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The Effects and Evaluation Study on Peripherally Inserted Central Catheter and under Collarbone Central Venous Catheter Applied to Patients with Malignancy

Author: LiLanHua
Tutor: XuLingZhong
School: Shandong University
Course: Social Medicine and Health Management
Keywords: PICC CVC malignant tumor Comparative study
CLC: R472
Type: Master's thesis
Year: 2011
Downloads: 200
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Abstract


With the evolution of social economy and environmental change caused by industrialization and urban development, natural ecological balance has been destroyed. As a result, the incidence of malignant tumor has been increasing year by year. Presently, chemotherapeutics plays a significant role against these diseases. In clinical treatment, the main method of administration is repeating intravenous injection, which may inevitably cause vascular injury. If there are some improper operations, useful drug may exude out of the vessel giving rise to the necrosis of local tissue, even worse, to the effectiveness of current therapy. With the developing of medical technology, tumor patients have more various and advanced ways to be given drugs. Venous transfusion technique has a long history over 500 years, and forms an integrated system. Now it has become one of the most useful and directs way of clinical care. In America, about 90% inpatients need intravenous transfusion, while in China, almost every patient needs such treatment, including replenishing antibiotics, water, electrolytes, pain-killers, nutrient solution, chemotherapyand other comprehensive cares. On average, every therapist comes into contact with 500 kinds of intravenous fluids and blood products every day. The venous environment of patients varies from the best to the worst, changing every time. Therefore, how to establish a safe venous channel becomes a big challenge every day. Every therapist and nurse should figure out why the traditional ways always fail and correctly estimate the situation of the veins and then choose a proper central vein for further treatment as soon as possible. Over 20 years, Intravenous infusion way, materials management system at home and abroad have changed significantly, which is a kind of evolution. Venipuncture tools also have big modifications from scalp needle, intravenous catheter, and central venous catheter to intravenous infusion port and so on. Currently, among the patients on chemotherapy, inserted central catheter has become the first choice to give medicine. However there are some complications including pneumothorax, arterial injury, infection, catheter detached and so on. Also this technique is hard to master resulting in the clinical doctors has more concerns. So, how to find a more reasonable, secure and effective way to place the central venous catheter becomes a new challenge. Peripherally inserted central catheter (PICC) was first used by a German doctor named Forssmaon and then widely adopted by the clinical doctors due to its convenience safety and validity. This catheter is made by new polyurethane and able to stay in veins over 2 years, which has common use in patients on chemotherapeutics, patients with short-time dialysis pathways before forming hemodialysis fistula, abdominal tumor patients after surgery and total parenteral nutrition. This technique is a useful way to keep venous patency and prevent phlebitis, which is used in the patients with long-time venous transfusion and irritating medicine. More and more health care workers and patients has accepted this technique because of its advantages containing less trauma, fewer complications, no life-threatening, high puncture success rate, simple operation, safety and effectiveness.Research PurposeTo compare the conveniences, superiority, rates of complication, etc. of peripheral Inserted Central Catheters (PICC) and under collarbone Central Venous Catheter (CVC) when patients with malignant tumor have a long time application.Data and Methods We have chosen 260 patients with malignant tumor, who were first diagnosed and hospitalized in Qilu Hospital of Shandong University from 2007.06-2010.06. Among them, we picked 154 patients who had good environment of elbow blood vessels to undergo PICC as experimental group; other 96 patients undergone CVC as control group. Then, we have recorded the average time of placing catheter and success rate, catheter retention time, time of completing high-dose infusion, incidence of untoward effect, analysis of economic benefit and degree of satisfaction, etc. of two groups.ResultsThere is no significant difference between total success rate of placing catheter to all the research objects (P>0.05), however as for once success rate, that of experiment group is 92.21%, higher than that of control group 76%, and there is an obvious difference (p<0.01); The average time of placing catheter of experiment group is 13±2.5minutes, shorter than that of control group (19±4.5 minutes), and there is a significant difference(p<0.01); the incidence of untoward effect of experiment group is 48.63%, while that of control group is 46.88%, there is no significant difference (P>0.05). the incidence of phlebitis of experiment group is 17.53%, much higher than that of control group 5.21%, and there is a big difference(p<0.01); plugged catheter happens 22.08% in experiment group much more than 7.29% in control group, and there is evident difference (p<0.01); the incidence of catheter shift of experiment group is 4.6%, higher than that of control group 0%, and there is a significant difference(p<0.01); the incidence of pneumothorax, arterial injury and local hematoma is 5.19% in experiment group, much lower than 18.75%, which is the incidence of control group. There is a significant difference(p<0.01); the rate of accomplishment of treatment (accomplish the fluid volume for transfusion in a specific time) is 95% in experiment group and 100% in control group, and there is no difference in statistic (P>0.05); the economic benefit of two group are nearly equal; the degree of satisfaction of experiment group is 96%, higher than that of control group 72%, and there is a significant difference(p<0.01). Conclusions and suggestionsPICC can be used in various patients with malignant tumor for chemotherapy, middle-and long-time venous transfusion, parenteral nutrition and antibiotic therapy. This method not only provides a safe, effective way to venous transfusion, but also decreases the incidence of severe untoward effect caused by placing catheter. Because once success rate of placing catheter of experiment group is higher than the control group, we can save time and work force, decrease the complication, keep venous channel for a longer time and provide patients with malignant tumor who need long time venous transfusion more convenience and safety.. Due to its simple operation, lower complication and risk than traditional ways, this technique will become more and more welcome.

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