| Objectives: Compare the effect of three models of maintaining PICC among returning tohospital, in community hospital and home-care, in order to explore a more effective maintainingsystem of PICC.Methods：This trial was conducted in a Three-A hospital in Guangzhou from11/11-10/12withpatients placed PICC. Since they had PICC placed, we had prepared them for discharging fromhospital, told the patients and their relatives about the aim of placing PICC and coached themhow to maintain catheters. We divided patients with PICC into three groups，one is those whoreturn to hospital, one is those who maintain catheters in community hospital and the anothergroup is those who belong to home-care. They were all told to change dressing and flushcatheters once a week. After they left hospital we followed them up every week by phone, andask them whether they maintain catheters in time or not, answered them if they had questionsand wrote these things down. We tried our best to assess the situation of the catheters and notedthem down. Until the deadline, three kinds of index were monitored among the three groupsWhich include complications rates (catheter dislodgment, catheter breakage, thrombosis,infection, occlusion),the mean service interval of the catheters and the fee to maintain catheters.Results：There were423patients placed PICC,30died during the interval in the hospital,85completed their therapies and pulled catheters out during the interval in the hospital,70were stillin the hospital without discharge,5got their catheter occluded.4got their catheter dislodged and1got his PICC pulled out for suspecting infection, so there were201patients without dischargedwith PICC. There were222patients got discharged with their catheters,108patients in thehospital group,72patients in community hospital group,42patients in home-care group.72patients who getting catheter maintenance in the community hospitals mean saved1524minutesand1332￥.42patients who getting catheter maintenance at home mean saved2988minutesand1638￥. There were no statistically significant differences among the three groups in thecounts for not receiving catheter flushed in time（P=0.958）. Use Cox proportional hazard modelto analyze the effect factors for PICC complications. Single factor analyze indicated that themodel of PICC maintenance, sex, the location of PICC, the type of PICC, the length of PICC exposed outside of the body and whether or not maintain catheter in time are factors thataffecting catheter complications. Multiple factor analyze indicated that the location of PICC, thelength of PICC exposed outside of the body and whether or not receive catheter flushed in timeare independent factors affecting catheter complications.Placing the catheter under the elbow is2.25times to occur catheter complications than placing the catheter above the elbow, and theinfluence is statistical significantly（P=0.002）. Making the lengths of PICC exposed outside ofthe body longer than8cm is3.64times to occur catheter complications than that within8cm.,andthe lengths of PICC exposed outside of the body is statistical significantly（P=0.000）. Theprobability to occur catheter complications for those who without receiving catheter flushed intime is3.64times than those in time, and the influence is statistical significantly（P=0.037）.Conclusions： Comparing with returning to hospital for catheter maintenance, the method ofmaintaining PICC in community hospital and at home can save both time and money. So it isfeasible to maintain PICC at home after the patients and their relatives are well trained. WherePICC is placed, the length of PICC exposed outside of the body and whether or not maintainPICC in time are single factors affecting PICC complication rates. We can develop andconstruct the community web later on in order to make patients receiving better, safer and moreconvenient service for their catheter maintenance. |
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