| ObjectivesTo explore the best mode of functional exercise for preventing PICC-related thrombosis after operation.Quantify the details of the exercise mode,i.e.the frequency,duration and frequency of exercise.To observe the hemodynamic changes of PICC patients at different time points before and during catheterization.To investigate the effects of PICC and catheterization on the hemodynamics of catheterized vessels.In addition,a qualitative study was conducted to explore the real experience of functional exercises in PICC patients after operation.To provide a theoretical basis for the selection of functional exercises mode for PICC patients after operation.Methods1.A total of 240 patients who received catheterization from February 2017 to February 2018 in PICC clinic of a third-level hospital in Shandong Province were selected by convenience sampling method.The eligible patients were divided into two experimental groups and a control group,80 in each group,according to the residual number divided by 3.The experimental group:S1 group,S2 group,and control group:D group were given routine health education.24 hours after catheterization,the three groups were given quantitative version of handgrip exercise,quantitative version of hand functional exercise and routine health education respectively.The intervening time was 20 days.The changes of vessel diameter,time-mean flow velocity(TMFV),maximum blood flow velocity(Vmax)and grip force were measured by color Doppler ultrasound and electronic gripper at 24 hours before catheterization,24 hours after catheterization and 5 days after catheterization,21 days after catheter:ization and 24 hours before extubation.During the whole period,the patients’exercise implementation and complications were followed up strictly.SPSS23.0 was used for statistical analysis.2.Phenomenological methods were used to conduct semi-structured interviews with 15 PICC patients with different functional exercises after operation.Colaizzi phenomenological seven-step analysis was used to analyze the data.Results1.A total of 240 patients were collected from February 2017 to February 2018.Among them,3 patients in group S1 quit the study for their own reasons 5 days after catheterization(4 days after continuous intervention).237 patients were actually included in the first round of analysis.During the follow-up intervention and catheterization,28 patients died,20 patients were unplanned extubation,109 patients received chemotherapy in different places,23 patients refused to participate in or lost contact,and 3 patients had incomplete data.Finally,all the follow-up and monitoring during the 20-day intervention and catheterization were strictly completed.54 cases were actually included in the analysis,including 19 cases in the quantitative version of handgrip exercise group(S1),18 cases in the quantitative version of tand functional exercise group(S2)and 17 cases in the daily activities group(D).2.The general data,medical history and catheter information of the three groups were well distributed 24 hours before and 24 hours after catheterization,and the diameter of vessels,TMFV,Vmax and grip strength were comparable(P>0.05).TMFV,Vmax and grip strength were significantly lower 24 hours after catheterization than before catheterization(P<0.05).3.After two brief exercises,TMFV and Vmax increased significantly in the two experimental groups compared with the control group(P<0.05),but there was no significant difference between the two experimental groups(P>0.05).4.In the resting state of 5 days after catheterization,the vessel diameter and TMFV of the two experimental groups increased significantly compared with 24 hours after catheterization(P<0.05),while that of the control group decreased slightly.The Vmax of the handgrip exercise group was the best(P<0.05),and the grip strength of the hand functional exercise group increased more significantly(P<0.05).5.The duration of exercise was longer in the two experimental groups(P<0.05),but there was no significant difference in the causes of extubation and the incidence of common complications among the three groups(P>0.05).6.At different time points before and after PICC catheterization and during the process of catheterization,there were significant differences in TMFV among groups(P<0.05),and there were significant differences in vessel diameter and Vmax between the two experimental groups at different time points(P<0.05).7.At 21 days after catheterization,there were significant differences in vessel diameter,TMFV and Vmax between the two experimental groups and the control group(P<0.05).24 hours before extubation,the values of the three groups tended to be the same(P>0.05).8.Through semi-structured interviews,four topics were drawn:the benefits of postoperative functional exercise,the obstacles encountered in carrying out postoperative functional exercise,the acceptance of postoperative functional exercise,and the suggestions for education related to postoperative functional exercise.Conclusions1.Implantation of PICC catheter will result in stress contraction of vessel diameter,decrease of TMFV and Vmax,and decrease of grip strength.Mechanical injury,complications and space-occupying effect of PICC catheter during catheter indwelling process can lead to persistent contraction of internal diameter of the catheter side,and decrease of TMFV and Vmax.2.Long-term adherence to the quantitative version of handgrip exercise and quantitative version of hand functional exercise have significant effects on improving the reduction of vessel diameter,TMFV and Vmax on the catheter side.3.The grip strength of the patients will gradually recover during catheter indwelling process,and the hand function exercise has a more significant effect in accelerating the recovery of grip strength during catheter indwelling process.4.Quantitative version of f handgrip exercise and quantitative version of hand functional exercise can increase exercise duration of patients,improve patients’exercise compliance and improve exercise effect.5.The patients with PICC should adhere to long-term and appropriate postoperative function exercises to stabilize the effect of pre-exercise and reduce the incidence of complications in post-catheterization period.6.The patients think that the functional exercise after operation is easy and effective,but due to the worries about complications and forgetfulness,the compliance in the later period of catheter indwelling is not high,the medical staff should further promote the postoperative functional exercise and improve the way of health education. |
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