Analysis of the current status and influencing factors of kinesiophobia in tumor patients with peripherally inserted central catheter: A cross-sectional study.

BackgroundPeripherally Inserted Central Catheters (PICCs) are widely utilized in tumor patients due to their lower risk of complications, extended indwelling duration, reduced local tissue trauma, and overall cost-effectiveness. Based on the Health Action Process Approach (HAPA) theory, this study aims to explore the current status and influencing factors of kinesiophobia in tumor patients with PICCs. The study provides reference for clarifying the mechanism of kinesiophobia and developing nursing intervention plans.MethodThrough convenience sampling, 162 tumor patients who underwent PICC maintenance in three hospitals in Jiangsu Province from December 4th, 2023, to December 31st, 2024 were selected. The patient general information questionnaire, Tampa scale of kinesiophobia, medical coping modes questionnaire, exercise self-efficacy scale, risk perception questionnaire, outcome expectation scale, exercise intention scale, and social support rating scale were used for evaluation.ResultTumor patients carrying PICC had a kinesiophobia score of 20.11 ± 6.94 points, and 42.59% of tumor patients with PICC had kinesiophobia. The results of multiple linear regression showed that the duration of catheter placement(t = −3.506,P = 0.001), pain(t = 2.652,P = 0.009), exercise self-efficacy(t = −3.891,P < 0.001), and risk perception(t = 3.157,P = 0.002) are the main influencing factors of kinesiophobia in tumor patients with PICC.ConclusionThe findings underscore a significant clinical concern regarding kinesiophobia among tumor patients with PICC. It is essential for nursing staff to implement systematic assessments and tailored interventions aimed at mitigating kinesiophobia. Addressing this issue can contribute to reducing associated adverse reactions and improving patient mobility and overall quality of life.

Risks associated with peripherally inserted central catheters – Authors' reply

Peripherally Inserted Central Catheter Safety and Efficacy in Acute Lymphoblastic Leukemias: A 16-Years Monocentric Experience

Objective To observe the application and effects of self-management model in tumor patients with peripherally inserted central catheter (PICC).Methods Totals of 100 tumor patients with PICC were randomly divided into control group (n=50 ) which received routine care,and intervention group (n=50) which received the self-management model on the basis of routine care.The self-rating anxiety scale (SAS) and exercise of self-care ability scale ( ESCA ) score and the incidence of catheter-related complications were observed before intervention,10th days and 30th days after intervention,respectively.Results The SAS score after intervention (40.34±4.49 ) was significantly lower than that before intervention (46.32±7.71 ) in intervention group ( t=4.17,P＜0.01 ).Totals score of ESCA ( 103.06±16.22) and its four aspects including self-management skill ( 46.45±9.74 ),health knowledge level ( 47.43±8.66 ),self-care responsibility (16.61±3.20) and self-concept (19.06±4.06 ) in intervention group were all significantly higher that in control group (90.61±17.09,21.78±4.31,39.73±9.88,12.35±3.09,15.77±3.79,respectively ) ( t=2.830 2,3.386 0,2.860 5,1.983 4,1.677 6 ; P＜0.05).At 10th day,the incidence of catheter-related complications in intervention group (5 cases) and control group (7 cases),no significant difference was detected (t=0.334 2,P＞0.05 ).While at 30th day,the incidence of catheter-related complications in intervention group was 4.0％,which was significantly lower than 19.6％ in control group (t=7.1324,P＜0.01).Conclusions Self-management model can effectively improve the self-nursing ability,relieve the anxiety and prevent the catheter-related complications for tumor patients with PICC. Key words: Tumor patient; Self-management model; PICC

Objective To explore the effects of cluster intervention on the intracavitary electrocardiogram (ECG) positioning of three-position valve peripherally inserted central catheter (PICC) in tumor patients. Methods The patients who had PICC for chemotherapy from October 2014 to January 2017 in the tumor ward of Beijing Hospital were selected by convenience sampling method. A total of 374 cases of vitro measurement combined with X-ray leading three-position valve PICC were assigned into the control group, and 320 cases of vitro measurement combined with intracavity ECG oriented and X-ray cluster intervention were assigned into the intervention group. The position accuracy of the PICC tip and the catheter heterotopia situation of the patients were analyzed. Results The position accuracy of PICC tip of the cluster intervention group was higher than that of the control group, and the catheter heterotopia cases of the cluster intervention group was lower than that of the control group. All the differences were statistically sigfinicant (P<0.01) . Conclusions The cluster intervention of vitriol measurement combined with intracavity ECG oriented and X-ray in cancer patients with indwelling three-position valve PICC can improve the catheter tip position accuracy, correct the internal jugular ectopic which cannot be found by B-ultrasound, and reduce the ectopic occurrence because of short catheter. Key words: Nursing care; Intracavity electrocardiogram; Peripherally inserted central catheter; Tip positioning; Cluster intervention

6572 Background: Peripherally inserted central catheters (PICCs) are widely utilized in oncology. Previous studies have shown a high risk of catheter-related thrombosis and bloodstream infection in the uniquely susceptible oncologic population; however, most studies are limited by single center, outpatient, retrospective designs. Therefore, we performed a multi-center study to further describe PICC use and complications in the solid tumor population within the inpatient setting. Methods: Data was collected on PICC lines inserted across 50 hospitals in Michigan from November 2013 to December 2019. Patients with a solid tumor diagnosis at time of PICC insertion were selected (n = 3,956). Indications for PICC placement, catheter characteristics, and associated complications were compared by metastatic (n = 1,488) and non-metastatic (n = 2,468) disease. Complications were also compared by cancer type. Major complications were defined as central line associated blood stream infection (CLABSI), catheter occlusion, deep vein thrombosis (DVT), and pulmonary embolism (PE). Paired t-test and Pearson Chi-square test were used for analyses. Results: PICCs were most commonly placed for antibiotics (n = 1232, 31%) and chemotherapy (n = 907, 23%). The majority of catheters were multi-lumen with 61% (n = 2362) double lumen and 8% (n = 326) triple lumen. Median dwell time was 13 days. Notably, 17% of patients had another central venous catheter (CVC) at time of placement. Metastatic patients were more likely to have a PICC placed for difficult venous access (24.7% vs 17.7%, p &lt; 0.001) and total parenteral nutrition (20.2% vs 12.3%, p &lt; 0.001) as well as to have a current CVC in place (22% vs 14%, p &lt;.001). Non-metastatic patients were more likely to have a PICC placed for chemotherapy (24.1% vs 20.9%, p = 0.02) and have a longer median dwell time (13.0d vs 11.0d, p = 0.04). Of all solid tumor patients, 15.5% (n = 612) experienced a major complication. Catheter occlusion occurred most frequently (n = 402, 10.2%) followed by DVT (n = 138, 3.5%), CLABSI (n = 107, 2.7%), and PE (n = 22, 0.6%). Catheter occlusion was more likely to occur in non-metastatic patients (11% vs 8.8%, p = 0.03). Rates of CLABSI, DVT, and PE did not differ significantly by presence of metastases. Certain cancers had a higher frequency of major complications when compared to the average solid tumor cohort rate of 15.5%; these were malignant brain (17.2%), pancreatic (18.4%), uterine (18.5%), and ovarian tumors (24.2%). Conclusions: PICCs are associated with significant complications in 16% of patients with solid organ cancers. Alternate access such as an implanted port should be considered; alternatively, limiting PICC placement in the presence of concurrent CVC or minimizing use of multiple lumen PICCs may limit complications and resultant morbidity. Specifically, these considerations may apply preferentially to patients with certain solid organ cancers with higher rates of PICC associated morbidity.

Background: Peripherally inserted central catheters (PICCs) are an effective method for medication and nutrition infusion in preterm neonates. The present study aimed to identify the incidence of the most common complications of PICC implantation and evaluate the risk factors of each complication. Methods: This historical cohort study was conducted on 2500 neonates with birth weights (BWs)≥500 g and gestational age (GA)>24 weeks who had a history of PICC inserted in three NICUs between August 2015 and August 2018. Data were collected by reviewing medical records. Demographic data and indices of catheter placement, duration of catheter placement, and common complications were recorded. Data analysis was done using SPSS-21. Results: The median cubital vein had the most PICC placement (43%). The most common complication was tip malposition (48.2%). The incidence rates (95% CI) of the main complications such as malposition, edema/occlusion, and PICC migration were 0.0356 (0.0337-0.0377), 0.0134 (0.0122-0.0147), and 0.0088 (0.0079-0.0099), respectively. PICC insertion position was the strongest predictor of malposition for the cephalic vein. Besides, the incidence of malformation in the cephalic vein was about six times higher than in the median cubital vein. Independent risk factors for non-technical complications included BW (OR=0.59, 95% CI 0.44-0.79), administration of hyperosmolar medications (OR=3.43, 95% CI 2.62-4.51), position (OR=2.43, 95% CI 1.92- 3.08), and duration of catheter presence (OR=1.02, 95% CI 1.01-1.03) (P<0.001). Conclusion: The most common complication was malposition related to catheter placement in an emergency. Moreover, BW, administration of hyperosmolar medications, and duration of catheter presence were the most critical risk factors for non-technical complications. Therefore, it is recommended to educate the PICC insertion team to reduce tip malposition and replace long-term catheters.

Peripherally inserted central catheter (PICC) is widely used in chemotherapy due to its minimal complications and simple wound care. This study explored the effects of tai chi on catheterrelated complications, catheter management ability, and quality of life in tumor patients with PICC at the intermission of chemotherapy. This study was an open parallel trial. A total of 98 patients with malignant tumors who underwent long-term chemotherapy with PICC were randomly divided into an observation group (49 cases) and a control group (49 cases). The control group received grip strength exercise for 3 months, while the observation group received 24 simplified tai chi exercises. The coagulation function, thrombosis rate, self-management ability, and quality of life were compared between the two groups before and after the intervention. After the intervention, the activated partial thromboplastin time (APTT) and prothrombin time (PT) in the observation group were longer than those in the control group, while fibrinogen (FIB) was lower than that in the control group (all P<0.05). After the intervention, the total score of self-management ability of the observation group was higher than that of the control group (t=2.038, P=0.047), and the scores of exercises ability and quality of daily life with catheters were significantly increased (all P<0.05). In terms of quality of life, scores of role-physical (RP), social functioning (SF), mental health (MH) and role-emotional (RE) in the observation group were higher than those in the control group (all P<0.05), while there was no statistical difference between the bodily pain (BP) scores of the observation group and the control group (P>0.05). The incidence of venous thrombosis in the observation group was lower than that in the control group, the difference was statistically significant ( χ 2 =4.439, P=0.035). Tai chi can prevent PICC thrombosis, reduce PICC-related complications, improve selfmanagement ability, and improve quality of life in at-home patients with long-term PICC.

At the site of peripherally inserted central catheter (PICC) catheterization in tumor patients, medical adhesive-related skin injury (MARSI) was reported related to patient age, infusion of certain chemotherapeutic agents, and tumor type, but did not review its relation to the use of clear patches and the puncture site of PICC. This study aims to analyze the risk factors for MARSI in more detail to provide supported data for reducing MARSI. Total 382 cancer patients receiving catheterization via PICC were involved in this study from March 1, 2021, to September 28, 2021. According to MARSI occurrence or not, they were assigned into MARSI or non-MARSI group. Univariate and multivariate logistic regressions were used to analyze the risks of MARSI occurrence at PICC insertion site. 15% (60 of 382 cases) resulted in MARSI, out of which 8.1% (31/382) was categorized as contact dermatitis, and 7.1% (27/382) as mechanical injuries. The univariate analysis showed that there were significant differences in six aspects of the study, including BMI, MARSI history, dressing types, treatment by paclitaxel or 5-FU versus oxaliplatin, dressing frequency, and catheterization at biceps brachii medial (p < 0.05). Via multivariate logistic regression analysis, it was discovered that except for previously reported risk factors, dressing change frequency (OR (95% CI) = 7.49 (2.36-23.80), p = 0.001), catheterization at biceps brachii medial (OR (95% CI) = 4.07 (1.82-9.10), p = 0.001), and breast cancer (OR (95% CI) = 3.27 (1.05-10.15), p = 0.041), there were significant risk factors for MARSI occurrence in tumor patients with PICC catheterization. Our study revealed a high incidence of MARSI at the PICC insertion site of cancer patients, presenting with contact dermatitis and mechanical injury. Independent risk factors were previous history of MARSI, a diagnosis of breast cancer, frequent dressing replacement, use of paclitaxel or 5-FU, and PICC catheterization at biceps brachii medial.

Central venous catheters (CVC) are essential for the management of patients with hematologic malignancies, facilitating chemotherapy infusion, antibiotics, parenteral nutrition, blood products, and blood samples collection. In this population, peripherally inserted central catheters (PICC) seem to be associated with lower complications, compared with conventional percutaneously inserted devices (CICC). Data on the PICC in allogeneic hematopoietic stem cell recipients (allo-HSCT) are limited. We have prospectively evaluated the safety and efficacy of 100 polyurethanes or silicone PICC, inserted into 100 adult allo-HSCT recipients, at the Hematology of Sapienza University of Rome (Italy), between October 2012 and August 2017. The median duration of PICC placement was 117days. Overall, 68% of patients maintained the device for the entire transplant procedure and PICC were removed after day 100 from allo-HSCT; of these, 44% did not experienced any PICC-related complications. Catheter-related bloodstream infections (CRBSI) occurred in 32% of patients (2.5/1000 PICC days), associated with thrombosis in 8 cases. CRBSI were observed in 42% of patients with polyurethane and 20% with silicone PICC (p = 0.02). Catheter-related thrombosis occurred in 9% of patients, never requiring anticipated PICC removal. Mechanical complications occurred in 15% of cases (1.2/1000 PICC days). On the whole, adverse events were manageable and did not affect transplant outcome. No deaths related to PICC-complications were observed. PICC are a safe and reliable long-term venous access in allo-HSCT recipients.

Purpose: The use of peripherally inserted central catheters (PICCs) had gradually increased in recent years,especially incancer patients, as it facilitates blood sampling and treatment administration. Unfortunately, they were associated with a high incidence of complications that limited their widespread use. The purpose of this study is to evaluate the characteristics of oncology patients presenting for complications of their PICC lines and to establish possible associated factors such as age, sex, type of cancer, site of insertion of PICC in our institution. Materials and methods: This retrospective study includes all cancer patients who underwent placement of PICC, from January 2012 till December 2013, under radiology guidance at Hotel-Dieu de France university hospital. All patients were evaluated at enrollment for age, sex, site of PICC insertion, type of neoplasia (solid vs. hematologic malignancy), and followed up for complications for a minimum of two months. Results: During the recruitment period, forty-four patients were enrolled in our study with 54.4% women and 45.6% men. Mean and median age at PICC insertions were 57 and 59 years respectively (standard deviation 16).Nineteen patients (43.2%) had hematologic malignancies and twenty-five had solid tumors (56.8%). Complications including dislodgement, infection, and thrombosis were encountered in eight patients. Thrombosis was the most frequent complication and was reported in six out of eight patients. Time of thrombosis occurrence varied from 1 to 132 days with an average of 37 days. No statistically significant association was found between thrombosis of the PICC and any of the evaluated factors listed above but we found a trend toward a higher rate of thrombosis in hematological cancer patients compared to solid tumor patients (26% v/s 4%). Conclusions: Venous thrombosis complicating PICCs was reported in 13.7% of our oncology patients which represents a similar rate compared to the literature. However, the small number of recruited patients limits any conclusion and warrants more patients to be enrolled with a longer follow-up period.

To explore how the timing of the initial dressing change influences bacterial growth when alginate dressings were used after peripherally inserted central catheter (PICC) line insertion in tumor patients. In total, 186 tumor patients who had an alginate dressing after PICC insertion were randomly divided into a control group, observation group one (OG1), and observation group two (OG2). The control group had their first dressing change 48 h after PICC insertion, while OG1 was after 72 h and OG2 was after 96 h after. Samples were taken at the dressing change from the insertion site and surrounding skin. The results of the bacterial culture were compared to investigate how the timing of the first dressing change affected catheter infection. Of the 186 patients, 29 had a positive bacterial culture. Of these, 10 were in the control group, 9 were in OG1, and 10 were in OG2. IBM SPSS Statistics 21.0 was adopted to analyze the correlation between the timing of the first dressing change and insertion site infection. No statistical significance between the timing of the first dressing change and insertion site infections was found (P > 0.05). The condition of each tumor patient should be comprehensively evaluated after PICC placement to determine when the first dressing change should occur, but it can likely be extended to 96 h after insertion to promote wound healing, reduce clinical workload, and lower patient economic burden.

Peripherally inserted central catheters (PICCs) are useful routes for intermediate central venous access; however, there is a paucity of data regarding their use in the intensive care setting. We have been using PICCs on our ICU since 2006 and have undertaken a retrospective audit of all PICC use during one year to define complication rates. PICCs were inserted by a dedicated vascular access team (VAT). Microbiology and radiology databases were used to assess rates of line-related bacteraemias and catheter misplacements. Blockage rates were collected from VAT records. Data was available on 116 PICCs, corresponding to 1,558 line days. The median duration of placement of PICCs was 9 days (range 0–100) in situ with a misplacement rate at insertion of 12.1%. The catheter-related blood stream infection rate was zero. The blockage rate was 29.5/1,000 line days; 87% of these blockages were cleared using urokinase. We believe that PICCs can be safely used in intensive care patients.

Peripherally inserted central catheter (PICC) fracture and embolozation in the pediatric population

This paper aimed to explore the risk factors of peripherally inserted central catheter (PICC) related thrombosis (PICC-RT) in tumor patients mediated by ultrasound images under minimum variance (MV) algorithm and put forward the corresponding nursing intervention methods based on the risk factors. The smoothing algorithm, diagonal loading algorithm, and coherence factor algorithm were optimized via MV algorithm. The optimized algorithm was compared with other algorithms to analyze its image quality and image processing speed. Literature retrieval was conducted to analyze the risk factors of PICC-RT in tumor patients. Tumor patients who received PICC for chemotherapy in the hospital from June 2018 to December 2019 were selected. Patients who were accepted before the experiment were taken as the controls, and there were control group (89 cases) and observation group (91 cases). Exercise, average flow rate of axillary vein per unit time, and PICC-RT were compared between the two groups. The results showed that the optimized algorithm (MV-N) had better image resolution, image contrast, and calculation speed than other algorithms. Gender, body mass index (BMI), pathological type, clinical stage, disease history, fibrinogen (FIB), and use of anticoagulant drugs were risk factors for PICC-RT in tumor patients. The number of PICC-RT and complications in the observation group was notably lower in contrast to the control group ( P &lt; 0.05 ). It indicated that a novel algorithm was successfully established, which could increase the ultrasonic image quality and computing speed, and upper limb exercise could reduce the incidence of PICC-RT and its complications in tumor patients.