PICC Maintenance Research Articles

Permanent education in nursing care in the maintenance of the central venous catheter of peripheral insertion

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.

PICC catheterization and maintenance for severely and critically ill patients with COVID-19 in the isolation ward

PICC catheterization and maintenance for severely and critically ill patients with COVID-19 in the isolation ward

Analysis on the Demand and Influencing Factors of PICC Maintenance Service for Tumor Patients during Intermittent Chemotherapy

Analysis on the Demand and Influencing Factors of PICC Maintenance Service for Tumor Patients during Intermittent Chemotherapy

Analysis of quality control group of departments on improving effect of PICC maintenance quality in outpatient children with tumor

To explore the clinical effect of quality control group of departments on improving PICC maintenance quality in outpatient children with tumor. Methods: A total of 4100 children with tumor who were treated in our outpatient department of intravenous therapy from January to December 2020 were divided into observation group (July to December 2020: after the establishment of quality control department) and control group (January to June 2020: before the establishment of quality control group of departments). In the control group, conventional PICC treatment management and maintenance measures were used. In the observation group, quality control group was used to manage, and moreover, the PICC maintenance quality, the incidence rate of PICC-related risk events and the level of PICC maintenance knowledge and satisfaction evaluation were compared between the two groups. Results: (1) Comparing the PICC maintenance quality between the two groups, the rate of absence of PICC maintenance during the course of tumor management in the observation group (1.14%) was significantly lower than that in the control group (4.00%), and there was significant difference in the PICC maintenance quality between the two groups (P<0.05). (2) Comparing the relative indexes of children with tumor: Before intervention, there was no significant difference in the relative indexes of children with tumor (PICC maintenance knowledge level) between the two groups (P>0.05), but after intervention, the relative indexes of children with tumor (PICC maintenance knowledge level, and service evaluation recognition degree) in the observation group were significantly higher than that in the control group (P<0.05). (3) Comparing the probability of PICC-related risk events between the two groups: In the course of tumor management, PICC-related complications were observed in the observation group (3.59%, 3.18%), which were significantly lower than those in the control group (11.95%, 11.37%) (P<0.05). Conclusion: The application of quality control group of departments in the management of PICC in outpatient children with tumor has obvious clinical effect. It can effectively improve the level of maintenance knowledge and service satisfaction of family members, optimize the quality of maintenance, reduce the rate of lack of maintenance and risk related to PICC, and is worthy of being popularized in clinical practice.

Construction and practice about the fine management of cancer patients during the epidemic of Covid-19

Purpose: This paper explored the construction and practice of the fine management of cancer patients during the Covid-19 outbreak. Methods: To establish the medical groups for the fine management of cancer patients during the Covid-19 outbreak, 6 doctors and 6 backbone nurses were selected from the oncology department since January 28th, 2020. And then the medical needs of cancer patients were obtained through telephone follow-up network. Next, the medical group was further divided and the we-media was used for the fine management of cancer patients based on patients' needs. When the we-media failed to solve problems in some special or emergent situations, a pattern combining hospitals, communities with patients was used to provide continuous medical care for cancer patients. Results: The medical group effectively completed the information collection registration of 198 cancer patients through the telephone follow-up network. The current needs of 198 patients were ranked from high to low, and they were: knowledge of diseases, psychological support, PICC maintenance, complication treatment, medication use instructions, rehabilitation exercise instructions and diet combination methods, respectively. Based on patients' needs, the medical group has carried out the fine management for 198 patients through the following activities: 16 live broadcast, 4 recorded videos, 27 group activities targeted at patients, 48 one-to-one telephone counselling, 1 disease brochure, 1 nutritional diet recipe and 1 list for self-monitoring patients' diseases. During the epidemic outbreak, no death or infection cases were found. Conclusion: The fine management effectively helped meet the urgent needs of cancer patients who sought medical service and treatment during the epidemic outbreak. © 2021 A. CARBONE Editore. All rights reserved.

Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study

BackgroundPeripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared...

Effects on the integrated treatment of colorectal cancer patients during COVID-19 epidemic in China: a cross-sectional study

Objective: To understand the treatment status and effects on colorectal cancer (CRC) patients in China during the COVID-19 pandemic, and provide evidence for decision-making for health-care workers. Methods: The method of cross-sectional study was applied. A questionnaire survey of CRC patients in China was carried out. Their basic and treatment information during the COVID-19 were collected and associated effects on treatment, nursing, state of psychology and needs of social support were analyzed. Results: Of the 1147 participants in the study, 635 (55.4%) were male and 512 (44.6%) were female with mean age of (52.8±12.8) years. The treatment or follow up of 896 (78.1%) CRC patients were affected during the COVID-19 outbreak. A total of 253 patients (22.1%) had their treatment regiments changed, of whom 141 (12.3%) had their chemotherapy regiments postponed or changed, and 83 patients (7.2%) had their surgical treatment affected. Among the above 83 patients, 39 patients (3.4%) underwent emergency surgery. A total of 277 patients (24.1%) had their out-of-hospital care needs affected, mainly due to maintenance of PICC (49.5%, 137/277). CRC patients had poorer sleep quality and increased levels of insomnia than before (P<0.001), and were more distressed, anxious, depressed, and angry than they were before. They presented the more requirements of help (P<0.001). In addition, 376 patients (32.8%) had received telemedicine services, but only 36.4% (137/376) of them were satisfied. Conclusions: The COVID-19 epidemic has effect on the integrated treatment of CRC patients include diagnosis, treatment, examination and prognosis. While protecting CRC patients from being infected with SARS-CoV-2, health-care workers should also actively help them to receive timely and correct treatment and pay attention to their nursing, nutritional, psychological and social support needs in the COVID-19 epidemic.

Investigation and Analysis of Catheter-Associated Skin Impairment in PICC’s Patients in Jingzhou City

Objective: To understand the status quo of PICC Catheter-associated Skin Impairment (CASI) in some hospitals at all levels in Jingzhou city, and to explore the risk factors for PICC Catheter-associated Skin Impairment. Methods: From June 2019 to July 2020, a self-made questionnaire for CASI status was used to facilitate the extraction of CASI patients in PICC in some hospitals at all levels in Jingzhou city. Local skin lesions were collected and classified during PICC maintenance, and the damage types, occurrence frequency and related influencing factors of CASI were counted to identify independent risk factors. Results: In this study, there were 173 cases of CASI in PICC’s patients including local infection 56.1% (97/173), exudation at the puncture site 16.8% (29/173), irritant dermatitis 21.4% (37/173), allergic dermatitis 4.6% (8/173), and tension injury 1.2% (2/173). After univariate analysis, there were statistically significant differences between CASI occurrence type and duration of catheter wear, age, underlying disease, skin moisture and hyperhidrosis, PICC maintenance as required, hospital grade maintenance and intermittent chemotherapy (P < 0.05). Then, disordered multiple Logistic regression analysis was performed, and exudation at the puncture site was used as the reference group. The results showed that patients with PICC were more likely to have CASI if they were aged, long catheter time, had diabetes, had moist and sweaty skin, and were in the intermittent stage of chemotherapy. Conclusion: The incidence of CASI is high in patients aged 70 - 79 years, and local infection is the most common. PICC’s patients with diabetes are at high risk of CASI. PICC’s patients with excessive sweating are more likely to have CASI. The intermittent stage of chemotherapy is the excessive CASI; time with tube affects CASI occurrence.

The user experience of patients with PICC catheter for PICC maintenance network: a qualitative research

Objective To explore the real user experiences of patients with PICC catheter for PICC maintenance network in Shandong province. Methods Descriptive phenomenological methodology was adopted in this study. A semi-structured interview was conducted with 18 patients of PICC-line maintained in different hospitals from PICC maintenance network in Shandong province. We analysed the data by Colaizzi′s phenomenological research method. Results The experiences of patients with PICC catheter for PICC maintenance network in Shandong province contain positive and negative aspects. The positive aspects were convenient medical treatment, cooperation in various level hospitals, progress of basic hospitals, and enthusiastic services; the negative aspects were personnel shortage, different levels of nurses and imperfect supporting system. Conclusions Patients with PICC maintenance network possessed positive experience, but the accessibility of PICC maintenance network should be further enhanced, specialized development should be promoted. Meanwhile, for the questions proposed by patients, some measures should be taken to improve the overall PICC maintenance service from various level hospitals in Shandong province and make the experience of patients better. These measures include strengthening the standardized training and quality control of PICC, improving the supporting system, and promoting the implementation of continuous nursing mode in the primary hospitals. Key words: [Key words]Catheterization, central venous; Nursing care; Maintenance network; Qualitative research

Application of the "3Y" shape Multipore tape combined with transparent dressing in the maintenance of double lumen Power PICC

Objective To observe the effect of the application of the 3Y shape Multipore tape combined with transparent dressing in the maintenance of double lumen PowerPICC. Methods Totally150 patients inserted double lumen powerPICC were randomly assigned to experimental group and control group, each group included 75 patients. when maintaining PICC, the 3Y shape Multipore tape combined with transparent dressing were used for experimental group, while traditional method were used for control group. The endpoints were: the time for dressing change,the incidence of catheter migration,the incidence of dressing rolling or loosing,the incidence of PICC related complications. Results The time for dressing change of experimental group (13.14±0.23) min was significant longer than control group (12.99±0.24) min (t=4.025, P<0.05) ; incidence of catheter migration of experimental group (5.3%,4/75) was significant lower than control group (18.7%, 14/75) (χ2=6.424, P=0.04). Incidence of dressing rolling or loosing of experimental group (9.3%,7/75) was significant lower than control group (22.7%,17/75)(χ2=7.028, P=0.03). Incidence of complication of experimental (1.3%, 1/75) was significant lower than control group (9.3%, 7/75) (χ2=4.754, P=0.03) . Conclusions Application of the 3Y shape Multipore tape combined with transparent dressing in the maintenance of double lumen PowerPICC cost a little bite more time,while reduce the incidence of catheter migration and related complications, improve patients′degree of comfort, worth to be widely used. Key words: Nursing care; Double lumen Power PICC; 3Y shape Multipore tape

Application of Friction and Spiral Disinfection in PICC Maintenance

Objective: To compare the application of friction disinfection and spiral disinfection in PICC catheter maintenance. Methods: Ninety patients with PICC catheter were enrolled in this study. They were randomly divided into experimental group (43 cases) and control group (47 cases). In the experimental group, the skin around the puncture site was disinfected by frictional disinfection method, and spiral methods for the control groups. Sampling inspection was done before and after the disinfection. The number of bacterial culture colonies, catheter maintenance time, patients’ and nurses’ evaluation of operation before and after disinfection were compared between the two groups. Results: There was statistically significant difference between the two groups for bacterial colony count before the disinfection(P 0.05). The nurses’ and patients’ satisfaction for the procedure were higher in the experimental group compared with that in the control groups(P<0.05). Conclusions: during the PICC Maintenance, Friction methods can reach the technical standards of disinfection (Bacterial colony count≤5 CFU／cm2) and the antibacterial effect was also better during the 7 days after maintenance. The Satisfaction and acceptance from nurses and patients were higher than spiral methods.

Influences and countermeasures of catheter-related bloodstream infections with peripherally inserted central catheters in ICU

Objective To analyze the influences of catheter related bloodstream infection (CRBSI) for ICU patients with PICC. Methods Information and documents of 164 PICC patients were collected from October 2014 to December 2016, general information, intravenous drugs and skin conditions were analyzed if they have any impacts on CRBSI. Results Sixteeen patients with CRBSI and 148 patients with non-CRBSI. The acute physiology and chronic health evaluation (APACHE Ⅱ) score, hospitalization time, PICC catheterization time was (22.25 ± 4.95) points, (99.44 ± 57.34) d, (67.44 ± 48.30) d in CRBSI patients, and (14.64±6.86) points, 21.00(22.00) d, 12.00 (14.00) d in non-CRBSI patients. There were significant differences (U=439.00, 299.00, 383.00, all P<0.01). The incidence of injection of vasoactive drugs and skin edema were accounted for 8/16, 10/16 in CRBSI patients, and 25.00%(37/148), 31.08%(46/148) in non-CRBSI patients, the difference was statistically significant (χ2=4.53, 6.34, P<0.05). The APACHE II score was an independent risk factor for PICC catheter-related infections (OR=1.21, P<0.01). Conclusions The environment in ICU is quite complicated and patients often have the characteristic of instability, which drives us to evaluate the influence factors of CRBSI and offer guidance for PICC maintenance. These can help reduce the incidence of CRBSI in ICU and improve the quality of patients. Key words: Nursing care; Intensive care units; Catheterization, central venous; Catheter related bloodstream infection

Survey of construction of PICC nurses of Shandong province

Objective To investigate the construction of catheterization nurses in Shandong province. Methods A total of 235 hospitals were investigated from PICC maintenance network in Shandong province with self-designed questionnaire through internet survey. Results 179 hospitals established intravenous (IV) nurse team(76.17%). 86.92% (93/107) of the tertiary hospitals established IV nurse team, which was higher than 67.19% (86/128) of the secondary hospitals, the difference was statistically significant(χ2=12.50,P<0.01). There were 1335 trained and certificated nurses while 1382 nurses engaging in catheterization, and there were more catheterization nurses in tertiary hospitals than secondary hospitals, the difference was statistically significant(t=7.23,P<0.01). 22.98% (54/235) of the hospitals had more catheterization nurses than trained and certificated nurses, 11.49% (27/235) of the hospitals had more trained and certificated nurses than catheterization nurses. 7.81% (108/1 382) of the catheterization nurses worked full-time and 31.91% (441/1 382) had a manager position. 51.06% (120/235) of the hospitals had set up clear selection criteria for catheterization nurses, mainly focusing on education background, professional tittle and (or) work experience. Organization in training was diversified, giving priority to nursing association in provinceand nursing association in city. catheterization nurses in only 20.43% (48/235) of the hospitals would accept training annually, 31.49% (74/235) of the hospitals would re-certificate nurses. Conclusion PICC nurse team has been preliminarily established in Shandong province, but nursing staff deployment was unevenness, and primary hospitals should be further reinforced. The position role of nurses should be further clarified. The selection criteria of nurses should be further standardized. And the training space of nurses should be further promoted. Key words: Catheterization, central vein; Nurses; Questionnaires

Medical adhesive-related skin injury associated factors at PICC insertion site in patients with hematologic malignancies

Objective To measure the prevalence and analyzed associated factors of medical adhesive-related skin injuries (MARSI) at PICC insertion site in patients with hematologic malignancies. Methods A cross-sectional observational study lasting two weeks was carried out in Department of Hematology. Skin assessment data and photographs of skin were collected during PICC maintenances by the same investigator. The related information was got out from the medical record. The observed skin injuries were classified by the dermatologist and PICC specialized nurse together. MARSI prevalence was calculated. The associated factors were analyzed statistically. Results All of the 153 patients with hematologic malignancies were included. The prevalence of total MARSI at PICC insertion site was 33.99% (52/153), including mechanical skin injury (22.87%,35/153), contact dermatitis (CD) (9.80%,15/153), moisture-associated skin damage (0.65%,1/153), folliculitis(0.65%,1/153), respectively. Multivariate analysis identified two independent risk factors for mechanical skin injury including age≥ 50 years old, P=0.016, odds ratio (OR)=5.919, 95% CI 1.389-25.220 and non-specialist nurses in PICC maintenance, P=0.013, OR=8.333,95%CI 1.566-44.360. History of skin allergies (P=0.000, OR=12.333, 95%CI 3.669-41.454) and arsenic trioxide infusion through PICC (P=0.003, OR=4.565, 95%CI 1.661-12.547) were associated with CD. Conclusions MARSI at PICC insertion site is a prevalent event in the patients with hematologic malignancies. Epidemiological data and independent risk factors are presented in our study, which provide a basis for future study in this area. Key words: Hematologic neoplasms; Catheterization,central venous; Epidemiology; Factor analysis, statistical; Skin injury

The effect of the application of quality control circle to the standardization of the process of PICC maintenance

Objective To explore the effect of the application of quality control circle to the standardization of the process of PICC maintenance. Methods 12 people was included in the QCC who analyzed the problems existing in the operating process of PICC in ICU of neurology department, found out the causes and put forward the countermeasures. The relevant indictors before and after the activity was analyzed. Results The qualified rate of the standardized maintenance of PICC and average time of insertion, comprehensive ability were all significantly enhanced (P<0.05). Conclusions The QCC is shown excellent in the standardization of the maintenance process of PICC and the improvement of nursing quality of PICC. And meanwhile, it also improves the sense of quality management of members, sense of teamwork and organizing and planning ability. Key words: Quality control circle; PICC; Standardized nursing

Application of Skinner teaching theory in health education of cancer patients with PICC placements

Objective To explore the application effects of Skinner process teaching and its reinforcement theory in health education of cancer patients with PICC placements so as to improve the quality of nursing. Methods We recruited patients with PICC placements for the first time in oncology department of a class Ⅲ grade I hospital in Cangzhou from January 2015 to June 2015. They were randomly divided into control group (84 cases, routine health education) and experimental group (81 cases, health education applying Skinner process teaching and its reinforcement theory). The intervention was carried out for 4 chemotherapy cycles. We compared the situation of PICC related complications and maintenance of catheters after intervention. Results There were 8 cases (9.88%) with catheter related complications in experimental group after intervention which was less than that in control group with a significant difference (P<0.01). The number of patients and the frequency in delayed maintenance of catheters in experimental group were less than those in control with significant differences (P<0.05). Conclusions The application of Skinner process teaching and its reinforcement theory in health education of cancer patients with PICC placements is beneficial to help patients establish healthy behavior, reduce the incidence of complications, improve patients′ compliance of catheters maintenance and quality of life in patients. Key words: PICC; Health education; Skinner process teaching; Reinforcement theory

Comparative study of patient comfort and nursing workload in different PICC catheter sites

Objective To explore the differences of patient comfort and nursing workload between ultrasound guidance on upper arm placement of PICC and traditional placement of PICC, and to provide a reference for correct selection of catheter way. Methods Using a nonrandomized controlled study, a total of 1 116 patients were divided into the control group and the observation group, patients with traditional placement of PICC were set as the control group, and the patients with upper arm placement of PICC were named as the observation group. The patient comfort and workload of use and maintenance of PICC by nurses were compared between two groups. Results The incidence of catheter sliding out of PICC in the observation group was 1.9%(7/365), obviously higher than that of the control group, which was 0.3%(2/751), the difference was significant (χ2=8.37, P=0.007). The patient comfort had no statistical significance between two groups (t=2.13, P=0.082). The workload of use and maintenance of PICC in the observation group were (1.87±0.31) min and (9.16±1.07) min ,which were obviously higher than that of the control group [(0.85±0.16) min and(7.22±2.13) min] in winter (t=4.39, P=0.022; t=3.44, P=0.041), but there was no statistical significance between two groups in summer (P > 0.05). Conclusions The workload of use and maintenance of PICC on upper arm placement was higher than traditional placement of PICC in winter, but the obvious differences of patient comfort and nursing workload in summer between the two PICC groups were not been found. Key words: Catheterization, peripheral; Ultrasonography; Comfort; Workload

Construction of specialized transitional care process and effect evaluation

Objective To build the specialized transitional care process and evaluate its effect . Methods Firstly,the specialized transitional care organization structure was constructed , to make clear the responsibility of the member;to develop the specialized transitional care process .The transitional care content , medical costs including expense and time cost , patients’ satisfaction, and nurses’ satisfaction were investigated through self-made questionnaire .Results The main transitional care programs provided by the professional team were ordered from high to low： catheter care （ including PICC maintenance , stomach tube, catheter, etc., 27.3%）, wound care （including colostomy care, 25.5%）, pressure ulcers care（21.8%）, peritoneal dialysis care （ 16.4%）, function exercise guidance （ including surgery, hemiplegia after stroke, diabetic foot, postpartum breast massage guidance , etc., 9.0%）.There were statistically significant differences about medical expense [（195.73 ±114.77） vs （95.11 ±25.68）] and time cost [（195.73 ±12.00）h vs （3.95 ± 1.68）h] before and after the operation of specialized transitional care process （t=69.71,80.93,respectively;P〈0.05）.Conclusions Building the specialized transitional care process is helpful to reduce the medical expense and time cost ,and to improve patients ’ satisfaction to nursing service .In the future it is necessary to optimize transitional care process based on the hospital-community-family ternary linkage . Key words: Transitional care; Process; Effect evaluation

Comparative research of removal alcohol with iodine or not in PICC maintenance

Objective To observe the effect of removal alcohol with iodine or not in PICC maintenance. Methods Sixty patients who had PICC were randomized into observation group (n=30) and control group (n=30). Besides routine disinfection method and operation, the observation group used alcohol to remove the iodine. While the control group only received the routine disinfection method and operation. The bacterial cultivation of the skin surface around the PICC insertion site, drying time and time to change the dressing were compared between groups, and observed rolled-up dressing after 7 days of change the dressing. Results The bacterial cultivation of the skin surface around the PICC insertion site were not significantly different between groups (t=6.38, P>0.05). The natural air drying time and the total time of change the dressing of the observation group were (6.41±4.80) minutes and (16.60±2.71) minutes, which were significantly shorter than those of the control group (t=6.38, 2.89, respectively; P<0.05). And the rolled-up dressing was 93.3% in the control group and 10.0% in the observation group. The difference was significant (χ2=41.72, P<0.05). Conclusions Using alcohol to remove the iodine in PICC maintenance can shorten the nursing time and improve the work efficiency. It can also decrease the rolled-up dressing, reduce the rate of infection of the insertion site and increase the safety of PICC indwelling. What's more, iodine on the skin removed with alcohol makes the patient feel much more comfortable. Key words: Alcohol; PICC; Dressing pad; Iodine

Improvement and effect observation on fixed way of tumor chemotherapy patients with PICC

Objective To investigate the clinical effect of different fixed way of tumor chemotherapy patients with PICC .Methods Totals of 90 patients during June 2009 to June 2012 were randomly divided into experimental group and control group , with 45 cases in each group .Experimental group used the puncture vascular direction fixing way ,while control group used the “S” shape traditional fixed method .The breakage of catheter, catheter-related complications, patients ’ satisfaction and comfort of two groups were observed . Results In experimental group , catheter fracture rate was significantly lower than that in control group , and the difference was statistically significant （4.4% vs 20.0%, χ2 =5.075, P=0.024）.Local bleeding occurred cases in experimental group were significantly less than that in control group （1 vs 9,χ2 =7.200,P=0.007）. While phlebitis , catheter related infection , catheter obstruction , the complications such as tube out between two groups, no statistically significant difference was found （P〉0.05）.Experimental group had lower patients ’ satisfaction and comfort scores than control group , and the difference was statistically significant [（1.02 ±0.27） vs （2.16 ±0.35）,（1.32 ±0.61） vs （2.45 ±0.67）, t =1.173,1.528,respectively; P 〈0.05]. Conclusions Using the puncture vascular direction fixing way can reduce the local bleeding of PICC application and maintenance process , at the same time can prevent the PICC catheter fracture and increase patients ’ satisfaction and comfort in clinic .It is worth promoting clinically . Key words: Tumor; Chemotherapy; PICC ; Fixed way