| BackgroundPeripherally inserted central catheter(PICC)refers to the catheter insertion method by puncturing the peripheral vein and placing the tip of the catheter in the upper or lower cavity,which can provide long-term chemotherapy,infusion and blood transfusion for tumor patients.PICC is widely used in clinic because of its simple operation and less puncture pain.However,the problems of catheter prolapse,unplanned extubation,oozing blood and fluid,unplanned extubation and so on caused by conventional PICC implantation methods can not be ignored.Tunnel PICC refers to the establishment of a subcutaneous tunnel at the puncture point on the basis of conventional PICC placement,and the catheter is led out through the tunnel needle,and the catheter outlet is placed in a position where the patient is comfortable and does not affect the physical activity,so as to reduce the complications of the patient during the catheter,increase the patient’s comfort,and promote the development of new technologies in PICC specialty and cultivate PICC specialists.ObjectiveTo compare the effects of tunnel PICC on blood loss,intubation time,pain and comfort of cancer chemotherapy patients,and the intervention effects of catheter prolapse,catheter-related infection,allergic dermatitis,unplanned extubation rate and adverse events during intubation.MethodsFrom July 1,2021 to November 1,2022,100 patients with tumor chemotherapy in a third-class first-class hospital in Lanzhou were placed PICC in the vascular access clinic according to the doctor’s advice.The patients were randomly divided into experimental group and control group,with 50 cases in each group.The experimental group used tunnel PICC tube placement method,while the control group used conventional PICC tube placement method.The general data of patients were collected before catheterization,including facial expression pain score,comfort score,intubation time and blood loss during catheterization.After catheterization,the incidence of blood leakage,catheter-related infection,catheter prolapse,unplanned extubation rate,adverse events,allergic dermatitis and comfort score were collected,and the data were statistically analyzed to evaluate the clinical application of tunnel PICC.ResultsA total of 104 patients were included in this study,with 3 cases lost in the control group and 2 cases lost in the experimental group.Finally,99 tumor chemotherapy patients completed PICC catheterization and data collection,with 50 cases in the experimental group and 49 cases in the control group.The main outcome measure results showed that:(1)The incidence of catheter detachment in the experimental group was lower than that in the control group(4.0%vs 22.4%)at 3 months after catheterization,and there was a statistically significant difference in the incidence of catheter detachment between the two groups(P<0.05).(2)The incidence of unplanned extubation in the experimental group at 3 months after catheterization was lower than that in the control group(4.0% vs 18.4%),and there was a statistically significant difference in the incidence of unplanned extubation between the two groups(P<0.05).(3)The incidence of allergic dermatitis in the experimental group at 3 months after catheterization was lower than that in the control group(6.0% vs 20.4%),and there was a statistically significant difference in the incidence of allergic dermatitis between the two groups(P<0.05).(4)The incidence of local catheter infection in the experimental group at 3 months after catheterization was similar to that in the control group(4.0% vs 4.1%),and there was no statistically significant difference in the incidence of local catheter infection between the two groups(P>0.05).(5)The incidence of active blood and fluid leakage within 48 hours after catheterization in the experimental group was lower than that in the control group(4.0% vs 18.4%),and the difference between the two groups was statistically significant(P<0.05).(6)The comfort scores of tumor chemotherapy patients in the two groups were evaluated one month,two months,and three months after tube placement.The repeated measurement ANOVA results showed that there was an interaction effect between groups and time(F interaction=4.902,P<0.05)in the comfort scale scores of tumor chemotherapy patients in the test group and the control group.The Main effect of the scale scores between groups was significant(F between groups=27.789,P<0.05),and was affected by time factors,The comfort score showed statistically significant differences at different times(F time=171.678,P<0.05).The comfort scale scores of the experimental group and the control group showed a significant downward trend over time,while the comfort scale scores of the control group were higher than those of the experimental group at the same time point.The secondary outcome indicators showed that during the catheterization process:(1)The visual simulation scale score of the experimental group was higher than that of the control group(4.38±1.01 vs 3.96±0.89),and the difference between the two groups was statistically significant(P<0.05).(2)The bleeding volume in the experimental group was higher than that in the control group(3.44±2.88 vs 1.68±1.32)g,and the difference between the two groups was statistically significant(P<0.05).(3)The catheterization time in the experimental group was longer than that in the control group(20.20±4.32 vs 14.92±3.29)minutes,and the difference between the two groups was statistically significant(P<0.05).(4)The comfort scale score of the experimental group was slightly higher than that of the control group(14.12±1.78 vs 13.73±1.34),and there was no statistically significant difference between the two groups(P>0.05).ConclusionTunnel PICC can significantly reduce the incidence of bleeding,catheter prolapse,unplanned extubation and allergic dermatitis at the puncture point,and improve the comfort of patients,although it takes a long time,has a large amount of bleeding and has a high pain score by establishing a subcutaneous tunnel. |
PDF Full Text Request