Effect Of Different Frequency Of Handgrip Exercise On PICC-related Venous Thrombosis

Peripherally inserted central catheter(PICC) provides a convenient, effective venous pathway for patients. It has many advantages and less complication. It not only avoids damaging the peripheral vascular and developing phlebitis because of the infusion of hypertonic and stimulating drugs, but also relieves patients’ suffering from repeating insertion because of the long-term infusion. The advantages of PICC are very obvious especially in tumor, ICU, long-term infusion patients, it has been widely used in clinical practice recently. However, the complications of PICC have been paid much more attention. PICC-related venous thrombosis(PICC-related VT) is one of the most serious complications, especially PICC-related upper extremity deep venous thrombosis(UEDVT). It not only makes patients suffer from physical pain, but also increases the psychological pressure, even threatening patients’ lives because of the dropped embolus.The slower upper limb blood flow is one of the reasons for PICC-related VT forming. Some scholars put forward that the upper limb with catheter doing some physical activity earlier can accelerate the upper limb venous blood flow and prevent the occurrence of PICC-related VT. However, the inappropriate activities could cause catheter related complications such as phlebitis, catheter malposition, thrombosis and so on. Therefore it is very important to make an effective exercise method and appropriate exercise frequency for patients who suffer from PICC.According to the reference literatures and rehabilitations’ suggestions, we guided patients to do handgrip exercise. We aimed to investigate the appropriate handgrip exercise frequency through making a comparison of the effect of different handgrip exercise frequency on the upper limb venous blood flow and on the PICC-related VT prevention under the observation of Color Doppler ultrasound. Objectives1. We aimed to investigate the effect of handgrip exercise on upper extremity venous blood flow and figure out the best number of handgrip exercise which could promote upper extremity venous reflux.2. We aimed to investigate the effect of different handgrip exercise frequency on upper extremity vein velocity and PICC-related VT prevention. Methods1. We recruited 40 volunteers(10 PICC patients, 30 healthy people) to do the exercise according to the unified handgrip exercise program(grip the ball for 10 s after relaxation 10 s, repeat 40 times in a row). Color Doppler ultrasound was used to measure upper extremity vein maximum Velocity(Vmax, cm / s) and Time-Mean Flow Velocity(TMFV, cm / s) at the time points at which the volunteers gripped 10, 15, 20, 25, 30, 35, 40 times separately and then relaxed for every 10 minutes separately. We analysised the changing between blood flow in resting status and other blood flow after exercise with Single factor repeat analysis of variance.2. We recruited 120 cancer patients with PICC and then randomly divided them into three groups, the control group(Group D), the experiment group 1(Group S1) and the experiment group(Group S2). All the groups were given the gripped ball. In the control group, the patients were guided to do regular exercise by nurse and in the experiment groups, the patients were guided to do handgrip exercise by researchers as follow. The patients were asked to grip the ball for 10 s and relax for 10 s and repeat 25 times in one set. In the group S1, patients should repeat for 3 sets and in the Group S2, they should repeat for 6 set each day. We observed the change of Vmax and TMFV in axillary vein, the incidence of PICC-related VT and its stage on the 1st day, 2nd day, 3rd day, 21 day and analyzed Vmax and TMFV in axillary vein in different handgrip exercise trial with ANOVA, the prevention effect to PICC-related VT with Chi-square analysis and the thrombosis stages with Kruskal-Wallis. Results1. Handgrip exercise could increase the blood flow velocity. The increment of Vmax and TMFV after exercising has statistically significant(P<0.05).2. Following the increasing handgrip exercise frequency,The Vmax and TMFV increased in the former 25 times gradually and then dropped.3. In the resting period, Vmax and TMFV decreased gradually. The TMFV recovered to the normal resting state level after the gripping action stopped for 40 min.4. Axillary vein Vmax and TMFV in the control group decreased gradually after we inserted central catheter. The Vmax and TMFV were less than those in experiment groups and even themselves before exercising. The blood velocity has no statistically significant difference between the experiment group 1 and 2.5. The incidence of PICC-related VT was less than the one in the control group at the 2nd to 3rd days and the 21 st day respectively especially level III thrombosis. The incidence of PICC-related VT has no statistically significant difference between the experiment group 1 and 2.Conclusions1. The effect of hemodynamic is the best when the patients successively gripped the ball for 10 s and then relaxed for 10 s, repeated for 25 times in a row, mainly Vmax and TMFV in axillary vein were significantly increased.2. Each patient after inserted PICC catheter should do handgrip exercise in early time, and it is recommended to do at least one set in the morning, in the noon and in the evening respectively each day, which can significantly reduce venous stasis and prevent PICC-related VT.