| ObjectiveTo explore the risk factors of persistent insertion wound oozing andphlebitis after peripherally inserted central catheter (PICC) placement inpatients with liver transplantation, aiming to improve the clinical application ofPICC in patients with liver transplantation, to solve the clinical problem, toprovide the scientific basis for the PICC catheter standards and standardizationcare plan of liver transplant patients.MethodsThis study was divided into two parts.The first part: The measures were to collect the173patients who madeliver transplantation with the PICC in May2010to September2011,21cases ofpatients ruled out other diseases which caused clotting mechanism sent,thrombocytopenia abnormal laboratory test indices, the patients who did nottake part in the experiment after researchers’ explanation and dying patiets. Tocollect general material152cases of patients met with the criteria such as age,gender, buying tube time, buying tube vein, puncture way, the puncture andlaboratory analysis index such as Prothrombin time (PT), Activatedpartialthromboplastintime(APTT), Thrombintime(TT), Fibrinogen(FG),Plateletcount(PLT), Albumin(ALB). To analyze the relationship between theseindicators and the wound oozing or bleeding within one week after PICC bySPSS16.0. General material descriptive statistics: frequency, percentage, mean differences±standard deviation (plus or minus s), median (M), four points digitsspacing (QU-QL); The single factor analysis of laboratory analysis index and thetotal amount of ooze blood within one week of such as continuous variablesmaterial was normal distribution, the two independent sample group ofindependent t test, the single factor analysis of variance, Pearson correlationanalysis; Continuous variables such as did not follow normal distribution, usingSpearman related analysis; Many factors analysis would be the single factoranalysis of statistical significance of variables into, the total amount of oozeblood within one week of PICC for152cases of liver transplant patients as thedependent variable, and multivariate linear stepwise regression analysis.The second part: The case control study was applied. Tracking the207patients with liver transplantation after PICC in March2010to October2011,divided patients who met with the criteria into two groups in180patients,phlebitis as happened with the case group, had not occurred in patients withphlebitis as control group. Compared between the two groups the generalmaterial including age, gender, buying tube time, the primary disease,punctureway,the puncture, puncture number, buying tube vein, trying to buy the number,whether chemotherapy; blood clotting index includes PT, APTT, TT, FG, PLT,immune function index including White blood count (WBC),Hemoglobin(Hb),nutrition status indicators including ALB, Blood sugar level (Bs).Thestatistical analyzed by SPSS16.0statistical software, general materialdescriptive statistics: frequency, percentage, mean±standard deviation (plus orminus s); the single factor analysis of phlebitis which continuous variablesmaterial was normal distribution, the two independent t test sample; Countmaterial using2inspection; Many factors analysis would be the factors whichthe single factor analysis was statistically significant together into groupsLogistic multiple stepwise regression analysis. P was less than0.05fordifferences with a statistical significance. ResultsThe first part: Incidence of the wound oozing or bleeding was100%in152cases. Single factor analysis showed that opportunity, the catheter puncture,puncture way, prothrombin time,platelet count were related with the ooze bloodafter PICC. Multiple linear stepwise regression analysis showed that thepuncture and prothrombin time were the risk factors of PICC persistent insertionwound oozing or bleeding in patients with liver transplantation.The second part: Incidence of the phlebitis was15.6%in180cases. Singlefactor analysis showed that age, gender, primary disease, puncture way, tryingto buy tube times, the times, the puncture catheter vein, puncture, whetherchemotherapy, serum albumin levels were related with phlebitis afterPICC.Logistic regression analysis showed that age, sex, primary disease,catheter vein, puncture, trying to place the number of tube were the risk factorsof PICC phlebitis in patients with liver transplantation.ConclusionsThe first part: Medical staff should try to choose cubits on biopsy andconcern the prothrombin time when patients are ready to place PICC,especially PT quartile30s,choosing carefully puncture of PICC in order toreduce the incidence of persistent insertion wound oozing, durative time andbleeding,improve the service life of PICC forliver transplant patients.The second part: Medical personnel should pay special attention to womenaged liver cancer patients, try to choose your to vein, cubits, ensuring one-timecatheter, in order to reduce the puncture patients after catheter phlebitis, ensurethat the incidence of PICC in liver transplantation in patients with normal usedwhen patients are ready to place PICC in order to reduce the incidence ofphlebitis and duration. |
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