| ObjectiveIn this study,precise and standardized handgrip exercise guidance scheme was developed for patients with tumor PICC,personalized functional exercise health education was provided,and the influence of precise handgrip exercise guidance on PICC-RT was observed,providing reference for further standardization of handgrip exercise and effective prevention of PICC-RT formation in future clinical practice.Methods1.Pre-experiment(1)Test 1: 30 subjects(tumor chemotherapy patients with PICC implantation for the first Time)were recruited.TMFV(Time-Mean Flow Velocity,cm/s)at calm time were measured during the 24-hour maintenance after PICC implantation,and the patients were asked to grip the handle of the electronic handgrip device with their maximum strength in a standard posture.The maximum grip strength value was recorded,and the 80% grip strength value and 60% grip strength value were calculated.Patients were instructed to perform handgrip tests using maximum,80%,and 60%.The F test was used to compare the blood flow velocity(cm/s)of patients holding the ball in the lateral vein of the catheter with different handgrip,and to determine the effective training vigour of the handgrip exercise in experiment 2.(2)Test 2,60 subjects(tumor chemotherapy patients with PICC implantation for the first time)were recruited.The TMFV of the lateral vein was monitored immediately before and after PICC implantation when the patient was calm;the TMFV of the lateral vein was monitored when the patient was calm during the first maintenance 24 hours after PICC implantation,and the maximum handgrip(Kg)of the patient was determined by handgrip test.Patients were instructed to use effective handgrip exercise,hold the ball with different duration-relaxation times(2s-2s,4s-4s,6s-6s,8s-8s,10s-10s),and measure the maximum blood flow velocity.F-test was used to compare TMFV before PICC implantation,immediately and 24 hours after PICC implantation.And the Vmax(Maximum Blood Flow Velocity,cm/s)of patients with different duration-relaxation time under the effective grip strength training intensity,to determine the best duration-relaxation time of handgrip training in the precise handgrip exercise program and the range of effective blood flow velocity should be reached during handgrip exercise.2.Formal trial210 subjects(tumor chemotherapy patients with PICC implantation for the first time)were recruited and divided into 3 groups according to random number table method,with70 cases in each group.The control group received routine health education.On the basis of the control group,experiment group 1 received daily handgrip exercise using the optimal duration-relaxation time(duration 2s-relaxation 2s)of handgrip exercise obtained from the results of the first part of the study.On the basis of the control group,the effective handgrip was determined for the patients in experiment group 2,and the guidance scheme of precise handgrip exercise was designed,and the electronic grip strength device was used to check the commonly used strength of the patients,the patients whose maximum blood flow velocity was not within the range of effective blood flow velocity when holding the ball were given handgrip correction exercises to form muscle memory and carry out daily training.Subjects underwent catheter maintenance every 7 days,and a total of 8maintenance cycles were observed.The TMFV,Vmax and ball handgrip of the side vein of catheterization were observed during the maintenance of the patient.The formation of PICC-RT and the grade of thrombus were observed at the end of the intervention,and the influencing factors of the occurrence of PICC-RT were analyzed.At the end of the intervention,patients were given a satisfaction questionnaire.F-test was used to analyze the TMFV of lateral catheterization veins,Vmax during ball holding and ball holding strength of the three groups of patients at different time periods,and T-test was used for pairwise comparison.The incidence of PICC-RT among the patients was compared by Chi-square test or Fisher exact test,and pairwise comparison was performed.Kruskal-Wallis H test was used to compare the incidence of thrombus of different grades.F test or t test was used to compare the satisfaction of the three groups of patients with nursing work.Pearson correlation coefficient was used to analyze the influencing factors of PICC-RT formation.Result1.There was a statistically significant difference in the blood flow velocity of the vein on the catheterization side between the patients with different handgrip(P < 0.05).Compared with the blood flow velocity of the vein on the catheterization side in the calm state,there was a statistically significant difference in the blood flow velocity of the vein on the catheterization side when the handgrip was 80%(P<0.05).2.There were significant differences in the TMFV of the catheterization side of the patients before and immediately after catheterization,and 24 hours after catheterization(P<0.05).There were significant differences in the TMFV of the catheterization side of the patients immediately and 24 hours(P<0.05).3.There were significant differences in blood flow velocity between the two groups under different continuous-relaxation time(P<0.05),and the results of x±s showed that the blood flow velocity of the vein on the catheterization side when the patient was held for2 s was higher than that under other continuous-relaxation time.4.There was no statistically significant difference in the incidence of symptomatic thrombosis and thrombosis grade among the three groups within 8 maintenance cycles(P>0.05),and there was no statistically significant difference between the three groups(P>0.05).There was a significant difference in the incidence of asymptomatic thrombosis(P<0.05),and there was a significant difference between the two groups(P<0.05).5.At the 7th and 8th maintenance,there were significant differences in TMFV between the three groups(P<0.05).The results of inter-group comparison showed that there was no significant difference in TMFV between the control group and the test group1(P>0.05),but there was significant difference in TMFV between the control group and the test group 2 at the fourth maintenance and after(P<0.05).There was a significant difference in TMFV between test group 1 and test group 2 at the 8th maintenance(P<0.05).The results of intra-group comparison showed that there was no significant difference in TMFV of the catheterization side vein before and at the 8th maintenance after catheterization in the control group and the test group 1(P>0.05),and there was significant difference in TMFV of the catheterization side vein before and at the 8th maintenance after catheterization in the test group 2(P<0.05).6.There were significant differences in Vmax between the three groups of patients during different maintenance periods(P<0.05).The results of inter-group comparison showed that there were statistically significant differences in Vmax of venous ball grip on the catheterization side between the control group and the test group 1 before and after the7 th maintenance(including the 7th maintenance)(P < 0.05).There were significant differences in Vmax between the control group and the test group 2 before and after the 4th maintenance(including the 4th maintenance)(P<0.05).There was a significant difference in Vmax between test group 1 and test group 2 during each maintenance cycle(P<0.05).The results of intra-group comparison showed that there were significant differences in Vmax of venous ball grip on the catheter side at 24 hours after catheterization and the 8th maintenance after catheterization in the control group and the test group 2(P<0.05),and there was no significant difference in Vmax of venous ball grip on the catheter side at 24 hours after catheterization and the 8th maintenance after catheterization in the test group 1(P>0.05).7.There were significant differences in handgrip among the three groups in different maintenance cycles(P<0.05).The results of inter-group comparison showed that there was a significant difference in handgrip between the control group and test group 1 and test group 2 at each maintenance cycle(P<0.05).There was statistically significant difference in handgrip between test group 1 and test group 2 after the second maintenance(including the second maintenance)(P<0.05).There was no statistically significant difference in handgrip between test group 1 and test group 2 at 24 hours(P>0.05).There were significant differences in handgrip after the second maintenance(including the second maintenance)(P<0.05).The results within the group showed that there were statistically significant differences in handgrip 24 hours after catheterization and the 8th maintenance after catheterization in the control group and the test group 2(P<0.05),and there was no statistically significant difference in handgrip 24 hours after catheterization and the 8th maintenance after catheterization in the test group 1(P>0.05).8.There were statistically significant differences in the total score of satisfaction and scores of each dimension among the three groups(P < 0.05),The results of inter-group comparison showed that the satisfaction scores of control group and trial group 1,control group and trial group 2,and trial group 1 and trial group 2 were statistically significant(P< 0.05).9.Pearson correlation coefficient was used for univariate analysis of general data,disease data and catheterization data of the two groups of patients.The results showed that diabetes,hypertension and higher D-dimer level before catheterization were the influencing factors of thrombosis in tumor patients with PICC catheter.Conclusion1.Precise handgrip exercise program can effectively improve blood flow velocity and blood stasis in patients with tumor PICC duct under calm state,significantly reduce the incidence of asymptomatic thrombosis,and thus reduce the risk of symptomatic thrombosis.2.The precise handgrip exercise program enables patients to complete the training plan in a state of relative force saving,which helps to improve patients’ functional exercise compliance,handgrip training efficiency and self-management ability.3.The precise handgrip exercise program can improve patients’ satisfaction with health education and professional recognition of nursing staff,which is conducive to improving the sense of professional value and mission of nursing staff and promoting the professional development of nursing.4.Diabetes mellitus,hypertension and higher than normal D-dimer level before catheterization were the factors influencing the occurrence of PICC-RT in this study. |
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