Analysis Of Risk Factors Of MARSI At PICC Implantation Site In Chengdu And The Establishment Of Prediction Model

Objective : Peripherally Inserted Central Venous Catheters-Medical AdhesiveRelated Skin Injury was a common and often neglected complication of patient with peripherally inserted central venous catheters.This thesis discussed the prevalence of PICC-MARSI in Chengdu,and analyzed the risk factors,constructed a PICC-MARSI prediction model,to provide basis and reference for clinical prevention of PICC-MARSI.Methods:806 patients with PICC from 6 hospitals in Chengdu were investigated by convenience sampling.According to the occurrence of PICC-MARSI,the MARSI group and the non-MARSI group were divided into two groups.Univariate analysis was used to screen out statistically significant variables,and then Multivariate logistic regression analysis was used to identify the independent risk factors for PICC-MARSI,the correlation coefficient was extracted to construct the prediction model,and evaluated the model.Results:A total of 806 patients were enrolled in this study,and 173 patients developed PICC-MARSI,with a prevalence of 21.5%.Univariate analysis showed statistically significant differences in age,drinking history,MARSI history,allergic history,surgical history,fall history,glucocorticoid,activity status,edema,infection at puncture point,catheter material,catheter retention time,type of dressing,type of disinfectant and whether skin protective agent was used between the two groups（P<0.05）.Multivariate analysis showed that age≥65 years（OR=3.723,95%CI=2.07-6.677,P<0.001）,drinking history（OR=1.998,95%CI=1.213-3.292,P=0.007）,MARSI history（OR=14.793,95%Cl=7.788-28.096,P<0.001）,allergic history（OR=6.052,95%CI=3.089,11.857,P<0.001）,surgical history（OR=6.300,95%CI=3.551-11.176,P<0.001）,glucocorticoid（OR=3.826,95%CI=2.227-6.572,P<0.001）,edema（OR=3.932,95%CI=1.103-14.016,P=0.035）,infection at puncture point（OR=3.657,95%CI=1.697-7.882,P=0.001）were independent risk factors for PICC-MARSI（P<0.05）.Catheter indwelling time>30 days（OR=0.453,95%CI=0.228-0.902,P=0.024）was a protective factor.The prediction model of PICC-MARSI was established based on regression coefficient,when the Yoden index was 0.673,the sensitivity and specificity were 80.9%and 86.4%,respectively,indicating that the model had strong predictive ability.Conclusion:The prevalence of PICC-MARSI was 21.5%,age ≥65 years old,drinking history,MARSI history,allergic history,surgery history,glucocorticoid,edema,puncture site infection were the high risk factors for PICC-MARSI,catheter indwelling time>30 days was a protective factor.The prediction model in this thesis can effectively predict the incidence probability,and effective prevention and treatment measures can be taken according to the high risk factors and predicted results to prevent the occurrence of PICC-MARSI.