Objective:The aim of our research was to study the incidence,clinical diagnosis and treatment of peripherally inserted central catheters(PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemot...Objective:The aim of our research was to study the incidence,clinical diagnosis and treatment of peripherally inserted central catheters(PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy.Methods:The data of the incidence,diagnosis and treatment of PICC-related sepsis in 215 cases of breast cancer patients carrying PICC catheter for chemotherapy in our hospital from August,2009 to September,2011 were analyzed retrospectively.Results:216 PICCs had been successfully applied in 215 cases of breast cancer patients and followed for a total of 19,109 catheter days,(median catheterization duration,88.9 days,range 1-212 days).Among those,3(1.39%) PICCs were removed respectively as a result of PICC-related sepsis in 29,73 and 108 catheter-days(median 70 d),with a rate of 0.16 per 1000 catheter-days.Conclusion:Chemotherapeutic treatment via PICC for breast cancer patients is one of the most secure and effective measures but there exists small number of cases in which PICC catheter related sepsis is possible.Careful observation of relevant symptoms and signs,early diagnosis and treatment,not relying completely on blood culture tests and timely removal of PICC catheter can be very effective in treating PICC-related sepsis in these patients.展开更多
BACKGROUND Individuals with diabetes mellitus have a higher risk of developing malignant tumors,and diagnosing these tumors can be challenging.AIM To confirm the benefits of using peripherally inserted central cathete...BACKGROUND Individuals with diabetes mellitus have a higher risk of developing malignant tumors,and diagnosing these tumors can be challenging.AIM To confirm the benefits of using peripherally inserted central catheters(PICCs)in contrast-enhanced computerized tomography(CECT)for diagnostic imaging in diabetic patients with malignant tumors and to provide a research basis for follow-up research.METHODS This retrospective study analyzed 204 diabetic patients with malignancies treated at The Second Affiliated Hospital,Jiangxi Medical College,Nanchang University,from January 2024 to June 2024.The patients were divided into two groups:A control group(n=102)with indwelling peripheral intravenous catheters and a research group(n=102)with high-pressure-resistant PICC.The study compared baseline data,the incidence of iodine contrast extravasation during CECT,the incidence of adverse events(discomfort,redness and swelling at the puncture site,and blood oozing),imaging quality,nursing time,intubation success rate,number of venipuncture attempts,and catheter maintenance cost.RESULTS Male patients accounted for 51.96%in the control group and 55.88%in the research group;the average age was(59.68±11.82)years in the control group and(61.41±12.92)years in the research group;the proportions of lung cancer,colorectal cancer,and gastric cancer patients in the control group were 42.16%,38.24%,and 19.61%,respectively,while those in the research group were 34.31%,37.25%,and 28.43%,respectively.Except for the gender distribution,age,and cancer type mentioned above,other general information such as underlying diseases,puncture location,and long-term chemotherapy shows no significant differences as tested(P>0.05).The results showed that the research group had significantly reduced incidence of iodine contrast extravasation(7 vs 1,P=0.031),similar incidence of adverse events(11 vs 7,P=0.324),reduced nursing time[(18.50±2.68)minutes vs(13.26±3.00)minutes,P=0.000],fewer venipuncture attempts[(2.21±0.78)times vs(1.49±0.58)times,P=0.000],lower catheter maintenance cost[(1251.79±205.47)China yuan(CNY)vs(1019.25±117.28)CNY,P=0.000],increased intubation success rate(16.67%vs 58.82%,P=0.000),and better imaging quality(85.29%vs 94.12%,P=0.038).CONCLUSION High-pressure-resistant PICCs can lessen the physical burden of diabetic patients during nursing,reduce treatment costs,and improve the efficiency and quality of imaging for diagnosis malignant tumors.展开更多
Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rat...Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.展开更多
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.展开更多
We report a case of a 7-year-old child who received a peripherally inserted central catheter (PICC) for chemotherapy. He suffered from an unusual PICC fracture in vivo with pulmonary embolism after eight circles of ch...We report a case of a 7-year-old child who received a peripherally inserted central catheter (PICC) for chemotherapy. He suffered from an unusual PICC fracture in vivo with pulmonary embolism after eight circles of chemotherapeutic agents administered. In this case report, we review the literatures for the underlying pathophysiology of this uncommon phenomenon. IV nurses should consider the possibility of the infusion dysfunction deriving from the PICC line fractured. Accurate tip catheter placement and specific care may reduce morbidity.展开更多
目的对比经外周静脉穿刺置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)带量采购前后的临床使用情况及患者治疗费用,为优化临床决策、完善医用耗材带量采购政策提供参考。方法通过关键知情人访谈收集PICC带量采购前后...目的对比经外周静脉穿刺置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)带量采购前后的临床使用情况及患者治疗费用,为优化临床决策、完善医用耗材带量采购政策提供参考。方法通过关键知情人访谈收集PICC带量采购前后的临床使用情况,基于文献回顾、关键知情人访谈等构建PICC整体费用模型,采用Kruskal-Wallis检验对患者整体治疗费用进行分析。结果通过护士访谈,带量后的PICC实际平均留置时间相较于带量前平均留置时间缩短10.77%、穿刺时间增加14.21%、置管后导致的并发症或不良反应发生率相对带量前均有不同程度的上升;PICC带量采购前后患者的住院费用、卫材费差异均有统计学意义(P<0.05)。带量采购后的PICC单价和均次置管总费用明显下降,但均次并发症费用呈上升趋势,差异均有统计学意义(P<0.05)。结论带量采购后,PICC的质量及临床使用情况并不十分理想。建议各医疗主体加强对医用耗材带量采购前、中、后的质量评估体系建设和临床使用监测,系统分析患者治疗费用,逐步建立针对医用耗材带量采购的质量和整体费用评价标准,进一步完善医用耗材带量采购体系。展开更多
目的:探究基于跨理论模型(trans-theoretical model,TTM)的延续护理干预在癌症经外周中心静脉置管(peripherally inserted central catheter,PICC)带管出院患者居家应用的必要性。方法:选取2022年6月—2023年6月在普洱市人民医院行PICC...目的:探究基于跨理论模型(trans-theoretical model,TTM)的延续护理干预在癌症经外周中心静脉置管(peripherally inserted central catheter,PICC)带管出院患者居家应用的必要性。方法:选取2022年6月—2023年6月在普洱市人民医院行PICC并带管出院的96例癌症患者,按随机数表法分为两组。对照组(n=48)给予常规延续护理,研究组(n=48)在此基础上接受基于TTM的延续护理。比较两组PICC相关并发症发生情况、自我管理能力、护理满意度及生活质量。结果:研究组PICC相关并发症总发生率为12.50%,比对照组的33.33%低,差异有统计学意义(P<0.05)。研究组自我管理能力各维度评分及总分均比对照组高,差异有统计学意义(P<0.05)。研究组护理总满意度为95.83%,比对照组的81.25%高,差异有统计学意义(P<0.05)。研究组生活质量各维度评分及总分均比对照组高,差异有统计学意义(P<0.05)。结论:基于TTM的延续护理干预在癌症PICC带管出院患者居家应用效果较好,可明显降低导管相关并发症发生率,提升患者自我管理能力及生活质量,提高满意度。展开更多
文摘Objective:The aim of our research was to study the incidence,clinical diagnosis and treatment of peripherally inserted central catheters(PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy.Methods:The data of the incidence,diagnosis and treatment of PICC-related sepsis in 215 cases of breast cancer patients carrying PICC catheter for chemotherapy in our hospital from August,2009 to September,2011 were analyzed retrospectively.Results:216 PICCs had been successfully applied in 215 cases of breast cancer patients and followed for a total of 19,109 catheter days,(median catheterization duration,88.9 days,range 1-212 days).Among those,3(1.39%) PICCs were removed respectively as a result of PICC-related sepsis in 29,73 and 108 catheter-days(median 70 d),with a rate of 0.16 per 1000 catheter-days.Conclusion:Chemotherapeutic treatment via PICC for breast cancer patients is one of the most secure and effective measures but there exists small number of cases in which PICC catheter related sepsis is possible.Careful observation of relevant symptoms and signs,early diagnosis and treatment,not relying completely on blood culture tests and timely removal of PICC catheter can be very effective in treating PICC-related sepsis in these patients.
基金Supported by Jiangxi Provincial Department of Education Science and Technology Research Project-Youth Project(Research on the application of high-pressure PICC catheter in abdominal CT enhancement of tumor patients),No.200242.
文摘BACKGROUND Individuals with diabetes mellitus have a higher risk of developing malignant tumors,and diagnosing these tumors can be challenging.AIM To confirm the benefits of using peripherally inserted central catheters(PICCs)in contrast-enhanced computerized tomography(CECT)for diagnostic imaging in diabetic patients with malignant tumors and to provide a research basis for follow-up research.METHODS This retrospective study analyzed 204 diabetic patients with malignancies treated at The Second Affiliated Hospital,Jiangxi Medical College,Nanchang University,from January 2024 to June 2024.The patients were divided into two groups:A control group(n=102)with indwelling peripheral intravenous catheters and a research group(n=102)with high-pressure-resistant PICC.The study compared baseline data,the incidence of iodine contrast extravasation during CECT,the incidence of adverse events(discomfort,redness and swelling at the puncture site,and blood oozing),imaging quality,nursing time,intubation success rate,number of venipuncture attempts,and catheter maintenance cost.RESULTS Male patients accounted for 51.96%in the control group and 55.88%in the research group;the average age was(59.68±11.82)years in the control group and(61.41±12.92)years in the research group;the proportions of lung cancer,colorectal cancer,and gastric cancer patients in the control group were 42.16%,38.24%,and 19.61%,respectively,while those in the research group were 34.31%,37.25%,and 28.43%,respectively.Except for the gender distribution,age,and cancer type mentioned above,other general information such as underlying diseases,puncture location,and long-term chemotherapy shows no significant differences as tested(P>0.05).The results showed that the research group had significantly reduced incidence of iodine contrast extravasation(7 vs 1,P=0.031),similar incidence of adverse events(11 vs 7,P=0.324),reduced nursing time[(18.50±2.68)minutes vs(13.26±3.00)minutes,P=0.000],fewer venipuncture attempts[(2.21±0.78)times vs(1.49±0.58)times,P=0.000],lower catheter maintenance cost[(1251.79±205.47)China yuan(CNY)vs(1019.25±117.28)CNY,P=0.000],increased intubation success rate(16.67%vs 58.82%,P=0.000),and better imaging quality(85.29%vs 94.12%,P=0.038).CONCLUSION High-pressure-resistant PICCs can lessen the physical burden of diabetic patients during nursing,reduce treatment costs,and improve the efficiency and quality of imaging for diagnosis malignant tumors.
文摘Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
文摘We report a case of a 7-year-old child who received a peripherally inserted central catheter (PICC) for chemotherapy. He suffered from an unusual PICC fracture in vivo with pulmonary embolism after eight circles of chemotherapeutic agents administered. In this case report, we review the literatures for the underlying pathophysiology of this uncommon phenomenon. IV nurses should consider the possibility of the infusion dysfunction deriving from the PICC line fractured. Accurate tip catheter placement and specific care may reduce morbidity.
文摘目的对比经外周静脉穿刺置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)带量采购前后的临床使用情况及患者治疗费用,为优化临床决策、完善医用耗材带量采购政策提供参考。方法通过关键知情人访谈收集PICC带量采购前后的临床使用情况,基于文献回顾、关键知情人访谈等构建PICC整体费用模型,采用Kruskal-Wallis检验对患者整体治疗费用进行分析。结果通过护士访谈,带量后的PICC实际平均留置时间相较于带量前平均留置时间缩短10.77%、穿刺时间增加14.21%、置管后导致的并发症或不良反应发生率相对带量前均有不同程度的上升;PICC带量采购前后患者的住院费用、卫材费差异均有统计学意义(P<0.05)。带量采购后的PICC单价和均次置管总费用明显下降,但均次并发症费用呈上升趋势,差异均有统计学意义(P<0.05)。结论带量采购后,PICC的质量及临床使用情况并不十分理想。建议各医疗主体加强对医用耗材带量采购前、中、后的质量评估体系建设和临床使用监测,系统分析患者治疗费用,逐步建立针对医用耗材带量采购的质量和整体费用评价标准,进一步完善医用耗材带量采购体系。
文摘目的:探究基于跨理论模型(trans-theoretical model,TTM)的延续护理干预在癌症经外周中心静脉置管(peripherally inserted central catheter,PICC)带管出院患者居家应用的必要性。方法:选取2022年6月—2023年6月在普洱市人民医院行PICC并带管出院的96例癌症患者,按随机数表法分为两组。对照组(n=48)给予常规延续护理,研究组(n=48)在此基础上接受基于TTM的延续护理。比较两组PICC相关并发症发生情况、自我管理能力、护理满意度及生活质量。结果:研究组PICC相关并发症总发生率为12.50%,比对照组的33.33%低,差异有统计学意义(P<0.05)。研究组自我管理能力各维度评分及总分均比对照组高,差异有统计学意义(P<0.05)。研究组护理总满意度为95.83%,比对照组的81.25%高,差异有统计学意义(P<0.05)。研究组生活质量各维度评分及总分均比对照组高,差异有统计学意义(P<0.05)。结论:基于TTM的延续护理干预在癌症PICC带管出院患者居家应用效果较好,可明显降低导管相关并发症发生率,提升患者自我管理能力及生活质量,提高满意度。
