The Comparative Study Of Venous Port Access（VPA）&Peripherally Inserted Central Catheters(PICC) In Application With Breast Cancer Chemotherapy

ObjectiveThis study focused on the comparative analysis of VPA and PICC, which weretwo major deep venous catheter surgeries in the breast cancer chemotherapy, and tolearn whether VPA is better than PICC in terms of the difficulty of operation,complications, and the change of patients’ life quality post chemotherapy, etc.Therefore，a better way of deep venous catheter would be chosen in the breast cancerchemotherapy.Materials and method1. Objects of Study and GroupTwo hundred and five breast cancer patients with the chemotherapy were chosenfrom Breast Surgery Department in Panyu Central Hospital from Dec.2009to June2011, whom agreed to do the study without mental illness, and met the need of study.The205cases were randomly divided into two groups. They were study group andcomparison group. The study group was named for the infusion port group, with atotal of105cases, and with the age of27~72years old. The median age is48.Theaverage age is49.8years old. The comparison group was named for the PICC group,with a total of100cases, and with the age of27~71years old. The median age is48.The average age is49.7years old. Patients in the study group and comparison group were female. Two groups of the patients with breast cancer needed the chemotherapyin the treatment of deep venous catheter. They all had primary school level or evenabove. They were volunteers and not seriously ill.2. Methods and Material2.1Type of Catheter:⑴Type-safe three-way valve PICC single lumen catheter (Model: with pipediameter4Fr, a length of60cm, with tick marks), with safe Introcan needle from U.S.Bard International Limited.⑵Small single chamber venous port,(Model: with pipe diameter7Fr, a lengthof50cm, with the tick mark of35cm) to connect the three-way valve surgery cathetersfrom United States Bard International Limited.2.2B-sonography: Model: DP6600, produced by Shenzhen Mindray Company.3. Methods of Study3.1Collecting materials of patients’ general demographic features and clinicalfeatures: First, collecting materials of medical record, materials of patients’ generaldemographic features and clinical features may affect the operation of the catheter,catheter complications, and the patients’ quality of life.3.2Methods and indicators of evaluation for the degree of operative difficulty:Write down the followings:①Rate of success of tube;②Length of tube;③Number of catheter;④To analyze whether we should adjust the position of tube;⑤Complications in operation;⑥Analysis of the related factors of complications in operation3.3Methods and indicators of evaluation during catheterization andcomplications after catheterization were as follows: type of complications duringcatheter, type of complications after catheter, the rate of complications.3.4Methods and indicators of evaluation of breast cancer patients’ quality of life:Adopted the patients’ quality of life score table: ECOG score table，Karnofsky scoretable，QLICP-BR(V1.0) score table. Before the chemotherapy, according to theECOG score standard, patient’s capacity situation should be considered, in order todecide whether the patient is able to do the treatment or not. After three treatments of chemotherapy, Kamofsky score and QLICP-BR（V1.0）score were adopted as the lifequality score table during the cycle of chemotherapy.4. Statistical AnalysisAccording to data collected, SPSS16.0statistical software was adopted for thestatistical analysis. Groups were compared by using independent-sample t test toverify the ratio between two groups with χ2test, to test the relationship betweensingle factor and multiple factors of logistic regression analysis.Results1. The comparison of difficulty between VPA group and PICC group in thesurgery: Compared the VPA group and PICC group, the difference between theoverall number of catheter and the rate of success is not statistically significant (P>0.05).The proportion of adjustment of position in VPA group was lower than in PICCgroup. The difference was statistically significant (P<0.05). The length of tube wasthe dangerous factor of the complications during catheterization （OR:1.042，95%CI:1.011~1.074）. The longer the catheter was, the greater chances it would maketo lead to complications during catheterization.2. The comparison of complication rate of VPA group and PICC group: Thecatheter complication rate of PICC group was higher than the VPA group (P <0.01) interms of operation, incidence of catheter complications and the overall complicationrate. There were different types of complications. The length of tube was thedangerous factor of the complications after catheterization （OR:1.067，95%CI:1.039~1.097）. The longer the catheter was, the greater chances it would maketo lead to complications after catheterization.3. The comparison of quality of life of VPA group and PICC group: Beforechemotherapy, both VPA group and PICC group met the standard of ECOG score.There was no significant difference between them（P＞0.05）. After three timeschemotherapy, whether the total score and self-score of the Karnofsky score orQLICP-BR(V1.0), patients from the VPA group got higher score than the PICC group.The difference was statistically significant(P＜0.01), especially the small part ofrelative upper limb activities revealed that VPA was better than PICC in terms ofimproving patients’ upper limb activities. The difference was statistically significant (P＜0.01).Conclusion1. It’s concluded that there was no significant difference between the rate of successof Venous Port Access (VPA) and Peripherally Inserted Central Catheters (PICC).But the ratio of complication and re-adjustment of catheter position in the VPAgroup was lower than in the PICC group, which means VPA was easier than thePICC.2. The rate of complication of Venous Port Access (VPA) was lower thanPeripherally Inserted Central Catheters (PICC) during catheterization and aftercatheterization. It means that VPA was more clinically secure.3. The patients’ quality of life with breast cancer chemotherapy that chose VenousPort Access (VPA) was higher than that of Peripherally Inserted Central Catheters(PICC).In conclusion, the patients with breast cancer who need the chemotherapy shouldchoose the Venous Port Access (VPA) as the deep venous catheter method.