PICC Catheter Research Articles

Impact of four kinds of limit body position to PICC catheter tip position

Objective To find the body maximum scope of activities on patients with PICC catheter, in order to do better health education for patients after catheterization mission. Methods We chose 75 patients who accepted the catheter at right limb for the first time, with the location of the catheter tip in the superior vena cava lower 1/3, superior vena cava and right atrium in 3-4 cm. We defined arms natural prolapse as the 0 position, which was the controlled position. Position 1 referred to the fingers touching the back to the highest, position 2 as shoulder joint rear protraction to the biggest angle, position 3 as shoulder joint anteflexion to the biggest angle, position 4 as shoulder joint adduction to the biggest angle. After the 4 kinds of position, X-ray was taken, the highest level in the subclavian vein pipe as the zero line, computer software was used to measure the each asana PICC tip from zero distance. Results Tips of PICC catheters moved up when taking position 1 and 2, whereas tips moved down when taking position 3 and 4. Position 1, 2, 3 and 4 moved (-26.18±11.32) , (-16.09±10.97), (24.36±19.05) , (36.64±22.48) mm respectively compared with the controlled position(P<0.01). Conclusions According to 4 kinds of position which induced the PICC tip changes to guide the patients daily actions could ensure the quality of life of patients with PICC and the use value of catheter. Key words: PICC; Catheter tip heterotopia; Range of activity; Position determining; Limit position

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

低分子肝素钙对恶性肿瘤患者D-二聚体和PICC管堵塞的影响

目的：探讨低分子肝素钙对恶性肿瘤患者D-二聚体和PICC管堵塞的影响，及抗凝治疗对PICC导管堵塞的干预效果。方法：选择D-二聚体偏高并置有PICC导管的恶性肿瘤患者30例，随机分为两组，测定15例(治疗组)接受低分子肝素钙治疗后D-二聚体的变化，同时检测15例(对照组) D-二聚体值进行对比观察。结果：与治疗前比较，低分子肝素治疗组在治疗后的2、4和7天的降低率为49.22%、50.18%和61.92%；对照组患者的D-二聚体在治疗后2、4和7天的降低率为6.00%、22.13%和13.57%。治疗组的下降率高于对照组。同时，低分子肝素治疗组抗凝后出现1例PICC导管堵塞，堵管率为6.67%，对照组出现10例PICC导管堵塞，堵管率为66.67%。结论：恶性肿瘤患者存在血液高凝及凝血功能紊乱，经低分子肝素钙治疗后可明显改善症状，降低血浆D-二聚体水平，同时减少PICC导管的堵塞，值得临床推广和应用。 Objective: To investigate the effect of low molecular weight heparin in patients with cancer D- dimer and PICC tube blockage, and anticoagulation effect of interference PICC catheter blockage. Methods: D-dimer High malignancy in patients with PICC catheter 30 patients were randomly divided into two groups, measured 15 cases (treatment group) accept change after low molecular weight heparin therapy D-dimer, while detected 15 cases (control group) D-dimer values were compared. Results: The treatment with relatively low molecular weight heparin in the treat- ment group at 2, 4 and 7 days after treatment reduced rate of 49.22%, 50.18% and 61.92%; the control group of patients after treatment 2,4 D-dimer and 7 days reduced rate of 6.00%, 22.13% and 13.57%. The rate of decline in treatment group is higher than the control group. Meanwhile, the low molecular weight heparin anticoagulant therapy group 1 case PICC catheter blockage, plugging rate of 6.67% in the control group had 10 cases of PICC catheter obstruction, plugging rate was 66.67%. Conclusion: Cancer patients hypercoagulable and coagulation disorders, the low molecular weight heparin treatment can significantly improve symptoms, reduce plasma D-dimer levels, while reducing the PICC catheter blockage, worthy of promotion and application.

Evidence-based nursing practice on the puncture point oozing blood in elderly patients after PICC catheterization

Objective To investigate hierachical evidence-based nursing plan on the puncture point oozing blood among elderly patients after PICC catheterization. Methods Based on the PICO principles and patient′s PICC oozing blood condition, the reasons were analyzed about elderly patient′s oozing blood after PICC catheterization, and computer was used to retrieve PubMed, Medline, China hownet, VIP information and Wanfang database for collecting clinical evidence of locally oozing blood nursing. Results Eventually, there were 2 clinical practice guidelines, 2 Meta analysis and 19 RCTs included. According to the results of retrieval and combining with patient′s condition and the implementation of targeted nursing measures for oozing blood hierarchic, a total of 22 patients with oozing blood after PICC catherization were treated effectively. Conclusions For elderly patients with PICC catheterization, reasonable puncture technology and maintenance methods can effectively reduce the incidence of the puncture point oozing blood. Key words: Elderly; PICC catheterization; Evidence-based nursing; Puncture point oozing blood

The localization of PICC catheter in the superior vena cava guided by ultrasound

The localization of PICC catheter in the superior vena cava guided by ultrasound

Clinical application of atrial ECG guided the three directional valve PICC tip positioning method

Objective To investigate the clinical application effects of atrial electrocardiogram guided the three directional valve PICC tip localization method. Methods After application of instant location technology of arterial electronic monitoring in the experimental group, the patients received X ray examination on chest, and double check the top catheter location of PICC; the control group utilized routine location method to ensure the top catheter position, which inserted the fitted length of tube (from the puncture position to right chest lock joint then to the third intercostal space) then sent to do X ray examination to ensure the top catheter position. The incidences of location accuracy, operation time and cost were compared between two groups. Results The accuracy of locations were 98.7% in the experimental group and 91.0% in the control group (χ2=8.01, P 0.05). Conclusions The position control of atrial electrocardiogram technology was applied to place PICC, which can judge catheter top position promptly and accurately, improve the accuracy rate of PICC catheter positioning effectively, and increase work efficiency. Key words: Peripherally inserted central catheter; Catheter top location; Electrocardiogram

Effects of standardized health education on PICC catheterization during intermittent period of lymphoma treatment

Objective To explore the effects of standardized health education on PICC catheterization during intermittent period of lymphoma treatment. Methods A total of 68 PICC patients with lymphoma treatment were divided into experimental group and control group by random number table on average. During hospitalization, the patients of control group received routine PICC nursing while the patients of experimental group underwent standardized health education based on routine nursing. We compared health behavior ability and incidence rate of PICC complications between two groups in intermittent period. Results One month discharged from hospital in the experimental group, scores were higher than those of the control group in health responsibility, body activity, nutrition, mental health, pressure regulation, human relationships (P<0.05). The incidence of PICC related complications in the experimental group was lower than that of the control group (P<0.05). Conclusions The standardized health education can enhance health behavior ability during intermittent period of lymphoma treatment, and reduce incidence of PICC related complications. Key words: Lymphoma; Catheterization, central venous; Standardized health education

Effect assessment of PICC catheterization through upper arm basilic vein guided by ultrasound

Objective To investigate the reduction of ultrasound (US) guided combined with Seldinger technique (MST) for PICC catheter through upper arm basilica vein complications. Methods To select 400 patients received PICC from July 2012 to December 2013, they were divided into control group (n=196, using common methods in fossa cubitalis place to insert catheter to basilic vein) and observation group (n=204, using ultrasound combined with MST for catheterization). We compared the pain level during catheterization, the success rate of catheterization at first time, relevant infections and complications. Results The success rate of catheterization af first time was 99.50% in the observation group and 81.63% in the control group (χ2=38.06, P<0.01), and 1.16% of mechanical phlebitis, 1.16% of venous thrombus and 0.58% catheter rapture in the observation group lower than these of the control group (χ2=18.31, 7.76, 7.89; P<0.01). The maintenance and medical expenses of control group was (1 706.21±210.20) Yuan while (1 368.44±190.33) Yuan in the control group (t=15.47, P<0.01). Conclusions Ultrasound guided upper basilic vein PICC catheter can effectively improve the success rate of catheterization, reduce the complication of catheter, and save catheter maintenance and the cost of treatment, which is worth the clinical promotion. Key words: Catheterization, central vein; Upper arm basilic vein; Intubation; Complication

Influence of repeated PICC catheterized on catheter tip location

Objective To explore the influence of repeatedly PICC catheterized on catheter tip position. Methods We analyzed the catheter tip position of patients who located PICC in one level three class-A hospital in Beijing from May to October in 2014. A total of 381 effective medical records were collected and divided into having the history of catheterization group and having no history of catheterization group depending on patients whether catheterized before. The patients having the history catheterization were divided into ipsilateral catheter group (B1 group) and no ipsilateral catheter group (B0 group), the catheter tip position was compared. Results The best catheter tip position for patients having the history of catheterization was 30.79%, which was lower than patients having no history group of 52.66% (χ2=17.565, P<0.01), and the patients of having catheterization history group had the incidence rate of shallow catheterization (47.74%) higher than 35.40% in the no catheterization history group (χ2=5.817, P<0.05). The patients of having catheterization history group happened the incidence of catheter tip position acquired dystopia of venae subclavia higher than patients having no catheterization history group (P<0.05). The best catheter tip position had lower rate in the B1 group comparing with B0 group, but the patients acquired dystopia of venae subclavia in the B1 group was lower than the patients in the B0 group (P<0.05). Conclusions Multiple PICC catheterization reduces the accuracy of catheter tip position, and impacts the safety and reservation of PICC. We should minimize the non-planned extubation incidences. If patients require re-catheterizaiton, we should select the opposite limbs to catheterize without catheterizaiton contraindication to ensure the safe of PICC catheterization. Key words: PICC; Catheter, catheterize; Complication

Improved flusing pipe method for PICC infusion of amphotericin B

Objective To discuss the impact on PICC infusion amphotericin B by improved flushing method. Methods A total of 20 patients with the treatment of amphotericin B were chosen as control group by convenience sampling method of time sequence from January 2011 to January 2013, while 15 patients with the treatment of amphotericin B were selected as experimental group from February 2013 to June 2014. The patients of control group underwent impulsive type flushing pipe with 5% glucose injection 10 ml before amphotericin B infusion, while the patients of experimental group received improved flushing method. We compared the length of PICC catheter indwelling time and rate of unplanned extubation caused by drug blocking. Results The length of PICC catheter indwelling time were(30.5±15.3) days in the control group and (97.5±35.9) days in the experimental group (t=-6.785, P<0.01); the rate of unplanned extubation because of drug blocking were 80.0% in the control group and 6.7% in the experimental group (χ2=18.453, P<0.01). Conclusions Improved flushing pipe method can effectively extend the PICC single catheter indwelling time and reduce rate of unplanned extubation caused by drug blocking. Key words: PICC; Amphotericin B; Flushing pipe

Meta-analysis of health education in patients with PICC intubation

Objective To evaluate the application effect of domestic health education on patients with PICC insertion. Methods We retrieved the China biology medicine database (CBM), CQVIP Chinese science and technology journal full-text database and Chinese periodical full-text database, collecting all the research materials about health education in patients with PICC catheter published in China from 2000 to 2014.Performing meta-analysis by RevMan 5.0. Results Sixteen randomized controlled trials and 2 404 patients had been incorporated into this project, including 1 215 cases in health education group, 1 189 cases in control group. The results of Meta analysis showed that there was statistically significant difference between the health education group and control group in health education success rate, patients′ satisfaction, quality of life, catheter complications and catheter in dwelling time (P<0.05). Conclusions Health education can reduce the incidence of the complications of PICC catheter, extend the catheter indwelling time, improve the quality of life of patients, and improve the control rate of health education and satisfaction of patients. Key words: Health education; PICC; Meta-analysis

Application on Wechat group for health education in discharged patients with PICC catheter

Objective To investigate the clinical application on Wechat for health education in discharged patients with PICC catheter. Methods Totals of 120 discharged patients with PICC catheter were selected from January to December in 2013, they were divided into the Wechat group (68 cases) and control group (52 cases) by random numerical table method. Before discharging from hospital, both groups received health education of PICC catheter and self-nursing instruction. The control group was given the telephone visits regularly and outpatient PICC consultation in hospital. Besides, the Wechat group was aggregated in a group, in which the self-nursing education and maintenance knowledge of PICC catheter were provided, and the questions from patients were answered timely as well. The awareness of self-nursing of PICC catheter and rate of patients′ satisfaction for health education were compared between the two groups. Results The awareness self-nursing of patients in the Wechat group was 95%, while the control group was 77%.There was significant difference between the two groups (χ2=11.73, P<0.01). The rate of patients′ satisfaction in the Wechat group was 97%, while the control group was 75%. There was significant difference between the two groups(χ2=8.23, P<0.01). Conclusions Setting up a Wechat group can increase self-nursing education of the discharged patients with PICC catheter as well as the rate of patients′ satisfaction. Key words: PICC; Wechat group; Discharge; Knowledge education

Complications associated to central venous catheters in hematology patients

To discover the incidence of central venous catheters (tunnelled, subcutaneous and PICC) in patients with onco-hematological conditions, hospitalized in the Hematology or Transplantations of Hematopoietic Stem Cells Units, in two tertiary care hospitals. A cross-sectional, descriptive study form was developed in order to gather sociodemographic, clinical data as well as complications and follow-up of the care protocol. Each catheter was assigned a correlative identification number. Information was collected on 366 catheters: 185 in the University Hospital Ramón y Cajal (HURYC), 80 tunnelled, 40 subcutaneous venous access and 65 PICC, and 181 in the University Hospital Gregorio Marañón (HUGM), 101 tunnelled and 80 subcutaneous venous access. Major complications in the tunnellized were infections (13.7% in HURYC vs. 6.8% in HUGM - p<0.001) and occlusions (at least once in 3.8% vs. 21.8%). In subcutaneous venous access, infections were confirmed in 5% in HURYC vs. 1.2% in HUGM. There were occlusions at least once in 10% in HUGM and no other significant complications were detected. Regarding PICC, information was only collected in HURYC, where complications were phlebitis 10.8%, thrombosis 7.7%, confirmed or suspected infection 4.6%, occlusion at least once 7.7%. Differences between hospitals with regard to major complications, infection and occlusion may be related to different care protocol. We need to stress the high incidence of phlebitis and thrombosis in PICC catheters, compared with data of lower incidence of other papers.

Improving central line infection rates in the neonatal intensive care unit: Effect of hospital location, site of insertion, and implementation of catheter-associated bloodstream infection protocols

IntroductionCatheter associated blood stream infections (CABSIs) are morbid and expensive for all ages, including neonates. Thus far, the impact of CABSI prevention protocols, such as insertion and maintenance bundles, in the neonatal intensive care unit (NICU) is largely unknown. We hypothesized that lines placed in the operating room (OR) would have a lower infection rate due to established insertion protocols and a more sterile environment. MethodsA retrospective chart review of NICU patients who received a percutaneous or tunneled central venous catheter between 2005 and 2012 was performed. ECMO cannulas, PICC and umbilical catheters were excluded. Variables of interest included demographics, anatomical site, hospital location, line days, and line infection. Line infection was defined as a positive blood culture drawn through the catheter. ResultsA total of 368 catheters were placed in 285 NICU patients. Majority of catheters (65.5%) were placed in OR. Saphenous and femoral veins were most common anatomical sites (50.8%). Twenty-eight catheters were infected (7.6%). After adjusting for preoperative antibiotics, anatomical site, and SNAPPE-II scores, lines placed in OR were three times less likely to become infected (Odds Ratio=0.32, p=0.038). Although implementation of CABSI prevention protocols resulted in statistically significant reductions in infection (Odds Ratio=0.4, p=0.043), lines placed in the OR remained less likely to become infected. ConclusionsNICU line infection rates decreased with implementation of CABSI prevention protocols. Despite this implementation, catheters placed in the NICU continued to have higher infection rates. As a result, when patient status allows it, we recommend that central lines in newborns be placed in the operating room.

Alginate Dressing Application in Hemostasis After Using Seldinger Peripherally Inserted Central Venous Catheter in Tumor Patients.

The aim of this study is to observe hemostatic effects of alginate dressing after using seldinger PICC catheter in tumor patients. Sixty tumor patients with PICC receiving chemotherapy were divided into the test group (30 cases) and the control group (30 cases) randomly. The test group was treated with alginate dressing and oppressed by the puncture point, while the control group was treated with gauze of the same size. PICC transparent films were used in both groups. Finally, dressing ooze blood soaked states on the puncture points and dressing change times were observed in the two groups for 1week. Moreover, local infection rate and incidence of catheter leak were also evaluated. The results showed that the oozing of blood and the changing frequency in the test group were obviously less than that in the control group, and there has a statistical difference (P<0.05). Infection rate of puncture point and incidence of catheter leak were simultaneously reduced in the test group. Alginate dressing is effective in preventing seldinger PICC catheter-induced hemorrhage.

Effect of nursing intervention on recessive pipe of PICC of sweaty patients

Objective To explore the influence on incidence of recessive pipe of PICC with different fix methods and different frequencies of replacement transparent dressing in sweaty patients. Methods Totals of 101 cases hospitalized in the pulmonary division of second hospital of Hebei Medical University undergoing PICC catheter indwelling were randomly divided into control group (n=53) and intervention group (n=48). Control group adopted transparent dressing fixed the PICC, once of week replacement. Intervention group adopted transparent dressing fixed the PICC combined with discount colloid dressing on the 2 cm to puncture part, and replacement once of 3 days. Observed the incidence rates of PICC exodus. Results The incidence rate of PICC exodus of control group was significantly higher than that of intervention group (28.3% vs 10.4%, χ2=5.073 6; P<0.05). Conclusions Improved methods of PICC fixed and increasing frequencies of replacement transparent dressing can effectively reduce the incidence of recessive pipe of PICC in sweaty patients. Key words: Nursing care; Sweaty patients; PICC; Exodus; Fixation method; Replacement frequencies

Application of comprehensive nursing in the placement and maintenance of PICC catheter

Objective To explore the application of comprehensive nursing in the placement and maintenance of PICC catheter. Methods 185 patients with PICC catheter were chosen and by the use of random number table, patients were divided into observation group (93 cases) and control group (92 cases). The control group accepted routine nursing, and the observation group accepted the comprehensive nursing. The complication rate, treatment compliance and the patients’ satisfaction were compared between groups. Results In the observation group, one case had venous thrombosis, with the incidence of 1.08%; in the control group, 6 cases had phlebitis, 4 cases had venous thrombosis, 3 cases had associated infections, 5 cases had catheter blockage, 3 cases had catheter breakage, with the incidence of 22.82%. The incidence of complications between two groups was statistically significant (χ2=9.375, P<0.05). Compliance rate and satisfaction were 98.92% and 97.85% in observation group, which were significantly higher than 82.61% and 73.91% in the control group (χ2=4.182, 5.846, respectively; P<0.05). Conclusions The comprehensive nursing can improve the compliance rates and reduce the incidence of complications of patients with PICC catheter, and promote patients’ recovery and satisfaction. Key words: PICC; Complications; Catheter maintenance; Comprehensive nursing

Relationship between anxiety degrees and dimensionalities of survival quality of cancer patients with PICC

Objective To explore the influence PICC catheter factors of anxiety in patients with tumor, and analyze the effect of anxiety on patients survival quality.Methods Between December 2011 and January 2013, 280 patients with PICC catheter tumors received long-term intravenous chemotherapy, according to the anxiety self rating scale （ SAS） to assess the degree of anxiety patients, were divided into anxiety patients and non-anxiety patients, then collected the patient ’ s general information, conducted cancer patients life scale （ EORTC QLQ C30 ） survey, analyzed the results.Results Among 280 patients, according to SAS scores, 73 cases of normal （26.07%）, 207 cases with anxiety （73.93%）, in which 41 cases of mild anxiety （14.64%）, 106 cases of moderate anxiety （37.86%）,60 cases of severe anxiety （21.43%）.The onset of patients age, hospitalization payment method, culture degree, occupation, income and treatment time had significantly relationship with the incidence of anxiety （χ2 =3.673,128.354,28.566,35.363,38.455,3.257, respectively;P〈0.05）.In EORTC QLQ C30-scale survey, anxiety and non-anxiety patients in PF [（58.6 ± 21.3） vs （59.3 ±15.6）], RF[（61.4 ±26.1） vs （64.1 ±22.7）], DY scores [（41.6 ±28.9） vs （40.2 ± 27.5）] had no significant difference （t=-0.835,-1.256,0.248, respectively;P〉0.05）.And significant difference of 12 dimensions scores was found （ P〈0.05） .Conclusions Anxiety can affect 12 dimensions（ EF, CF, SF, FA, NV, PN, QL, SL, AP, CO, DI, FI ） of EORTC QLQ C30 scale, improving the patient’ s anxiety can help improve the quality of survival in patients with PICC catheter tumor. Key words: PICC; Anxiety; PICC; Cancer patients; Survival quality

Different bemostasis methods for neonates after PICC catheterization

Objective To explore an effective hemostasis method for neonates after PICC catheterization and ways preventing limb swell.Methods 132 neonates admitted into our department,needing PICC catheterization,and receiving routine nursing care were randomly divided into an observation group and a control group,66 for each group.The puncture sites of the control group were pressed with 2 cm × 2 cm gauze and were wrapped with bandages to increase pressure; while those of the observation group with selfmade gauze balls (0.5 cm × 0.8 cm),and the local pressure of the puncture sites was externally increased with transparent application.Puncture site oozing and limb swelling were observed in both groups.Results The hemostasis effect and limb swell control of puncture sites were better in the observation group than in the control group,with statistical differences (P＜0.05).Conclusions Pressing puncture sites with self-made disinfection gauze balls can rapidly achieve hemostasis effect and prevent limb swelling. Key words: Neonate PICC; Disinfection gauze balls; Hemostasis

The effects of humanized nursing on health knowledge and life quality in PICC cath-eterization patients

Objective To investigate the effects of humanistic nursing in PICC catheterization patients.Methods A total of 60 ca-ses of PICC catheterization patients were divided the observation group and the control group according to different nursing methods , 30 cases in each group .The control group was received routine nursing care , the observation group was given humanistic nursing , nursing effects were compared between the two groups.Results Health knowledge awareness rate , treatment compliance , comfort in the observation group were higher than those in the control group , the incidence rate of phlebitis was less than that in the control group , nursing satisfaction was higher than that in the control group , with statistical significance （ P〈0.05 ） .Life quality scores in physical function , social function , mental function in the observation group were higher than those in the control group , with statistical significance （ P〈0.05 ） .Conclusions Hu-manistic nursing can increase the health knowledge of PICC catheterization patients , improve the self nursing ability and life quality during treatment. Key words: Humanistic nursing; PICC ; Health knowledge; Life quality