Study On Safety And Efficacy Of Home Maintenance Model In Cancer Outpatients With PICC

Objective(1)To improve the self-management ability and catheter maintenance compliance of cancer outpatients with PICC;(2)To explore the method of home maintenance mode in cancer outpatients with PICC;(3)To analyze the effect of home maintenance mode in cancer outpatients with PICC.Method From May 2015 to July 2016,a total of 217 cancer outpatients with PICC in the Department of oncology of the First Affiliated Hospital of Guangxi Medical University were enrolled in the study.They were divided into the hospital maintenance group of 136 patients and the home maintenance group of 81 patients according to the wishes of patients and their families.The two groups were all given routine health education and follow-up.During discharge,the hospital maintenance group was given hospital maintenance;the home maintenance group was given home maintenance,which was carried out by the patients' families for catheter maintenance at home.Compliance of catheter maintenance,indwelling time of catheter,patient self-management ability,the incidence of PICC related complications(tension blisters,catheter dislodgement,catheter blockage,puncture site infection,allergic dermatitis,catheter-related bloodstream infection,deep venous thrombosis),the cost and time of going to the hospital and coming back from the hospital for catheter maintenance duringdischarge in two groups of patients were compared from the catheters were inserted to they were removed.Results(1)In the follow-up process,6 patients died,2 patients were transferred to other hospitals for treatment,1 patient lost contact in the hospital maintenance group;3 patients died,1 patient was transferred to other hospitals for treatment,1 patient lost contact,1 patient dropped out in the home maintenance group;two groups were included in the total of 202 patients,in which the hospital maintenance group of 127 patients,the home maintenance group of 75 patients.(2)The total indwelling time of catheter in 202 cancer outpatients with PICC was 27371 days.In the hospital maintenance group,the total indwelling time of catheter in 127 cancer outpatients with PICC was 16895 days,PICC related complications occurred in 88 patients(69.3%),the incidence of complications was 5.21/1000 catheter days.Tension blisters occurred in 2patients(1.6%),the incidence of tension blisters was 0.12/1000 catheter days;catheter dislodgement occurred in 10 patients(7.9%),the incidence of catheter dislodgement was 0.59/1000 catheter days;puncture site infection occurred in14 patients(11%),the incidence of puncture site infection was 0.83/1000 catheter days;allergic dermatitis occurred in 28 patients(22%),the incidence of allergic dermatitis was 1.66/1000 catheter days;catheter-related bloodstream infection occurred in 2 patients(1.6%),the incidence of catheter-related bloodstream infection was 0.12/1000 catheter days;deep vein thrombosis occurred in 30 patients(23.6%),the incidence of deep vein thrombosis was1.78/1000 catheter days;catheter blockage occurred in 2 patients(1.6%),the incidence of catheter blockage was 0.12/1000 catheter days.In the home maintenance group,the total indwelling time of catheter in 75 cancer outpatients with PICC was 10476 days,PICC related complications occurred in 62 patients(82.7%),the incidence of complications was 5.92/1000 catheter days.tension blisters occurred in 8 patients(10.7%),the incidence of tension blisters was0.76/1000 catheter days;catheter dislodgement occurred in 17 patients(22.7%),the incidence of catheter dislodgement was 1.62/1000 catheter days;puncture site infection occurred in 13 patients(17.3%),the incidence of puncture site infection was 1.24/1000 catheter days;allergic dermatitis occurred in 7 patients(9.3%),the incidence of allergic dermatitis was 0.67/1000 catheter days;catheter-related bloodstream infection occurred in 0 patients(0),the incidence of catheter-related bloodstream infection was 0.00/1000 catheter days;deep vein thrombosis occurred in 16 patients(21.3%),the incidence of deep vein thrombosis was 1.53/1000 catheter days;catheter blockage occurred in 1patients(1.3%),the incidence of catheter blockage was 0.10/1000 catheter days..(3)Through the follow-up of the two groups of patients from the catheters were inserted to they were removed,the home maintenance group was better than the hospital maintenance group in the patient self-management ability,the time and cost of going to the hospital and coming back from the hospital for catheter maintenance during discharge,compliance of catheter maintenance and the incidence of allergic dermatitis,the difference was statistically significant(p<0.05);the hospital maintenance group was better than the home maintenance group in the incidence of tension blisters and catheter dislodgement,the difference was statistically significant(p<0.05);the home maintenance group and the hospital maintenance group showed no significant difference(p>0.05)in the incidence of catheter blockage,puncture site infection,catheter-related bloodstream infection,deep venous thrombosis and indwelling time of catheter.(4)Through the follow-up of the two groups' the first three times of catheter maintenance,the hospital maintenance group was better than the homemaintenance group in the incidence of tension blisters and catheter dislodgement,puncture site infection,the difference was statistically significant(p<0.05);there was no significant difference in the other catheter-related complications and compliance of catheter maintenance(p>0.05).(5)Through the follow-up of the two groups of patients during the period from fourth time of catheter maintenance to PICCs were removed,the home maintenance group was better than the hospital maintenance group in the incidence of allergic dermatitis and compliance of catheter maintenance,the difference was statistically significant(p<0.05);there was no significant difference in the other catheter-related complications(p>0.05).Conclusion(1)The mode of home maintenance in cancer outpatients with PICC can improve compliance of catheter maintenance and patient self-management ability;can reduce the incidence of catheter related allergic dermatitis;can not increase the incidence of puncture site infection and catheter-related bloodstream infection,catheter blockage,deep vein thrombosis;can not affect the indwelling time of catheter;can save the time and cost of going to the hospital and coming back from the hospital for patients and their families,which can reduce their burden.(2)The mode of home maintenance in cancer outpatients with PICC still need further improvement,in order to reduce the incidence of the tension blisters,catheter related puncture site infection and ensure patient safety,pre training and assessment for patients and their families especially need to be strengthened.(3)On the premise of standardized training,the application of home maintenance model in cancer outpatients with PICC is feasible,and has a certain clinical significance.