| Objective:To investigate the level of the risk of unplanned extubation in patients with THDC insertion;to analyze the independent risk factors for the risk of unplanned extubation in patients with THDC insertion;to construct and validate a nomogram prediction model,and to provide a reference basis for effectively reducing the rate of the risk of unplanned extubation of THDC and for formulating corresponding nursing interventions.Methods:A total of 421 patients with THDC insertion were screened into the study based on inclusion and exclusion criteria,who had undergone hemodialysis treatment at a hemodialysis room in a hospital in Changsha from January 2016 to December 2019 were used as the study subject,using a retrospective cohort study method.According to the occurrence of unplanned tube drawing,421 patients with indwelling temporary dialysis catheter were divided into unplanned tube drawing group and normal tube drawing group.Basic information and case data from patients have been used to retrospectively investigate the conditions of unplanned extubation of THDC insertion to analyze characteristics of unplanned extubation in patients.The SPSS Statistics(version 25.0)was used for statistical analysis,with count data described by rate and composition ratio,normally distributed quantitative data described by mean±standard deviation,Student’s t-test(t-test)for intergroup comparison of normally distributed quantitative data,and?~2test or Fisher’s exact test for comparison of categorical variable data;Logistic regression analysis was used for multinomial analysis to explore the independent risk factors for the risk of unplanned extubation in patients with THDC insertion;The logistic regression model was constructed,and the independent risk factors obtained based on multinomial logistic regression analysis were visualized by developing nomogram model using the R programming language(version R4.1.2)software’s RMS package;the area under the curve(AUC)values were calculated by calculating the concordance index(C-index)of the model,plotting the receiver operating characteristic(ROC)curves and the Hosmer-Lemeshow test was used to verify and evaluate the discriminability and calibration precision of the model,and the calibration curve was plotted.Results:(1)The incidence of unplanned extubation in 421 patients with THDC insertion in this study was 14.252%,with a high risk of unplanned extubation,including 38 extubation cases due to catheter infection(63.333%),13 extubation cases(21.667%)due to catheter malfunction,6 extubation cases(10.000%)due to patient self-extubation,two extubation cases(3.333%)due to sutures dislodgement leading to the avulsed catheter,and one extubation case(1.667%)due to catheter discomfort.(2)The prevalence of unplanned extubation in patients with THDC insertion was predominantly in the elderly with functional impairment in self-care of daily life(n=41,68.333%)and in those with internal jugular vein(n=35,58.333%)insertion.(3)The results of the univariate analysis showed statistically significant differences(P<0.05)in the unplanned extubation rate of patients with THDC by age,sex,self-care ability,presence of a chaperone,whether it was their first dialysis,presence of hypoproteinemia,and activated partial thromboplastin time(APTT).(4)Multinomial logistic regression analysis showed that male(OR=2.420,95%CI:1.118 to 5.239),unaccompanied(OR=17.418,95%CI:5.121 to 59.237),first dialysis(OR=4.945,95%CI:2.391 to 10.225),and hypoproteinemia(OR=2.105,95%CI:1.058 to4.187)were independent risk factors for unplanned extubation in patients with THDC insertion.(5)Logistic regression results were used as the basis for constructing a predictive model for the risk of unplanned extubation in patients with THDC insertion:Logit=-6.049+0.884×male+2.857×without chaperone+1.598×first dialysis+0.744×hypoproteinemia.The AUC of the ROC curve of this prediction model was 0.770(95%CI:0.693-0.846),the maximum value of the correct index(i.e.,the Youden’s index)is 0.419,and the corresponding best cutoff value is-1.536,the specificity is 0.836,and the sensitivity is 0.583.The concordance index(C-index)of the model is calculated to be 0.775(95%CI:0.704 to 0.846),indicating good model discriminability.The Hosmer-Lemeshow test showed thatχ~2=2.264,P=0.812,(p>0.05),suggesting a high fitting degree of the model.Internal validation of the model suggested a sound consistency between the predicted probability of unscheduled extubation in patients with indwelling temporary hemodialysis catheters and the actually observed probability.Conclusion:Patients with THDC insertion are at high risk of unplanned extubation,and men,unaccompanied care,first-time dialysis,and the presence of hypoproteinemia are independent risk factors for the occurrence of unplanned extubation of THDC.The results of the multinomial logistic regression analysis showed that the predictive performance of the nomogram prediction model for unplanned extubation in patients with THDC insertion was good,providing a convenient and intuitive tool for clinical assessment of the risk of unplanned extubation in patients with THDC insertion,which is helpful for healthcare professionals to formulate targeted prevention and control measures to prevent the occurrence of unplanned extubation and to protect patients’life safety and save medical expenses. |
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