肿瘤PICC化疗患者无针输液接头留置时间的临床研究

Clinical study on the indwelling time of needle-free infusion connectors of peripherally inserted central venous catheter in tumor patients with chemotherapy

目的探讨经外周静脉置入中心静脉导管(PICC)无针输液接头留置时间。方法选取2019年4—10月在某三甲医院进行PICC维护的肿瘤化学治疗患者,根据使用PICC无针输液接头的种类将患者分为A、B两组,A组使用不透明金属弹簧机械阀无针输液接头(A输液接头),B组使用透明硅胶机械阀无针输液接头(B输液接头),收集患者更换的无针输液接头进行细菌定性及定量培养,比较两组患者PICC留置4~、8~、15~、>21 d时输液接头培养阳性率。结果共纳入174例患者,11例患者PICC无针输液接头定量细菌培养阳性,阳性率为6.32%,其中A组阳性率为8.70%(8/92),B组阳性率为3.66%(3/82)。不同留置时间无针输液接头定量培养阳性率比较,A组差异有统计学意义(P<0.05),B组差异无统计学意义(P>0.05);不同留置时间输液接头定性培养阳性率比较,A、B两组差异均无统计学意义(P>0.05)。相同留置时间A、B两组输液接头定量、定性培养阳性率比较,差异均无统计学意义(均P>0.05)。A组输液接头留置8~14 d、B组留置15~21 d时,其培养阳性率为0。共分离出5种11株细菌,其中最常见的细菌种类蜡样芽孢杆菌(4株)。结论A输液接头不同留置时间定量细菌培养存在差异,A、B两种输液接头留置相同时间其细菌培养阳性率未见差异。

Objective To explore the indwelling time of needle-free infusion connectors of peripherally inserted central venous catheter(PICC).Methods Tumor patients with chemotherapy who underwent PICC maintenance in a tertiary first-class hospital from April to October 2019 were selected and divided into group A and B according to the types of PICC needle-free infusion connectors.Group A used opaque metal spring mechanical valve needle-free infusion connectors(infusion connector A),group B used transparent silica gel mechanical valve needle-free infusion connectors(infusion connector B),needle-free infusion connectors were collected for qualitative and quantitative bacterial culture,positive culture rates of infusion connectors were compared between two groups when PICC was retained for 4-,8-,15-,and>21 days.Results A total of 174 patients were included in the study,quantitative bacterial culture of 11 patients with PICC needle-free infusion connectors was positive,positive rate was 6.32%,positive rates of group A and group B were 8.70%(8/92)and 3.66%(3/82)respectively.There was significant difference in the positive rate of quantitative culture of needle-free infusion connectors with different indwelling time in group A(P<0.05),but there was no significant difference in group B(P>0.05);positive rates of qualitative culture of needle-free infusion connectors with different indwelling time were not significantly different in both group A and group B(P>0.05).There was no significant difference in the positive rates of both quantitative and qualitative culture of needle-free infusion connectors with the same indwelling time between group A and group B(both P>0.05).Positive rate of culture was 0 for 8-14 indwelling days in group A and for 15-21 indwelling days in group B.11 strains of 5 species of bacteria were isolated,Bacillus cereus(4 strains)was most common specie.Conclusion Quantitative bacterial culture of infusion connectors in group A with different indwelling time are diffe-rent,there is no difference in bacterial culture positive rate between transfusion connectors A and B with the same indwelling time.