| Intravenous therapy is an important method for clinical rescue and treatment, in the past40years, great changes have happened in the intravenous infusion technology, accompanied by a vascular access device development. Bounds of venous indwelling needles, peripherally inserted central catheters (PICC), central venous catheters (CVC) and totally implanted venous ports(TIVAP)are used in three levels of public medical institutions. And many medical institutions have set up a professional team of intravenous infusion, intravenous infusion nurses training. Intravenous infusion has developed into a multi-disciplinary clinical practice skills, technical content and risk is more and more high.However, with the extensive use of novel vascular device, there are bounds of studies reported their complications, patients with tumor often require multiple infusion, the infusion time, input drug irritation, the transfusion related complications are also more common. Therefore, it is very important to ensure that their choice of vascular access device suitable. for fulfilling patients, clinical physiology and psychology. Currently, there are many types of vascular access device in using, for patients, choosing a device which can meet the needs of patients is not easy. most previous studies on standardizing the operation process in order to reduce the complications, improve patient satisfaction. In this research, we evaluated the relevant factors that influencing the choice of the vascular device from the patient’s perspective, thus,provide a scientific basis for the correct selection of vascular access device, radically reduce the incidence of related complications.ObjectiveTo find out the status and influencing factors of the selection of the intravenous vascular access device in patients with tumor who accepting the intravenous therapy.To provide scientific basis for reducing patient vein transfusion related complications.A study involving the patients’ general data, patients’will, vascular site puncture situation and vascular access device using status was conducted. to explore their influence on patients during choosing a vascular access device, thus provide suggestions to the patients according to their characteristics.To investigate symptom distress in tumor infusion patients, to further explore the general condition of the different vascular access device, vascular conditions, clinical disease characteristics of the patients distress at clearly affect the interaction between the factors, formulate scientific selection of vascular access strategy to improve the quality of life of patients and provide a basis to enhance the patient’s mental health.Methods:This survey was performed from September2012to November2012in three oncology department facilities in Guangzhou. By using convenience sampling, patients were investigated with the self-designed questionnaire, which including the general data, patients will, illness information, vascular site puncture situation and vascular access device using.Describe the use of vascular access in patients with different tumor patients generally, compare different demographic characteristics in different vascular access. Using the general condition of patients, the willingness of patients, vascular condition, channel usage, clinical situation as variables, a single factor analysis of whether to choose the central venous catheter, and further two classification logistic analysis,to analyze the factors affecting choosing vascular access device. A self-designed questionnaire was used to investigate the patients distress degree. symptoms include whether the puncture failure, local infection, phlebitis, thrombosis, seepage and leakage, catheter embolization, shift; Each dimension related item score and as each dimension score, the score of each dimension and as a patient distress degree score.Using SPSS16.0software to establish database, processing and analysis of data. The internal consistency coefficient (Cronbach’a coefficient) for reliability analysis on the questionnaire; using frequency, proportion for statistical description; single factor analysis of variance was used to compare different selection between a vascular access device characteristics of patients; the results further non-conditional Logistic multivariate analysis using the significant test level a=0.05regression equation, using the Forward:LR stepwise regression analysis. The mean, standard deviation, percentage of symptom distress situation described, using single factor analysis of variance and compare the differences of vascular access device in patients with disturbance degree.ResultsOf the400questionnaires distributed, there were376valid surveys,and the return rate was100%, efficient rate was94%.there are154male and222female.Single factors analysis was, In the choice of whether patients with central venous transfusion device influence factors in the general condition of the patient (sex, age, marriage, paid), the willingness of patients (for other infusion device, the understanding degree of key decision makers, the infusion device if need maintenance, you can maintain), vascular status (puncture vascular puncture difficulty degree), channel condition (total amount of liquid, continuous infusion time, expected the indwelling time, extubation reasons, days of transfusion, chemotherapy days), clinical situation of patients (diagnosis, operation history, chemotherapy times) and other factors on the choice of whether patients with central venous infusion apparatus has a significant effect.Patients with central venous infusion or not in patients with payment methods, influence the decision tube, patients to maintain the infusion device, patients with vascular puncture is difficult to diagnosis, staging and expected in patients with indwelling time a total of6related. As follows:For private patients compared with the method of payment, there was significant difference between the choice of other forms of payment for central venous transfusion device (P=0.014), the OR values were81.369,29.251,28.477, refers to patients tend to choose central venous transfusion device, Patients with free medical care is81.369times at their own expense,29.251times the city Medicare patients are patients at their own expense, the new rural cooperative medical care system is28.477times of the patients at their own expenses, the patients at their own expense with key influencers are compared to the patients themselves and their families, and other decision makers of central venous infusion device selection of significant difference (P=0.000). OR, respectively,43.773、0.523、1.475, refers to the tendency of patients with central venous infusion apparatus, affected by the doctor’s decision was43.773times of their own, affected by nursing decision is0.523times of their own, affected by the patients and billboards is1.475times of their own. patients with community hospitals can not the transfusion device maintenance, can maintain hospital for transfusion device has significant differences regarding the center vein infusion device selection (P=0.001). OR value of16.123, refers to a patient of central venous infusion device of the communities in which there is a tendency to not maintenance16.123times times the infusion device. Compared with the very easy to puncture in patients with vascular, vascular puncture for easy selection of central venous infusion device a significant difference (P=0.032). OR value of0.141, refers to a patient of central venous infusion device0.141times the tendency is easy to puncture. Compared with patients diagnosed with Ⅳ, phase Ⅰ in patients with central venous infusion device for selection of significant difference (P=0.010) OR value to12.127refers to a patient the tendency of central venous infusion device is12.127times the phase IV patient. Vascular access device indwelling time of<1week compared indwelling central venous infusion in patients with longer device choices with significant differences (P=0.000). OR, respectively,67.498, refers to the indwelling time of2-3week a patient of central venous infusion device preference is less than or equal to67.498times times in a week, indwelling time>3weeks of patient choice of central venous infusion device preference is less than or equal to84.898times in a week.The occurrence of infusion symptoms among patients of tumor The results of this study show that during chemotherapy, the score of the troubled symptoms of patients on a drip is (10.74±3.30), in which the score of whether patients have this symptom is (1.30±1.44), and the score of the distressed degree is (9.43±2.01). The occurrence of the troubled symptoms among patients on a drip during chemotherapy, according to the incidence from high to low, could be counted as follows:the incidents of puncture failure was51.9%, the incidence of Phlebitis was20.5%, leakage17.8%, the puncture site pain17.6%, infection9.6%, the Venous catheter displacement5.3%, Plugging4.8%, and the incidence of thrombosis was1.1%.The score difference of the troubled symptoms among different ages, different levels of difficulty in Vascular Puncture, the times of Chemotherapy and even the patients’stage, has some statistic features(P<0.05).The scores of the troubled symptoms among patients above70are higher than those of the group of aged40-59(P=0.005) and the group of60-69(P=0.015); the scores among patients whose veins are difficult to puncture are significantly higher than that of those whose veins are very easy to puncture(P=0.033)and those whose veins are easy to puncture (P=0.009);the scores of patients who accepted the chemotherapymorethan10times are higher than that in group ofl-3times(P=0.001),4-6times(P=0.017),and7-9times(P=0.003); the scores of patients in stage Ⅲ are significantly higher than those of patients in stage Ⅱ(P=0.009), and the scores of patients in stage IV were much higher than that of patients in stage Ⅲ(P=0.001).Conclusion:Medical reimbursement ratio is a decisive role to choose catheter in patients, the higher the proportion of patients with Medicare reimbursement, the economic burden of patients suffered less, possibility of choosing the central venous infusion apparatus more. It is suggest that insurance relevant departments to increase the low income reimbursement proportionMedical health environment of residence for patients has an important role in choosing the vascular access device. It is suggested that the state departments should formulate related policies to strengthen primary health institutions investment, strengthen the grass-roots medical personnel training, and reduce medical treatment differences.The doctor’s attitude and the doctor-patient relationship are important factor to influence clinical decision making in patients, so communication should be strengthened between the patients and the health care workers, reduce the asymmetry of information between doctors and patients, increase their understanding of the infusion device, the key is allow patients to make the correct decision.Intravenous treatment cycles has an important affect in choosing central venous catheter, the expected time of indwelling catheter is longer, patients are more likely to choose central venous transfusion device.Staging of tumor has an important affect in for patients choosing vascular access device. Patients with early stage of tumor more inclined to choose the center type infusion device than patients with advanced.Symptom distress of patients is affected by age, the degree of vascular puncture, chemotherapy times and diagnosis staging. It suggested that nurses should pay attention to age more than70years, more than10times of chemotherapy for patients with stage III and IV.The symptom distress experience of implantable venous transfusion device in patients is significantly less than other types of venous transfusion device. |
PDF Full Text Request