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Cao X, Zhao L. A prospective observation of PICC related anaphylactoid reactions. J Vasc Access 2024; 25:1474-1478. [PMID: 37021340 DOI: 10.1177/11297298211016118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
PURPOSE To explore the incidence, signs and symptoms, causes and prognosis of anaphylactoid reactions in PICC catheterization. METHODS Prospectively observe the occurrence of anaphylactoid reactions in coated and uncoated PICC during insertion from November 2018 to April 2020. A diagnosis of anaphylactoid reactions was based on the signs and symptoms and laboratory results, and then collect data for analysis. RESULTS A total of 1439 coated catheters were inserted, of which 30 resulted in anaphylactoid reactions (2.08%). The signs and symptoms were mainly skin system symptoms, combined with respiratory, cardiovascular, and digestive system symptoms. The anaphylactoid reaction rates of coated catheters were higher than those of uncoated catheters (χ2 = 38.417, 19.352, p < .01). A 29 of 30 patients completed catheterization after symptoms were resolved, these catheters were removed after treatment completion. Catheterization was terminated in one patient. There were no anaphylactoid reactions in 2850 uncoated catheters. CONCLUSION Anaphylactoid reactions may occur during catheterization when using the coated PICC, which should be paid attention to in clinical application.
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Affiliation(s)
- Xiuzhu Cao
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linfang Zhao
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Jing Y, Qu J, Jiang S, Wang X. Case Report: A report on the countermeasures after PICC line breakage in 3 postoperative breast cancer patients. Front Surg 2024; 11:1416855. [PMID: 39229252 PMCID: PMC11368779 DOI: 10.3389/fsurg.2024.1416855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024] Open
Abstract
Peripherally inserted central catheter (PICC) is a widely used technique in oncology chemotherapy, characterized by safety, reliability, and long dwell time. However, a catheter can break due to various causes. When an acute rupture occurs, it always lead to sever complications which may threaten patients' safety and potentially result in medical disputes. In this study, we collected and analyzed 3 cases of PICC line breakage causing drug leakage in our hospital from 2018 to 2023. All these 3 cases were postoperative breast cancer patients accepting chemotherapy, with 2 cases involving external partial breakage and 1 case involving internal partial breakage. Due to timely and appropriate management, no acute rupture occurred. We propose some ideas such as selecting high-quality catheter materials and avoiding over extension or repeated bending are crucial in preventing PICC line breakage. In addition, we also recommend establishing a standardized and scientific management pattern of PICC to ensure the safety and effectiveness of its clinical application, including comprehensive assessment, "four-element" intervention, and continuous evaluation.
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Affiliation(s)
- Yuqin Jing
- Breast Surgery, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Qu
- Breast Surgery, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shuo Jiang
- Department of Nursing, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaomin Wang
- Department of Nursing, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China
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Kremer V, Rheinheimer A, Rodrigues AL, Taborda A, Coelho R, Zanette A. The Use of a High Flow PICC Catheter for Stem Cell and Lymphocyte Apheresis: The Initial Experience of a Pediatric Oncology Center in Brazil. J Pediatr Surg 2024; 59:1600-1604. [PMID: 38494399 DOI: 10.1016/j.jpedsurg.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplant (HSCT), characterized by high intensity chemotherapy followed by the infusion of HSC previously collected from the peripheral blood, is a procedure used in the treatment of several malignancies. In pediatrics, the apheresis procedure represents a challenge, due to the need for insertion of a rigid central venous catheter (CVC) in small children. The CVC is usually used for stem cell collection and then removed. Later, the patient will need a new device for cell infusion. AIM We propose the use of one single catheter for both apheresis and infusion. METHODS We present five children between 1 and 13 years of age who underwent apheresis using a high flow PICC catheter surgically inserted. RESULTS All patients utilized a PICC line double lumen 5Fr (PowerPICC™ 5Fr DL BARD/USA) placed in the brachiocephalic vein tunneled on the chest, inserted under 24 h prior to apheresis to assure the devices were pervious. Three of the patients were diagnosed with solid tumor and one with acute lymphoblastic leukemia (ALL) awaiting Car-T Cell therapy. The four children who underwent autologous HSCT used the same catheter for cell infusion and remained with the catheter following discharge. The child who was submitted for Car-T Cell still awaits infusion and the catheter was removed. CONCLUSIONS High flow PICC is a viable alternative for apheresis to maintain an adequate flow of 5 ml/s and can be used as a single catheter throughout the HSCT process, reducing the risks from anesthesia and the catheter insertion procedure. TYPE OF STUDY Clinical Research.
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Pan Z, Zhu J, Jiang Z, Chen L. Clinical application of intracavitary electrocardiogram localization combined with ultrasound in central venous catheterization in critically ill patients: An observational study. Medicine (Baltimore) 2024; 103:e38372. [PMID: 38847702 PMCID: PMC11155529 DOI: 10.1097/md.0000000000038372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/03/2024] [Indexed: 06/10/2024] Open
Abstract
To explore the clinical application value of intracavitary electrocardiogram (ECG) localization combined with ultrasound in central venous catheterization in critically ill patients. A total of 103 patients who were treated in the intensive care unit of our hospital from October 2020 to June 2023 were selected as the study subjects, and according to the differences in their central venous catheter placement methods, they were divided into study group (n = 52, receiving ultrasound combined with intracavitary ECG localization for catheterization) and control group (n = 51, receiving routine catheterization). The differences in the catheter placement accuracy, catheter depth, catheter placement duration, incidence of catheter-related complications, length of stay, and hospitalization expenses between the 2 groups were compared. The analysis utilizing X-ray for catheter tip positioning indicated that the catheter tip placement rate was higher in the study group than in the control group, and the catheter tip malposition rate was lower than in the control group (P < .05). There was no statistical significance in the catheter depth between study group and control group (P > .05), and the catheter placement duration of study group was significantly lower than that of control group, with statistical significance (P < .05). One case of partial catheter blockage, one case of catheter-related bloodstream infection, and one case of phlebitis were observed in study group, with an overall incidence of complications of 5.77% (3/52), which was significantly lower than 21.57% (11/51) of control group (P < .05). The length of stay and hospitalization expenses in study group were significantly lower than those in control group, with statistical significance (P < .05). The combined use of ultrasound and intracavitary ECG localization in critically ill patients undergoing central venous catheterization can help increase the success rate of catheter placement, shorten the catheter placement duration, reduce the incidence of various catheter-related complications, and also reduce the length of stay and hospitalization expenses.
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Affiliation(s)
- Zhenfei Pan
- EICU, The First People’s Hospital of Wenling, Wenling, China
| | - Jinqiang Zhu
- The First People’s Hospital of Wenling, Wenling, China
| | | | - Lili Chen
- The First People’s Hospital of Wenling, Wenling, China
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Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens 2024; 13:393. [PMID: 38787246 PMCID: PMC11124157 DOI: 10.3390/pathogens13050393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.
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Affiliation(s)
- Nesrine Bouhrour
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
| | - Peter H. Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Farida Bendali
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
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Gao X, Mi X, Hou S, Kang C. Analysis of factors related to thrombosis in patients with PICC placements. Medicine (Baltimore) 2024; 103:e37168. [PMID: 38306520 PMCID: PMC10843478 DOI: 10.1097/md.0000000000037168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
This study aimed to investigate the conditions of patients with peripherally inserted central catheter (PICC) placements, analyze the risk factors influencing thrombosis in PICC-placed patients, and formulate more accurate and effective PICC management strategies. A total of 147 patients undergoing PICC placements were selected as the study subjects. Clinical data were collected, and the patients were divided into thrombosis and non-thrombosis groups. Detect levels of bilirubin, white blood cells, venous pressure, heparin concentration, blood flow, citric acid, and platelets. Pearson chi-square test, Spearman correlation analysis, as well as univariate and multivariate logistic regression were employed to analyze independent risk factors. Among the 147 patients with PICC placements, there were 84 males and 63 females. Thrombosis occurred in 116 cases, with an incidence rate of 78.91%. Pearson chi-square test showed a significant correlation between citric acid, blood flow, platelets and frailty (P < .001) with thrombosis formation. Spearman correlation analysis revealed a significant correlation between citric acid (ρ = -0.636, P < .001), blood flow (ρ = 0.584, P < .001), platelet count (ρ = 0.440, P < .001), frailty (ρ = -0.809, P < .001) and thrombosis in PICC placement patients. Univariate logistic regression analysis indicated a significant correlation between thrombosis formation and citric acid (OR = 0.022, 95% CI = 0.006-0.08, P < .001), blood flow (OR = 33.973, 95% CI = 9.538-121.005, P < .001), platelet count (OR = 22.065, 95% CI = 5.021-96.970, P < .001), frailty (OR = 0.003, 95% CI = 0.001-0.025, P < .001). Multivariate logistic regression analysis also showed a significant correlation between thrombosis formation and citric acid (OR = 0.013, 95% CI = 0.002-0.086, P < .001), blood flow (OR = 35.064, 95% CI = 6.385-192.561, P < .001), platelet count (OR = 4.667, 95% CI = 0.902-24.143, P < .001), frailty (OR = 0.006, 95% CI = 0.001-0.051, P < .001). However, gender (OR = 0.544, 95% CI = 0.113-2.612, P = .447), age (OR = 4.178, 95% CI = 0.859-20.317, P = .076), bilirubin (OR = 2.594, 95% CI = 0.586-11.482, P = .209), white blood cells (OR = 0.573, 95% CI = 0.108-3.029, P = .512), venous pressure (OR = 0.559, 95% CI = 0.129-2.429, P = .438), and heparin concentration (OR = 2.660, 95% CI = 0.333-21.264, P = .356) showed no significant correlation with thrombosis formation. Patients with PICC placements have a higher risk of thrombosis, citric acid, blood flow, platelet count and frailty are the main risk factors.
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Affiliation(s)
- Xiaoli Gao
- Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
| | - Xihua Mi
- Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
| | - Shiyang Hou
- Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
| | - Chunbo Kang
- Gastrointestinal Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
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Pitiriga VC, Bakalis J, Campos E, Kanellopoulos P, Sagris K, Saroglou G, Tsakris A. Central Venous Catheters versus Peripherally Inserted Central Catheters: A Comparison of Indwelling Time Resulting in Colonization by Multidrug-Resistant Pathogens. Antibiotics (Basel) 2024; 13:89. [PMID: 38247648 PMCID: PMC10812679 DOI: 10.3390/antibiotics13010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The use of peripherally inserted central catheters (PICCs) as an alternative to central venous catheters (CVCs) has steadily risen over the last two decades. However, there is an ongoing debate regarding research evidence that supports any clear advantages or disadvantages of them compared to traditional central venous lines. The present study was conducted to compare the indwelling time of CVC and PICC placements leading to microbial colonization by multidrug-resistant microorganisms (MDROs) in critically ill patients. METHODS A single-center retrospective descriptive study was performed that reviewed the medical records of critically ill patients with colonized CVCs and PICCs who were hospitalized during a 24-month period (May 2019-May 2021). To evaluate the association between indwelling time of catheter placement and colonization rates, events were categorized into three groups, each representing a one-week time interval of catheter indwelling time: group 1: ≤7 days, group 2: 8-14 days, and group 3: >14 days. RESULTS A total of 207 hospitalized patients with colonized PICCs or CVCs were included in the study. Of these, 144 (69.5%) had a CVC placement and 63 (30.5%) had a PICC placement. The overall colonization rate (per 1.000 catheter/days) was 14.73 in the CVC and 5.67 in the PICC cohort (p = 0.003). In the group of PICCs, 12/63 (19%) of the pathogens were MDROs and 51/63 (81%) were non-MDROs, while in the group of CVCs, 86/144 (59.7%) were MDROs and 58/144 (40.3%) were non-MDROs (p < 0.001). The colonization rate in the CVC cohort, was 6.98 for group 1, 21.57 for group 2, and 21.6 for group 3 (p = 0.019). The colonization rate of MDROs was 3.27 for group 1, 14.47 for group 2, and 12.96 for group 3 (p = 0.025). Regarding the PICC cohort, the colonization rate was 1.49 for group 1, 3.19 for group 2, and 8.99 for group 3 (p = 0.047). No significant difference existed between the three groups in terms of MDRO pathogens, with the colonization rate being 0 for group 1, 0.8 for group 2, and 1.69 for group 3 (p = 0.78). Within the CVC cohort, the most common isolated microorganism was MDR Acinetobacter baumannii (n = 44; 30.6%), followed by MDR Klebsiella pneumoniae (n = 27; 18.7%). In the PICC cohort, the predominant isolated microorganism was Candida non-albicans (n = 15; 23.8%), followed by Candida albicans, coagulase-negative staphylococci, and MDR Klebsiella pneumoniae in equal numbers (n = 6; 9.5%). CONCLUSIONS Our findings show that while the indwelling time of PICC placement was longer compared to CVCs, its colonization rate was considerably lower. Furthermore, high colonization rates by microorganisms, especially MDROs, arose later during catheterization in PICCs compared to CVCs, suggesting that in terms of vascular infections, PICCs may be a safer alternative to conventional CVCs for long-term intravenous access.
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Affiliation(s)
- Vassiliki C. Pitiriga
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
| | - John Bakalis
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Elsa Campos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Petros Kanellopoulos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Konstantinos Sagris
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - George Saroglou
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
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García-Zambrano L, Morales-Gómez D, Dennis-Halley MJ, Román-Ortega CF, Cabrera-Rivera PA, Parra M. Making a difference? A retrospective review of peripherally inserted central catheters: A single-center experience in Colombia. SAGE Open Med 2023; 11:20503121231201349. [PMID: 37808511 PMCID: PMC10557411 DOI: 10.1177/20503121231201349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Peripherally inserted central catheters (PICCs) are an effective tool as a medical device in patients who require them. However, it is a procedure that has been associated with multiple complications and possible negative outcomes for the health of the patients. This paper seeks to describe the main complications derived from the insertion and maintenance of peripherally inserted central venous catheters (PICCs), based on the experience of a vascular accesses group in a cardiovascular center in Colombia. Methods A retrospective cross-sectional analytical study of the adult population undergoing PICC insertion at the Fundación Cardioinfantil-Instituto de Cardiología, during the period between 2019 and 2020 by the vascular access program, was performed. Results The frequency of any registered complication was 15.9% for 2019 and 11.2% for 2020. Bleeding at the procedure site occurred in 15.3% during 2019 and 7.0% in 2020, making it the most frequent complication during the procedure. All the variables of complications associated with infection (bacteremia, phlebitis, and catheter-related infection) showed a decrease in 2020 compared to the previous year. The central line-associated bloodstream infection registered for the year 2019 was 1.94 bacteremia's/1000 catheters-day compared to 0.29 bacteremia's/1000 catheters-day. Conclusions There has been a 4.7% reduction in the frequency of any registered complication after the implementation of the vascular access groups. Global and specific complications decreased significantly from 2019 to 2020. Notably, bacteremia, a common post-procedure complication, showed a substantial decrease in frequency compared to national and worldwide literature. It is also been described that complications associated with infection showed a decrease in 2020 compared to 2019. Whether or not all these findings are directly or somewhat related to the results stemming from the vascular access groups still needs further investigation.
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Affiliation(s)
- Laura García-Zambrano
- General Surgery Research Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Daniel Morales-Gómez
- General Surgery Research Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
- Department of General Surgery, Fundación Cardioinfantil-La-Cardio, Bogotá, Colombia
| | | | - Carlos F Román-Ortega
- General Surgery Research Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
- Department of General Surgery, Fundación Cardioinfantil-La-Cardio, Bogotá, Colombia
- Vascular Access Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
| | - Paulo A. Cabrera-Rivera
- General Surgery Research Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
- Department of General Surgery, Fundación Cardioinfantil-La-Cardio, Bogotá, Colombia
| | - Marcela Parra
- Vascular Access Group, Fundación Cardioinfantil-La Cardio, Bogotá, Colombia
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Andrade Soares Ribeiro de Campos G. Picc Line Associated Brachiocephalic Vein Rupture with Consequent Mediastinal Placement Causing Pneumomediastinum and Large Total Parenteral Nutrition Bilateral Effusion. Eur J Case Rep Intern Med 2023; 10:004103. [PMID: 37920225 PMCID: PMC10619533 DOI: 10.12890/2023_004103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 11/04/2023] Open
Abstract
We present a rare case of large bilateral pleural effusion, pericardial effusion and pneumomediastinum caused by a peripherally inserted central catheter (PICC) line rupturing the left brachiocephalic vein, causing severe respiratory failure. The PICC line had been inserted with the aim of providing total parenteral nutrition (TPN). The patient developed symptoms within a day with effusions diagnosed on computer tomography pulmonary angiogram (CTPA). Bilateral pleural drains were inserted with a white milk-like substance drained consistent with TPN, prompting a further review of the CTPA revealing the mediastinal-positioned PICC line. The patient was transferred to the thoracic unit and was successfully managed with conservative measures. We propose some ideas such as the use of intracavitary electrocardiogram (IC-ECG) guidance as an adjuvant to obtain a correct and safe position. LEARNING POINTS PICC lines, although seen as safer, have potential for catastrophic adverse effects.The use of intracavitary electrocardiogram may be a safe adjunct and even an alternative to the use of a chest X-ray.Aspirating blood from all lumens with particular emphasis on the distal most lumen is very important.
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10
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Bonfim ALV, de Brito GA, Baptista AL, Andrade LAS, Imanishe MH, Pereira BJ. Clinical study of complications of a peripherally inserted central catheter in cancer patients. Nurs Open 2023. [PMID: 36853924 DOI: 10.1002/nop2.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/17/2022] [Accepted: 02/05/2023] [Indexed: 03/01/2023] Open
Abstract
AIM To evaluate complications after PICC use in cancer patients. DESIGN This was a clinical and retrospective study in which the risk factors and complications of PICC use were evaluated. METHODS This study was carried out in the patient, emergency room, and intensive care units through the evaluation of electronic medical records. To assess the association between qualitative variables, the chi-squared test or Fisher's exact test was used, and to compare the reason for withdrawal, the Kruskal-Wallis test was applied. RESULTS A total of 359 patients (53.5% men) with 43.1 ± 14 years who had a PICC (88% with solid tumours) were evaluated. The most common complications were mechanical complications (61.2%), infection (38%), and thrombosis (57.1%). Patients with double-lumen catheters experienced thrombosis (85.7%). This study demonstrated the effectiveness of PICC and that patients with haematological cancer are more prone to multiple PICC passages and more mechanical complications and infections.
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Du S, Zhang Y, Wang H, Fan Y, Jiao BJ, Wang DN, Qi MM, Sun XW. More advantages of trocar compared than steel needle in deep venipuncture catheterization. Medicine (Baltimore) 2022; 101:e31216. [PMID: 36401416 PMCID: PMC9678495 DOI: 10.1097/md.0000000000031216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Deep venipuncture catheterization is widely used in clinical anesthesia. However, it is worth thinking about how to improve the rate of successful catheter insertion, and relieve patients' discomfort. This paper aimed to compare the clinical advantages between trocar and steel needle. METHODS Total 503 adult patients were recruited and randomly assigned. The control group was punctured with steel needle, and the experimental group was punctured with trocar needle. Clinical and followed-up information was recorded. Pearson's chi-squared and spearman test were performed to analyze the correlation between intervention and relative parameters. Univariate logistic regression was performed to verify the odds ratio of trocar needle compared with steel needle. RESULTS Pearson's chi-square test and Spearman's correlation test showed a significant correlation between puncture success, puncture comfort, successful catheter insertion, puncture time, thrombosis, catheter fever, bleeding, infection and interventions (P < .05). Univariate logistic regression showed that there existed better puncture comfort (odds ratio [OR] = 6.548, 95% confidence interval [CI]: 4.320-9.925, P < .001), higher successful catheter insertion (OR = 6.060, 95% CI: 3.278-11.204, P < .001), shorter puncture time (OR = 0.147, 95% CI: 0.093-0.233, P < .001), lesser thrombosis (OR = 0.194, 95% CI: 0.121-0.312, P < .001), lesser catheter fever (OR = 0.263, 95% CI: 0.158-0.438, P < .001), lesser bleeding (OR = 0.082, 95% CI: 0.045-0.150, P < .001) and lesser infection (OR = 0.340, 95% CI: 0.202-0.571, P < .001) in trocar group compared with steel needle group. CONCLUSION Trocar application in deep venipuncture catheterization can improve successful catheter insertion, relieve pain and discomfort of patients, reduce incidence of complications, and provide better security for patients.
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Affiliation(s)
- Suzhen Du
- Department of anesthesiology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
- * Correspondence: Suzhen Du, Department of anesthesiology, China Aerospace Science & Industry Corporation 731 Hospital, NO.3, Zhen Gang Nan Li, Yun Gang, Feng Tai District, 100074, Beijing, China (e-mail: )
| | - Yanbo Zhang
- Department of anesthesiology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Hui Wang
- Department of anesthesiology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Yan Fan
- Department of anesthesiology, Cangzhou Central Hospital, Cangzhou, P.R. China
| | - Bao-Jie Jiao
- Department of anesthesiology, Cangzhou Central Hospital, Cangzhou, P.R. China
| | - Dong-Ni Wang
- Nursing Department, Cangzhou Central Hospital, Cangzhou, P.R. China
| | - Man-Man Qi
- Department of anesthesiology, Cangzhou Central Hospital, Cangzhou, P.R. China
| | - Xiu-Wei Sun
- Department of anesthesiology, Cangzhou Central Hospital, Cangzhou, P.R. China
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Li S, Lu H. Functions of Heparin Sodium Injection in the Prevention of Peripherally Inserted Central Catheter-Related Venous Thrombosis in NSCLC Patients during Postoperative Chemotherapy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1239058. [PMID: 36299679 PMCID: PMC9592220 DOI: 10.1155/2022/1239058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
Objective This study intended to analyze hazardous factors of venous thrombosis by comparing the effect of different doses of heparin sodium injection on the incidence rate of peripherally inserted central catheter (PICC)-related venous thrombosis in non-small cell lung carcinoma (NSCLC) patients during postoperative chemotherapy. Methods 425 NSCLC patients who received PICC catheterization in Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital from July 2019 to July 2021 were collected. Based on their different pathological types, patients were given two different chemotherapy regimens: pemetrexed+cisplatin or paclitaxel+cisplatin. Patients were grouped according to the different doses of heparin sodium injection adopted. Control group (n = 140). Catheters were sealed with 10 mL saline only. Group I (n = 142). In addition to routine maintenance with normal saline, 2 mL of 10 IU/mL heparin sodium injection was sealed in the catheters under positive pressure every time after catheterization. Group II (n = 143). In addition to routine maintenance with normal saline, 5 mL of 10 IU/mL heparin sodium injection was sealed in the same manner as Group I. The baseline characteristics of the three groups of patients were compared by statistical means. Doppler ultrasonography was applied to check the venous thrombosis. The hazardous factors of venous thrombosis were analyzed through correlation analysis and binary logistic regression method. Results The incidence rates of thrombosis in the control group, Group I, and Group II were 20.00%, 7.04%, and 2.09%, respectively, with statistically significant differences (P < 0.01). Additionally, through the collinear correlation analysis of baseline characteristics, a significant correlation between the dosage of heparin sodium injection and the incidence of thrombosis was observed (P < 0.05), but there were no significant differences between other baseline data and the incidence of thrombosis (P > 0.05). Binary logistic regression analysis revealed that postoperative use of heparin sodium injection (Group I: OR = 0.312; P = 0.003; Group II: OR = 0.082, P < 0.001) was a protective factor for preventing thrombosis. In addition, the thromboprophylaxis effect of Group II was better than that of Group I. No serious adverse reactions were found in safety analysis. Conclusion Heparin sodium could significantly lower the incidence rate of PICC-related venous thrombosis in NSCLC patients during postoperative chemotherapy. Heparin sodium injection is safe enough to be promoted among PICC patients with a high risk of venous thrombosis.
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Affiliation(s)
- Shanquan Li
- Venous Catheterization Nursing Clinic, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital, Shenzhen, Guangdong Province, China 518100
| | - Hong Lu
- Nursing Department, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital, Shenzhen, Guangdong Province, China 518100
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Clinical Value of Coagulation Index Changes in Early Diagnosis and Nursing Intervention for PICC-Related Venous Thrombosis in Tumor Patients. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7579225. [PMID: 36034199 PMCID: PMC9392612 DOI: 10.1155/2022/7579225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/25/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
Purpose To explore the clinical value of coagulation index changes in early diagnosis and nursing intervention for PICC-related venous thrombosis in tumor patients. Patients and Methods. A total of 170 tumor patients hospitalized for the first time with catheterization were enrolled from February 2018 to June 2022. According to the diagnostic criteria of venous thromboembolism, high-risk patients with venous thrombosis within 13 days after catheterization were enrolled in the observation group, and those without thromboembolism were enrolled in the control group. Venous blood was taken from all patients on days 1, 5, 9, and 13 after catheterization to measure the change trend of coagulation indexes of patients and to compare the difference of coagulation indexes between the observation group and the control group. Results PT values of all patients were within the normal reference range at days 1, 5, 9, and 13 after catheterization. Compared with the control group, the observation group was significantly reduced on days 5, 9, and 13 after catheterization (P < 0.05), and continued to decrease with the prolonging of time(P < 0.05). After catheterization, the values of all patients at each time point were lower than the normal reference range. Compared with the control group, the values of tumor patients in the observation group were significantly decreased on days 5, 9, and 13 (P < 0.05) and continued to decrease at each time point (P < 0.05). DD values in the observation group were all higher than the normal reference range on days 1, 5, 9, and 13 after catheterization. Compared with the control group, DD values in the observation group were significantly higher on days 1, 5, 9, and 13 after catheterization (P < 0.05). Conclusion PT and APTT continued to decrease after catheterization, and DD kept fluctuating at a high level, highly suggesting the possibility of venous thrombosis. The nursing staff should keep high vigilance and give appropriate nursing intervention.
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Druar NM, Vosburg RW, Cahan M. Obesity increases the risk for upper extremity deep vein thrombosis and pulmonary embolism in patients with upper extremity central venous catheters. Clin Obes 2022; 12:e12526. [PMID: 35429144 DOI: 10.1111/cob.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/24/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
The morbidity and mortality of deep vein thrombosis (DVT) remain a significant burden for the healthcare system. The aim of this analysis was to examine the association of upper extremity central venous catheter (UECVC) and venous thromboembolism (UEVTE) with increasing body mass index (BMI) in a large database study and to further examine disposition. Inpatient data from the National Inpatient Sample from 2017 to 2019 were used to investigate the effect of obesity on patients diagnosed with DVT of the upper extremity or pulmonary embolism (PE) who had upper extremity venous central line placement. There was a total of 1690 cases of UEVTE and 3202 cases of PE within the sample. There was an increasing odds of UEVTE in the patients with UECVCs with increasing BMI. Patients with a BMI of 30-39, 40-49 and > 50 kg/m2 were significantly different than those with BMI of <19 and 20-29 kg/m2 in the UECVC group for UEVTE. This study demonstrated increased odds of UEVTE for patients with increased BMI. Practitioners should assume a greater risk for UEVTE and PE in patients with increased BMI when considering CVCs.
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Affiliation(s)
- Nicholas M Druar
- Department of Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
- Department of Surgery, St. Mary's Hospital, Waterbury, Connecticut, USA
| | - Ralph Wesley Vosburg
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Mitchell Cahan
- Department of Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts, USA
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Li FX, Li YP, Zhang HY, Tian MJ, Gao HH, Zhang GJ, Su P. Guidewire-Assisted Reduction Technology Combined with Postural Reduction Improves the Success Rate of Internal Vein Catheterisation. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7171578. [PMID: 35620382 PMCID: PMC9130005 DOI: 10.1155/2022/7171578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
Objective To investigate the value of guidewire-assisted reduction technology (which increases the stiffness of a catheter through the use of a guidewire, thereby protecting the puncture point and distal vein from breakage) combined with postural reduction for malpositioned catheters in the internal jugular vein during peripherally inserted central venous catheter catheterisation. Methods From January 2015 to August 2020, we used ultrasound to perform guided puncture and monitoring. We identified the tip of the catheter as malpositioned in the internal jugular vein in 99 patients during the catheterisation process. These patients were divided randomly into a control group and an experimental group. In the control group, 43 cases received guidewire-assisted reduction technology, while in the experimental group, 56 patients received guidewire-assisted reduction technology combined with an upright posture. This study compared the efficacy of these two methods. Results The results showed that 30 catheters were reduced successfully in the control group, with a success rate of 69.8%. In the experimental group, 53 cases were successfully reduced, with a success rate of 94.6%. The catheter reduction success rate in the experimental group was significantly higher than in the control group; this was a statistically significant difference (P=0.001). Conclusion Guidewire-assisted reduction technology combined with postural reduction can improve the success rate of the reduction of malpositioned catheters in the internal jugular vein.
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Affiliation(s)
- Feng-Xian Li
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Yan-Ping Li
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Hong-Yang Zhang
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Mei-Jing Tian
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Huan-Huan Gao
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Gui-Juan Zhang
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
| | - Peng Su
- Department of Oncology Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China
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Bayoumi MAA, van Rens R, Chandra P, Shaltout D, Gad A, Elmalik EE, Hammoudeh S. Peripherally inserted central catheters versus non-tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study. BMJ Open 2022; 12:e058866. [PMID: 35387831 PMCID: PMC8987782 DOI: 10.1136/bmjopen-2021-058866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We aimed to compare the success rates and other catheter-related parameters between peripherally inserted central catheters (PICCs) and non-tunnelled ultrasound-guided central venous catheters (USG-CVCs) including femoral, jugular, brachiocephalic and subclavian lines. DESIGN This was a retrospective observational study. SETTING The study was performed in a level III neonatal intensive care unit (NICU) in Qatar, as a single-site study. PARTICIPANTS This study included 1333 neonates who required CVC insertion in the NICU from January 2016 to December 2018. Of those, we had 1264 PICCs and 69 non-tunnelled USG-CVCs. OUTCOME MEASURES The success rate and other catheter-related complications in the two groups. RESULTS The overall success rate was 88.4% in the USG-CVCs (61/69) compared with 90% in the PICCs (1137/1264) group (p=0.68). However, the first prick success rate was 69.4% in USG-CVCs (43/69) compared with 63.6% in the PICCs (796/1264) group. Leaking and central line-associated blood stream infection (CLABSI) were significantly higher in the USG-CVC group compared with the PICC group (leaking 16.4% vs 2.3%, p=0.0001) (CLABSI 8.2% vs 3.1%, p=0.03). CLABSI rates in the PICC group were 1.75 per 1000 catheter days in 2016 and 3.3 in 2017 compared with 6.91 in 2016 (p=0.0001) and 14.32 in 2017 (p=0.0001) for the USG-CVCs. USG-CVCs had to be removed due to catheter-related complications in 52.5% of the cases compared with 29.9% in PICCs, p=0.001. In 2018, we did not have any non-tunnelled USG-CVCs insertions in our NICU. CONCLUSIONS The overall complication rate, CLABSI and leaking are significantly higher in non-tunnelled USG-CVCs compared with the PICCs. However, randomised controlled trials with larger sample sizes are desired. Proper central venous device selection and timing, early PICC insertion and early removal approach, dedicated vascular access team development, proper central venous line maintenance, central line simulation workshops and US-guided insertions are crucial elements for patient safety in NICU.
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Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Roland van Rens
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Deena Shaltout
- Medical Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Gad
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Einas E Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Samer Hammoudeh
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
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Choi K, Keum MA, Kim MS, Kim Y, Choi S, Kyoung KH, Kim JT, Kim S, Noh M. Feasibility of the Ultrasound-Guided Insertion of the Peripherally Inserted Central Catheter (PICC) by the Vascular Surgeon at the Bedside in the Trauma Intensive Care Unit. Ann Vasc Surg 2021; 80:143-151. [PMID: 34688877 DOI: 10.1016/j.avsg.2021.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study analyzed the outcomes of the ultrasound-guided insertion of the peripherally inserted central venous catheter (PICC) by experienced vascular surgeons at the bedside of the trauma intensive care unit (ICU) and compared the outcomes with those of fluoroscopy-guided PICC performed by radiologists in the interventional suite. METHODS Between May 1, 2016, and April 30, 2021, 97 patients who were hospitalized in the trauma ICU and underwent PICC insertion were enrolled in the study. Forty-two out of the 97 patients underwent PICC insertion by interventional radiologists in the interventional radiology suite under fluoroscopy guidance, while the remaining 55 cases underwent ultrasound-guided PICC insertion by the vascular surgeon at the trauma ICU bedside. RESULTS The technical failure (P = 0.504) and malposition (P = 0.127) rates were not significantly different between the 2 groups. However, it took significantly less time for the vascular surgeon to complete the PICC insertion procedure (P < 0.001). Significantly more patients of the ultrasound-guided group required inotropes (P = 0.012) and mechanical ventilation (P = 0.003) at the time of the procedure. In addition, the ultrasound-guided group appeared to be in critical condition in terms of kidney function according to laboratory data (P = 0.014). Meanwhile, the ultrasound-guided group maintained the central line catheter for a shorter time (P < 0.001). CONCLUSIONS In trauma patients, ultrasound-guided PICC insertion at the bedside by experienced vascular surgeons at the trauma ICU was feasible compared to fluoroscopy-guided insertion performed by interventional radiologists.
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Affiliation(s)
- Kyunghak Choi
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Min Ae Keum
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Min Soo Kim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Youngwoong Kim
- Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seongho Choi
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kyu-Hyouck Kyoung
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jihoon T Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sungjeep Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Minsu Noh
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
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Jie C, Chunxue P, Jiawei X, Hongmei L, Huohong Q. Multidisciplinary cooperative mode led by infusion nurse specialists used to ensure the nursing quality of peripherally inserted central catheters in China: A 5-year retrospective study. J Vasc Access 2021; 24:370-378. [PMID: 34289726 DOI: 10.1177/11297298211033507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the effect of multidisciplinary cooperation mode (MCM) led by infusion nurse specialists (INSs) on peripherally inserted central catheters (PICC) catheterization and indwelling nursing quality. METHODS Participants' demographic information, catheter types, catheterization approaches, puncture site, tip position, professional title of nurses, success rate of catheterization, consultation rate, detection rate of complications and outcome improvement rate of 6576 outpatients and hospitalized patients with PICC were analyzed retrospectively by a software named "questionnaire stars," in a large tertiary general hospital in Shanghai, from January 2015 to December 2019. SPSS 26.0 for Windows was used for data collection and description, Chi-square test were used for statistical analysis of enumeration data, and p < 0.05 was statistically significant. RESULTS According to the catheter types' data, the use rate of three-way valve catheters decreased from 79.9% to 14.5%, while the use rate of three-way valve solo catheters increased from 12.7% to 51.6%, and the use rate of power injectable and open-ended catheters increased from 7.4% to 33.9%. According to the data of PICC catheterization method, conventional technology decreased significantly from 16.8% to 1.1%, modified Seldinger technique (MST) increased gradually from 26.1% to 51.3%, while ultrasound guided modified Seldinger technique (US and MST) decreased slightly from 57.2% to 47.6%. 7.5% catheter tip ends were malpositioned while nine indwelled PICCs were traced to have tip end malposition. The consultation rate was significantly higher than that before applying MCM led by INSs (x2 = 151.713, p < 0.05). After applying MCM led by INSs, the detection rate of complications was significantly higher than before (x2 = 5.499, p < 0.05), the rate of successful insertion at one time was significantly higher than before (x2 = 187.589, p < 0.05). CONCLUSION After the application of INSs-led MCM, progresses have been achieved. The nursing quality of patients' PICC was significantly improved than before.
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Affiliation(s)
- Cao Jie
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Peng Chunxue
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xu Jiawei
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Li Hongmei
- Infusion Therapy Clinic, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qian Huohong
- Chairperson of Infusion Therapy Board in Changhai Hospital, Naval Medical University & Associate Chairperson of Infusion Therapy Committee in Shanghai Nurses Association, Shanghai, China
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