Study On The Struction And Application Of PICC Risk Management System For Patients With Malignant Tumor Chemotherapy

Objective:The PICC risk management system for patients with malignant tumors was constructed and its safety and effectiveness verified through clinical application.Methods:A total of 1761 cases were diagnosed as malignant tumors.from the Cancer Center of Xinjiang Uygur Autonomous Region from September 2017 to June 2018.The patients who underwent PICC catheterization for the treatment needs were studied.The design of the prospective cohort study was adopted.PICC risk management measures were divided into risk management group(n=885)and routine care management group(n=876).PICC-related thrombosis,PICC-related bloodstreaminfection,PICC catheterization,PICC catheter occlusion,contact dermatitis,PICC puncture site exocytosis and incidence density,unplanned extubation rate,and patient satisfaction were compared between the two cohorts.Results:1)Baseline results:There were balanced comparability between the two groups,and there was no significant difference in age(stratification factor),gender,education,place of residence,tumor type,catheterization and catheter type(P>0.05).2)PICC-related complication rate results:PICC-related thrombosis,catheterization,catheter occlusion,catheter-related bloodstream infection,puncture site exudate and contact dermatitis were lower in the risk management group than in the routine care management group.The difference was statistically significant(P<0.05).The PICC unplanned extubation rate in the risk management group was significantly different from that in the conventional nursing management group(P<0.05).3)PICC-related complications.Results:As of December 31,2018,1761 subjects were followed up for a total of 18,2,265 observers(days),of which 9,3771 were observed in the risk management cohort.On days,the regular care management cohort was 8,8494 person-days.The incidence of PICC-related thrombosis,catheterization,catheter occlusion,catheter-related bloodstream infection,puncture site exudate,and contact dermatitis was higher in the routine care management group than in the risk management group.The difference between the two groups was statistically significant(P<0.01).4)Analysis of factors affecting PICC-related complications in different nursing management.Kaplan-Meier survival analysis showed that different nursing management methods(conventional nursing management and risk management)PICC-related thrombosis(?~2=6.294;P=0.012),catheter The incidence of prolapse(?~2=4.893;P=0.027),catheter blockage(?~2=34.245;P=0.000),PICC-related infection(?~2=6.425;P=0.011),PICC puncture site exudate(?~2=6.164;P=0.013)There was a difference;the incidence of contact dermatitis(?~2=3.408;P=0.065)did not differ between different care management methods.The results of COX proportional hazard model analysis showed that the risk of thrombosis,catheter prolapse,catheter blockage,catheter-related bloodstream infection and puncture site exudation was higher in the routine care management group,which was 2.270 times,3.822 times,3.818 of the risk management group,respectively,3.363 times and 2.529 times.Conclusion:PICC risk management is superior to routine care management in patients with malignant tumors.The clinical application of this system is safe and feasible,which effectively reduces the incidence of major PICC-related complications in patients with malignant tumors,improves patient satisfaction,and is effective for primary hospitals.The implementation of the"Treatment of Nursing Care Technology"provides a new approach.To lay a foundation for further realizing the quality and quality management of PICC in patients with malignant tumors in Xinjiang.