| Research BackgroundPeripherally 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 and was introduced into China at the end of last century. As a kind of intravascular catheterization, PICC is the peripheral vein (basilic vein, median cubital vein, cephalic vein) cannulation, the position of the tip of the superior vena cava1/3, close to the vena cava and right atrium entrance deep vein catheterization, which has features of wide indication, such as (1) strong irritant drugs such as multiple courses of chemotherapy,(2) total parenteral nutrition(TPN),(3)long-term intravenous infusion,(4) preterm children or low weight children(<1.5kg),(5) home intravenous therapy. PICC has some advantages which scalp needle catheter can’t compare. For example, the indwelling time of which can last lyear, which can relieve the patients’suffering; the opening end of the catheter is in the superior vena cava, Drugs can be directly injected into the central venous, which can eradicate phlebitis and local tissue necrosis caused by drugs leaking. Therefore, PICC has been carried out rapidly since2005in the tertiary hospitals, the technology has become more mature and the indications have gradually expanded. U.S.CDC (Centers for Disease Control)2011emphasizes "Catheter maintenance should be the focus of infusion quality control and improvement after the placement of catheter." CDC believes outer joint of PICC is an important cause of microbial colonization of the catheter, especially the long-term indwelling catheters, which needs appropriate interfaces to close the conduit connector. Infusion connector should be changed once a week during the period of treatment, but how long should the infusion connector be changed to reduce the catheter-related infections to the minimum and save the medical resources and improve the efficiency of nurses, it is not clearly stated in the2011version of the INS (Infusion Nurses Society) of American, there is no research about it in China. Nursing staff formulated standards by themselves in China, Liao adopted changing the infusion connector every15-30days, Pan adopted changing the infusion connector every7-10days, and Tu adopted changing the infusion connector every2weeks. But all of which did not provide evidence. Evidence-based practice is the best evidence (research) combined to determine the interests of patients and health care workers so as to seek safer and higher quality results. Our research is to provide the evidence about the appropriate time to change the infusion connector for PICC patients in the non-treatment period.Research PurposeThe purpose of this research is to explore the appropriate time to replace the infusion joint for PICC patients in the non-treatment period and provide evidence-based clinical care; To analyze the influencing factors for catheter-related complications, to perform the catheter maintenance for the PICC patients in the non-treatment period to reduce the incidence of complications for PICC patients.Data and MethodsSample1:326PICC patients of outpatient care maintenance were collected in the non-treatment period from July2013to December2013in a hospital infusion positive joint was replaced after different days, PICC could be placed in the body for as long as one year, which needed maintained once a week. Replacement of infusion connector was conducted as the catheter maintenance was done. The patients were divided into one-week group, two-week group, three-week group; the error of one day was allowed. Bacteria were cultured observed and classified. The catheter-related infection rate, the economic benefitand the patients’satisfaction of the catheter maintenance in the non-treatment period were analyzed.Sample2:Two groups of patients of outpatient care maintenance were selected in the non-treatment period in a hospital. Among them,287cases with heparin cap at the end of PICC tube were selected from Jan.2013to June2013as the control group,326cases with needleless positive infusion connector at the end of PICC tube were selected from July2013to Dec.2013as the experiment group, The adopted tube-sealing solution, the process of the method to wash and maintain the tube-sealing solution was the same in two groups. Needle stick injuries of health care workers caused in two groups and catheter-related complications in two groups were analyzed.ResultsSample1:The results comparison of bacterial culture for patients with transfusion joints in three groups showed the colony count of bacterial culture in one-week group and two-week group was both zero, and no bacterial growth was observed. The colony count of bacterial culture in three-week group was found in5cases>15cfu/plate, there was significant difference. The comparison of incidence and types of catheter-related infection in three groups displayed there was one case of catheter-related infection each in one-week group and two-week group, there were altogether6cases of catheter-related infection in three groups, there was significant difference. The overall incidence of catheter-related infection in one-week group and two-week group was obviously lower than that of three-week group. There were no catheter colonization of pathogens in one-week group and two-week group, there were five cases of catheter colonization in three groups, there was significant difference. The catheter colonization in one-week group and two-week group was obviously less than that of three-week group. Cases of exit site infection, tunnel infection and catheter-related bloodstream infections were found in three groups, there was no significant difference. The comparison of bacterial culture, incidence and types of catheter-related infection showed although some patients’economic burden was relieved in three groups, it was easy to cause catheter colonization, there were security risks, promoting the use was not recommended, so cost of infusion joint replacement was conducted only in one-week group and two-week group in non-treatment period (P<0.05), there was significant difference. The cost in two-week group was obviously less than that of one-week group. The satisfaction rate of patients for catheter maintenance in three groups were91.45%,97.58%,89.41%respectively (P<0.05), the satisfaction rate of two-week group was obviously higher than that of three-week group.Sample2:Needle stick injuries of nurses caused by cases in two groups were compared, needleless infusion device was adopted in the experiment group, there was no needle stick injury,8cases of needle stick injuries occurred in the control group (P<0.01),there was significant difference. The experiment group was obviously lower than that of control group. The complication rates in two groups in non-treatment period were compared, the total incidence in the experiment group was5.21%, while6.62%in the control group (P>0.05), there was no significant difference, compared with the control group, the incidence of catheter blockage was X2=3.86, p<0.05, there was significant difference. The experiment group was obviously higher than that of the control group.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. Infusion connector can be replaced once every2weeks, which can reduce the catheter-related infections, ensure patient safety, relieve economic burden of patients and improve patient satisfaction, it is worthy of promotion and being used in the clinics. Needle-positive joints are very good at avoiding needle stick injuries, reducing blood-borne infections, preventing backflow of blood and reducing catheter blockage, which will become more and more popular with medical staffs and patients. |
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