso central (yugular-femoral) en pacientes pediátricos en una unidad de cuidados intensivos / Experience with ultrasound use in central venous catheterization (jugular-femoral) in pediatric patients in an intensive care unit

Objetivos. Describir el uso de la guía ecográfica en el cateterismo venoso central, comparando el número de intentos (1 versus 2 o más intentos), en relación con los catéteres insertados en vena yugular interna (VYI) versus vena femoral (VF). Material y métodos. Estudio descriptivo, prospectivo de catéteres venosos centrales (CVC) colocados mediante punción ecoguiada en pacientes de 1 mes a 18 años. Se realizó un modelo de regresión multivariado considerando el punto final primario, éxito a la primera punción en relación con el sitio de inserción (VYI versus VF) y variables predictoras de éxito. Resultados. Se colocaron 257 CVC, VYI 118 (45,9 %), VF 139 (54,1 %); 161 (62,7 %) insertados en la primera punción y 96 (37,3 %) requirieron más de una punción. Las inserciones en VYI fueron exitosas en la primera punción en 86 pacientes (53,5 %) y en VF fueron 75 (46,5 %) (p 0,0018; OR: 0,43 [IC95%: 0,24-0,76]). Hubo 21 (8,1 %) complicaciones inmediatas, 3 (1,86 %) se relacionaron con la primera punción, 18 (18,75 %) lo hicieron con más de una punción (p 0,0001 [IC95%: 3,36-45,68]). Las complicaciones graves, como neumotórax, fueron 4. Conclusiones. El cateterismo venoso guiado por ultrasonido demostró ser significativamente exitoso en el primer intento cuando el vaso de elección fue la VYI comparado con VF, especialmente en menores de 6 meses. Las complicaciones inmediatas fueron más frecuentes en los pacientes que requirieron más de una punción

Objectives. Describe ultrasound-guided central venous catheterization use comparing the number of attempts (1 versus 2 or more attempts) in relation to catheters placed in the internal jugular vein (IJV) versus the femoral vein (FV). Material and methods. Descriptive, prospective study of central venous catheters (CVCs) inserted via ultrasound-guided puncture in patients aged 1 month to 18 years. A multivariate regression model was done considering the primary endpoint, first puncture success in relation to the insertion site (IJV versus FV), and predictors of success. Results. A total of 257 CVCs were inserted: IJV 118 (45.9%), FV 139 (54.1%); 161 (62.7%) were inserted in the first attempt and 96 (37.3%) required more than 1 attempt. IJV insertions were successful with the first puncture in 86 patients (53.5%) and FV insertions, in 75 (46.5%) (p 0.0018; OR: 0.43 [95% CI: 0.24-0.76]). There were 21 (8.1%) immediate complications: 3 (1.86%) were related to the first puncture, 18 (18.75%), to more than 1 puncture (p 0.0001 [95% CI: 3.36-45.68]). There were 4 cases of severe complications, including pneumothorax. Conclusions. Ultrasound-guided venous catheterization demonstrated to be significantly successful in the first attempt when using the IJV versus FV, especially in infants younger than 6 months. Immediate complications occurred more frequently in patients requiring more than 1 puncture.

An unusual case of femoral arteriovenous fistula associated with acute limb ischemia following femoral vein catheterization for hemodialysis / Um caso incomum de fístula arteriovenosa femoral associada a isquemia aguda de membro após cateterização da veia femoral para hemodiálise

Abstract Co-occurrence of acute limb ischemia (ALI) and arteriovenous fistula (AVF) as a manifestation of inadvertent arterial injury during percutaneous femoral vein dialysis catheter insertion is a rare and dangerous, but preventable complication. Iatrogenic femoral AVF commonly presents late, with leg swelling or high output cardiac failure. However, the co-occurrence of a femoral AVF with both progressive leg swelling, and acute thromboembolism has not been previously reported. We report the case of an iatrogenic femoral AVF with superficial femoral artery (SFA) thrombosis and distal embolism in a 53-year-old female who underwent percutaneous femoral access for temporary hemodialysis. Both the SFA and AVF were managed with open surgical repair.

Resumo A coocorrência de isquemia aguda de membro (IAM) e fístula arteriovenosa (FAV) como uma manifestação de lesão arterial inadvertida durante a inserção de cateter para hemodiálise por via femoral percutânea é uma complicação rara e perigosa, porém evitável. A FAV femoral iatrogênica geralmente tem apresentação tardia, com edema dos membros inferiores ou insuficiência cardíaca de alto débito. No entanto, a coocorrência de FAV femoral com edema progressivo dos membros inferiores e tromboembolismo agudo não foi previamente relatada. Relatamos o caso de uma FAV femoral iatrogênica com trombose da artéria femoral superficial (AFS) e embolia distal em uma paciente do sexo feminino, 53 anos, submetida à acesso femoral percutâneo para hemodiálise temporária. Tanto a AFS quanto a FAV foram manejadas com reparo cirúrgico aberto.

Management of central catheters in newborns and children hospitalized in intensive care units / Manejo de catéteres centrales en recién nacidos y niños hospitalizados en unidades de cuidados intensivos / Manejo de cateteres centrais em recém-nascidos e crianças internadas em unidades de terapia intensiva

Objective: to identify the care strategies adopted by nursing professionals in the handling of central catheters in children and newborns hospitalized in an Intensive Care Unit. Method: descriptive research, with quantitative approach, of the non-participant systematic observation type, in a tertiary public hospital in Rio de Janeiro. A structured checklist was applied to the professionals who assisted this clientele. The data were submitted to simple descriptive analysis and organized in graphs. Results: 80 observations were obtained, separated into three stages: moments of hand hygiene; manipulation of the deep catheter; equipment and connectors. Conclusion: the nursing team has satisfactory support to items considered essential in the care and prevention of bloodstream infections related to central catheters in children and newborns hospitalized in the Intensive Care Unit.

Objetivo: identificar las estrategias de cuidado adoptadas por los profesionales de enfermería en el manejo de catéteres centrales en niños y recién nacidos hospitalizados en una Unidad de Cuidados Intensivos. Método: investigación descriptiva, con enfoque cuantitativo, del tipo observación sistemática no participante, en un hospital público terciario de Río de Janeiro. Se aplicó una lista de verificación estructurada a los profesionales que asistieron a esta clientela. Los datos fueron sometidos a un análisis descriptivo simple y organizados en gráficos. Resultados: se obtuvieron 80 observaciones, separadas en tres etapas: momentos de higiene de manos; manipulación del catéter profundo; equipos y conectores. Conclusión: el equipo de enfermería cuenta con un apoyo satisfactorio a los ítems considerados esenciales en el cuidado y prevención de infecciones del torrente sanguíneo relacionadas con catéteres centrales en niños y recién nacidos hospitalizados en la Unidad de Cuidados Intensivos.

Objetivo: identificar as estratégias de cuidado adotadas pelos profissionais de enfermagem no manuseio dos cateteres centrais em crianças e recém-nascidos internados em Unidade de Terapia Intensiva. Método: pesquisa descritiva, com abordagem quantitativa, do tipo observação sistemática não participante, em um hospital público terciário do Rio de Janeiro. Foi aplicado um check-list estruturado aos profissionais que assistiram essa clientela. Os dados foram submetidos a análise descritiva simples e organizados em gráficos. Resultados: obteve-se 80 observações, separadas em três etapas: momentos da higienização das mãos; manipulação do cateter profundo; equipos e conectores. Conclusão: a equipe de enfermagem possui uma adesão satisfatória aos itens considerados essenciais no cuidado e na prevenção de infecções da corrente sanguínea relacionados a cateteres centrais em crianças e recém-nascidos internados em Unidade de Terapia Intensiva.

Transfusão de hemácias em neonatos pelo cateter central de inserção periférica: revisão integrativa / Red blood cell transfusions in newborn infants through peripherally inserted central catheter: an integrative review / Transfusión de glóbulos rojos en neonatos a través de catéter central de inserción periférica: revisión integradora

Objetivo: identificar na literatura as implicações relacionadas à transfusão de hemácias, por meio do Cateter Central de Inserção Periférica, em neonatos. Métodos: revisão integrativa realizada nas bases de dados Web of Science, Scopus, Biblioteca Virtual em Saúde e PUBMED. Incluíram-se publicações em inglês, espanhol e português, disponíveis na íntegra, sem data limite. Resultados: selecionaram-se quatro (100,0%) pesquisas que abordaram hemólise das hemácias e dois deles (50,0%), também, versaram sobre obstrução do cateter durante a transfusão. Os estudos evidenciaram ocorrência de hemólise relacionada à velocidade de infusão e ao tempo de armazenamento das hemácias, porém sem relevância clínica. Referente à obstrução, observou-se ocorrência em apenas um cateter de 38 acompanhados em um estudo; no outro, não houve obstrução, sendo as transfusões consideradas tecnicamente viáveis. Conclusão: urgem estudos clínicos primários que avaliem as consequências clínicas das transfusões de hemácias por esse tipo de cateter, em neonatos.

Objective: this study aimed to identify in literature the implications related to red blood cell (RBC) transfusions, through Peripherally Inserted Central Catheter, in neonates. Methods: this is an integrative review conducted in the Web of Science, Scopus, Virtual Health Library, and PubMed databases. Publications in English, Spanish and Portuguese, available in full, without date limit, were included. Results: four (100.0%) studies that addressed hemolysis of RBCs were selected, of which two (50.0%) also addressed catheter obstruction during transfusion. Studies revealed the occurrence of hemolysis related to infusion rate and storage time of RBCs, however without clinical relevance. Regarding obstruction, it was verified in only one catheter out of 38 followed-up in a study; in the other, there was no obstruction and transfusions were considered technically feasible. Conclusion:there is urgent need for primary clinical studies to assess clinical consequences of red blood cell transfusions through this type of catheter in neonates.

Objetivo: identificar en la literatura las implicaciones relacionadas con la transfusión de glóbulos rojos, por Catéter Central de Inserción Periférica, en neonatos. Métodos: revisión integrativa, en las bases de datos Web of Science, Scopus, Biblioteca Virtual en Salud y PUBMED. Se incluyeron publicaciones en inglés, español y portugués, disponibles en totalidad, sin fecha límite. Resultados: seleccionaron cuatro (100,0%) estudios que abordaban la hemólisis de glóbulos rojos y dos de ellos (50,0%) la obstrucción del catéter durante la transfusión. Los estudios señalaron ocurrencia de hemólisis relacionada con velocidad de infusión y tiempo de almacenamiento de los glóbulos rojos, pero sin relevancia clínica. Sobre la obstrucción, se observó en catéter de 38 seguidos en un estudio; en otro, no hubo obstrucción, y las transfusiones se consideraron técnicamente factibles. Conclusión:se necesitan estudios clínicos primarios para evaluar las consecuencias clínicas de las transfusiones de glóbulos rojos a través de este tipo de catéter en los recién nacidos.

Cateter venoso central de curta permanência: produção de vídeos educativos para a equipe de enfermagem / Catéter venoso central de corta duración: producción de vídeos educativos para el equipo de enfermería / Short-term central venous catheter: Production of educational videos for the Nursing team

RESUMO Objetivo construir e validar roteiros e storyboards para a produção de vídeos educativos, em formato digital, sobre os cuidados e manutenção do cateter venoso central em pacientes adultos. Método estudo metodológico, descritivo, sobre construção e validação dos roteiros e storyboards para a produção de vídeos educativos, ocorrido em duas etapas metodológicas: de pré-produção e de produção. A etapa de pré-produção baseou-se em três fases: construção dos roteiros dos vídeos, elaboração dos storyboards e validação por peritos. A validação dos roteiros e storyboards foi realizada por nove juízes especialistas na temática e dois técnicos especialistas em vídeo. Calculou-se o Índice de Validação de Conteúdo (IVC), considerando-se como aceitável o índice mínimo de 0,80 para cada item dos instrumentos. Resultados produziram-se três vídeos educativos com as seguintes temáticas: cobertura, manutenção e troca e remoção do cateter venoso central. A respeito da validação pelos juízes especialistas na temática e pelos técnicos especialistas em vídeo, todos os itens avaliados resultaram na concordância em IVC de 100,0. Conclusão e implicações para a prática os vídeos educativos foram produzidos, validados e adequados para serem disponibilizados. A participação dos juízes na validação desse material foi fundamental para garantir a relevância teórica e prática do resultado.

RESUMEN Objetivo construir y validar guiones y storyboards para la producción de videos educativos, en formato digital, sobre el cuidado y mantenimiento del catéter venoso central en pacientes adultos. Método estudio metodológico y descriptivo sobre la construcción y validación de guiones y storyboards para la producción de vídeos educativos que se produjo en dos etapas metodológicas: preproducción y producción. La etapa de preproducción se basó en tres fases: construcción de los guiones de los vídeos, elaboración de storyboards y validación por parte de expertos. La validación de los guiones y storyboards fue realizada por 9 jueces especialistas en el tema y 2 técnicos expertos en video. Se calculó el Índice de Validación de Contenido (IVC), considerando como aceptable el índice mínimo de 0,80 para cada ítem de los instrumentos. Resultados se crearon tres vídeos educativos con los siguientes temas: cobertura, mantenimiento e intercambio y retirada del catéter venoso central. A partir de la valoración por parte de los jueces especialistas en el tema y de los técnicos especialistas en vídeo, todos los elementos evaluados resultaron en una concordancia en el IVC de 100,0. Conclusión e implicaciones para la práctica los videos educativos fueron construidos, validados y adecuados para ser puestos a disposición. La participación de los jueces en la validación de este material fue esencial para asegurar la relevancia teórica y práctica del resultado.

ABSTRACT Objective to prepare and validate scripts and storyboards for the production of educational videos, in digital format, about the care and maintenance of the central venous catheters in adult patients. Method a methodological and descriptive study about the elaboration and validation of scripts and storyboards for the production of educational videos that was conducted in two methodological stages: pre-production and production. The pre-production stage was based on three phases: preparation of the video scripts, elaboration of the storyboards, and validation by experts. Validation of the scripts and storyboards was in charge of 9 specialist judges in the subject matter and 2 technical experts in video; the Content Validation Index (CVI) was calculated considering as acceptable a minimum index of 0.80 for each item of the instruments. Results three educational videos were created with the following themes: dressing, maintenance and exchange and removal of the central venous catheter. Concerning the validation by expert judges in the subject matter and expert video technicians, all items evaluated resulted in agreement with a CVI of 100.0. Conclusion and implications for the practice the educational videos were elaborated, validated and suitable to be made available; the judges' participation in the validation of this material was essential to ensure the theoretical and practical relevance of the result.

Application of ultrasound-guided central venous catheterization at various sites in infants with shock / 中国当代儿科杂志

OBJECTIVES@#To study the clinical characteristics of ultrasound-guided central venous catheterization at various sites in infants with shock, and to explore how to quickly select the site for central venous puncture in infants with shock.@*METHODS@#The medical data of 112 infants who were diagnosed with shock and underwent central venous catheterization in the Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from January 2016 to December 2020 were reviewed retrospectively. The patients were divided into an ultrasound group (n=70) and a body surface location group (n=42) according to whether the catheterization was carried out under ultrasound guidance. The application of ultrasound-guided catheterization at various sites in infants was summarized and analyzed, and the success rate of one-time puncture, overall success rate, catheterization time, and complications were compared between these sites.@*RESULTS@#Compared with the body surface location group, the ultrasound group had a significantly higher success rate of one-time puncture, a significantly shorter catheterization time, and a significantly reduced incidence rate of complications in internal jugular vein and femoral vein catheterizations (P<0.05). In the ultrasound group, the proportion of internal jugular vein catheterization was the highest (51%, 36/70), followed by femoral vein catheterization (33%, 23/70), and subclavian vein catheterization (16%, 11/70). For the comparison between different puncture sites under ultrasound guidance, internal jugular vein catheterization showed the shortest time of a successful catheterization [5.5 (5.0, 6.5) minutes] (P<0.05). There was no significant difference in the incidence rate of complications among the different puncture sites groups (P>0.05).@*CONCLUSIONS@#In infants with shock, ultrasound-guided internal jugular vein catheterization can be used as the preferred catheterization method for clinicians.

Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates / 中国当代儿科杂志

OBJECTIVES@#To study the features of catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI) after peripherally inserted central catheterization (PICC) in neonates admitted to the neonatal intensive care unit (NICU) and the risk factors for CRBSI or CLABSI.@*METHODS@#A retrospective analysis was performed on the medical data of the neonates who were treated and required PICC in the NICU of the Children's Hospital, Zhejiang University School of Medicine from June 1, 2018 to May 1, 2020. The catheterization-related data were collected, including placement time, insertion site, removal time, and antimicrobial lock of PICC. The multivariate logistic regression model was used to investigate the risk factors for CRBSI or CLABSI in the neonates.@*RESULTS@#A total of 446 neonates were enrolled, with a mean gestational age of (30.8±4.0) weeks, a mean birth weight of (1 580±810) g, a median age of 9 days, and a median duration of PICC of 18 days. The incidence rates of CLABSI and CRBSI were 5.6 and 1.46 per 1 000 catheter days, respectively. Common pathogens for CLABSI caused by PICC included Staphylococcus epidermidis (n=19) and Klebsiella pneumoniae (n=11), and those for CRBSI caused by PICC included Klebsiella pneumoniae (n=6). The risk of CLABSI caused by PICC increased significantly with prolonged durations of PICC and antibiotic use, and the PICC-related infection probability at head and neck was significantly lower than that in the upper and low limbs (P<0.05), while the above conditions were more obvious in neonates with a birth weight of <1 500 g. The risk of CRBSI caused by PICC decreased with the increase in gestational age (P<0.05).@*CONCLUSIONS@#CRBSI and CLABSI remain serious issues in NICU nosocomial infection. The identification of the risk factors for CRBSI and CLABSI provides a basis for improving the quality of clinical care and management.

Prevention from PICC-related venous thrombosis in the upper limbs of malignant tumor patients with moxibustion combined with plucking at Jiquan (HT 1): a randomized controlled trial / 中国针灸

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.