BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombo...BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population.Several risk factors have been identified for the development of PICC-related thrombosis,including cancer type,stage,comorbidities,and catheter characteristics.Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer,construct a predictive model,and validate it.METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected.Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected,and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls.A total of 255 samples were collected and used as the training set,and 77 cases were collected as the validation set in a 7:3 ratio.General patient information,case data,catheterization data,coagulation indicators,and Autar Thrombosis Risk Assessment Scale scores were analyzed.Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors,and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Univariate analysis showed statistically significant differences(P<0.05)in age,sex,Karnofsky performance status score(KPS),bedridden time,activities of daily living impairment,parenteral nutrition,catheter duration,distant metastasis,and bone marrow suppression between the thrombosis group and the non-thrombosis group.Other aspects had no statistically significant differences(P>0.05).Multivariate regression analysis showed that age≥60 years,KPS score≤50 points,parenteral nutrition,stage III to IV,distant metastasis,bone marrow suppression,and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer(P<0.05).Catheter duration of 1-6 months and catheter duration>6 months were protective factors for PICC-related thrombosis(P<0.05).The predictive model for PICC-related thrombosis was obtained as follows:P predictive probability=[exp(Logit P)]/[1+exp(Logit P)],where Logit P=age×1.907+KPS score×2.045+parenteral nutrition×9.467+catheter duration×0.506+tumor-node-metastasis(TNM)staging×2.844+distant metastasis×2.065+bone marrow suppression×2.082+activities of daily living impairment×13.926.ROC curve analysis showed an area under the curve(AUC)of 0.827(95%CI:0.724-0.929,P<0.001),with a corresponding optimal cut-off value of 0.612,sensitivity of 0.755,and specificity of 0.857.Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence(P>0.05).ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets,respectively.CONCLUSION Age,KPS score,parenteral nutrition,TNM staging,distant metastasis,bone marrow suppression,and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer,while catheter duration is a protective factor for the disease.The predictive model has an AUC of 0.827,indicating high predictive accuracy and clinical value.展开更多
BACKGROUND Extremely premature infants have poor vascular conditions.Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters,and these vessels are often ac...BACKGROUND Extremely premature infants have poor vascular conditions.Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters,and these vessels are often accompanied by arteries;thus,it is easy to mistakenly enter the artery.CASE SUMMARY The case of an extremely premature infant(born at gestational age 28+3)in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported.On the 19th day of hospitalization,the index finger,middle finger and ring finger of the left hand were rosy,the left radial artery and brachial artery pulse were palpable,the recovery was 95%,and the improvement was obvious.At discharge 42 d after admission,there was no abnormality in fingertip activity during the follow-up period.CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2%nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb.Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.展开更多
Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rat...Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.展开更多
Objective: To study the clinical effect of aspirin in the prevention of venous thrombosis in breast cancer patients with postoperative chemotherapy after peripherally inserted central catheter (PICC) insertion. Method...Objective: To study the clinical effect of aspirin in the prevention of venous thrombosis in breast cancer patients with postoperative chemotherapy after peripherally inserted central catheter (PICC) insertion. Methods: 240 cases of female breast cancer patients with postoperative chemotherapy after PICC insertion in The First People’s Hospital of Jingzhou from June 2014 to December 2017 were selected and divided into experimental group (n = 120) and control group (n = 120) according to the length of stay. The modified Seldinger technique was used in both groups. The experimental group had oral Aspirin enteric-coated tablet on the day of PICC insertion, 100 mg/day until the PICC catheter was removed, while the control group did not take anticoagulant drugs. The therapeutic effects were evaluated by color Doppler ultrasound, Coagulation analysis, and complete blood count. Results: There were three cases with venous thrombosis in the experimental group, and the incidence rate was 2.5%, while ten cases in the control group developed venous thrombosis, and the incidence rate was 10%. There was a statistically significant difference in the incidence of thrombosis between the two groups (P Conclusion: This study showed that oral Aspirin can effectively reduce the incidence rate of venous thrombosis in breast cancer patients with postoperative chemotherapy after PICC insertion. Therefore, it is worthy of clinical application.展开更多
目的系统评价新生儿经外周置入中心静脉导管(PICC)相关性血栓的发生率。方法计算机检索Medline、Embase、Web of Science、CINAHL、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库中与新生儿PICC相...目的系统评价新生儿经外周置入中心静脉导管(PICC)相关性血栓的发生率。方法计算机检索Medline、Embase、Web of Science、CINAHL、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库中与新生儿PICC相关性血栓发生率相关的研究,检索时限为建库至2022年5月17日。双人进行筛选、质量评价后,采用Stata 16.0软件进行Meta分析。结果共纳入5项研究,总样本量为4573例,其中共发生104例PICC相关性血栓。Meta分析结果显示新生儿PICC相关性血栓的发生率为1.7%(95%置信区间:0.5%~3.6%)。亚组分析结果显示,发表年份为2017—2021年的文献、经下肢静脉置管的新生儿PICC相关性血栓的发生率更高。结论新生儿PICC相关性血栓的发生率为1.68%。经下肢静脉置管时,血栓的发生率更高,因此对于凝血功能障碍、血栓发生风险高的新生儿,应尽量避免选择经下肢静脉置管。展开更多
目的:目前关于中心静脉置管相关性血栓预防的内容涉及范围广且尚未形成系统的循证方案。本研究对化学治疗(以下简称“化疗”)患者经外周中心静脉导管(peripherally inserted central catheter,PICC)维持期深静脉血栓预防的相关证据提取...目的:目前关于中心静脉置管相关性血栓预防的内容涉及范围广且尚未形成系统的循证方案。本研究对化学治疗(以下简称“化疗”)患者经外周中心静脉导管(peripherally inserted central catheter,PICC)维持期深静脉血栓预防的相关证据提取汇总,评价后形成最佳证据,为临床护理实践提供循证依据。方法:通过PIPOST(population,intervention,professional,outcome,setting,type of evidence)法构建临床循证问题。检索乔安娜布里格斯研究所(Joanna Briggs Institute、JBI)、UpToDate、CINAHL、Cochrane Library、中国知网、万方、维普、Embase、PubMed、Sinomed、医脉通、美国输液护士协会网站中关于PICC维持期化疗患者相关深静脉血栓的相关指南、系统评价、专家共识、随机对照试验、临床决策、证据总结。检索时限为建库至2023年10月。由研究人员对所纳入的文献进行质量评价、证据等级划分,提取最佳证据。结果:最终纳入13篇文献,包括临床决策1篇、指南2篇、证据总结2篇、系统评价3篇、专家共识1篇、随机对照试验4篇。从评估、置管前中后、物理预防、药物预防、健康教育5个方面总结出36条最佳证据。结论:本研究总结了PICC维持期化疗患者相关深静脉血栓预防的最佳证据。医务人员和决策者可以结合具体的情况选择证据,以形成完整科学的护理管理策略,提升护理质量。展开更多
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population.Several risk factors have been identified for the development of PICC-related thrombosis,including cancer type,stage,comorbidities,and catheter characteristics.Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer,construct a predictive model,and validate it.METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected.Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected,and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls.A total of 255 samples were collected and used as the training set,and 77 cases were collected as the validation set in a 7:3 ratio.General patient information,case data,catheterization data,coagulation indicators,and Autar Thrombosis Risk Assessment Scale scores were analyzed.Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors,and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Univariate analysis showed statistically significant differences(P<0.05)in age,sex,Karnofsky performance status score(KPS),bedridden time,activities of daily living impairment,parenteral nutrition,catheter duration,distant metastasis,and bone marrow suppression between the thrombosis group and the non-thrombosis group.Other aspects had no statistically significant differences(P>0.05).Multivariate regression analysis showed that age≥60 years,KPS score≤50 points,parenteral nutrition,stage III to IV,distant metastasis,bone marrow suppression,and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer(P<0.05).Catheter duration of 1-6 months and catheter duration>6 months were protective factors for PICC-related thrombosis(P<0.05).The predictive model for PICC-related thrombosis was obtained as follows:P predictive probability=[exp(Logit P)]/[1+exp(Logit P)],where Logit P=age×1.907+KPS score×2.045+parenteral nutrition×9.467+catheter duration×0.506+tumor-node-metastasis(TNM)staging×2.844+distant metastasis×2.065+bone marrow suppression×2.082+activities of daily living impairment×13.926.ROC curve analysis showed an area under the curve(AUC)of 0.827(95%CI:0.724-0.929,P<0.001),with a corresponding optimal cut-off value of 0.612,sensitivity of 0.755,and specificity of 0.857.Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence(P>0.05).ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets,respectively.CONCLUSION Age,KPS score,parenteral nutrition,TNM staging,distant metastasis,bone marrow suppression,and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer,while catheter duration is a protective factor for the disease.The predictive model has an AUC of 0.827,indicating high predictive accuracy and clinical value.
文摘BACKGROUND Extremely premature infants have poor vascular conditions.Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters,and these vessels are often accompanied by arteries;thus,it is easy to mistakenly enter the artery.CASE SUMMARY The case of an extremely premature infant(born at gestational age 28+3)in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported.On the 19th day of hospitalization,the index finger,middle finger and ring finger of the left hand were rosy,the left radial artery and brachial artery pulse were palpable,the recovery was 95%,and the improvement was obvious.At discharge 42 d after admission,there was no abnormality in fingertip activity during the follow-up period.CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2%nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb.Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.
文摘Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.
文摘Objective: To study the clinical effect of aspirin in the prevention of venous thrombosis in breast cancer patients with postoperative chemotherapy after peripherally inserted central catheter (PICC) insertion. Methods: 240 cases of female breast cancer patients with postoperative chemotherapy after PICC insertion in The First People’s Hospital of Jingzhou from June 2014 to December 2017 were selected and divided into experimental group (n = 120) and control group (n = 120) according to the length of stay. The modified Seldinger technique was used in both groups. The experimental group had oral Aspirin enteric-coated tablet on the day of PICC insertion, 100 mg/day until the PICC catheter was removed, while the control group did not take anticoagulant drugs. The therapeutic effects were evaluated by color Doppler ultrasound, Coagulation analysis, and complete blood count. Results: There were three cases with venous thrombosis in the experimental group, and the incidence rate was 2.5%, while ten cases in the control group developed venous thrombosis, and the incidence rate was 10%. There was a statistically significant difference in the incidence of thrombosis between the two groups (P Conclusion: This study showed that oral Aspirin can effectively reduce the incidence rate of venous thrombosis in breast cancer patients with postoperative chemotherapy after PICC insertion. Therefore, it is worthy of clinical application.
文摘目的系统评价新生儿经外周置入中心静脉导管(PICC)相关性血栓的发生率。方法计算机检索Medline、Embase、Web of Science、CINAHL、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库中与新生儿PICC相关性血栓发生率相关的研究,检索时限为建库至2022年5月17日。双人进行筛选、质量评价后,采用Stata 16.0软件进行Meta分析。结果共纳入5项研究,总样本量为4573例,其中共发生104例PICC相关性血栓。Meta分析结果显示新生儿PICC相关性血栓的发生率为1.7%(95%置信区间:0.5%~3.6%)。亚组分析结果显示,发表年份为2017—2021年的文献、经下肢静脉置管的新生儿PICC相关性血栓的发生率更高。结论新生儿PICC相关性血栓的发生率为1.68%。经下肢静脉置管时,血栓的发生率更高,因此对于凝血功能障碍、血栓发生风险高的新生儿,应尽量避免选择经下肢静脉置管。
文摘目的:目前关于中心静脉置管相关性血栓预防的内容涉及范围广且尚未形成系统的循证方案。本研究对化学治疗(以下简称“化疗”)患者经外周中心静脉导管(peripherally inserted central catheter,PICC)维持期深静脉血栓预防的相关证据提取汇总,评价后形成最佳证据,为临床护理实践提供循证依据。方法:通过PIPOST(population,intervention,professional,outcome,setting,type of evidence)法构建临床循证问题。检索乔安娜布里格斯研究所(Joanna Briggs Institute、JBI)、UpToDate、CINAHL、Cochrane Library、中国知网、万方、维普、Embase、PubMed、Sinomed、医脉通、美国输液护士协会网站中关于PICC维持期化疗患者相关深静脉血栓的相关指南、系统评价、专家共识、随机对照试验、临床决策、证据总结。检索时限为建库至2023年10月。由研究人员对所纳入的文献进行质量评价、证据等级划分,提取最佳证据。结果:最终纳入13篇文献,包括临床决策1篇、指南2篇、证据总结2篇、系统评价3篇、专家共识1篇、随机对照试验4篇。从评估、置管前中后、物理预防、药物预防、健康教育5个方面总结出36条最佳证据。结论:本研究总结了PICC维持期化疗患者相关深静脉血栓预防的最佳证据。医务人员和决策者可以结合具体的情况选择证据,以形成完整科学的护理管理策略,提升护理质量。
