Research On Risk Factors And Changes In Coagulation Indicators For CRT With PICC In Cancer Patients

Objective To identify clinically important risk factors associated with catheter related thrombosis(CRT)following peripherally inserted central venous catheters(PICC)in cancer patients,analysis the relationship between CRT and blood coagulation indicators and thrombosis risk assessment scale application in patients with CRT.To provide reference for clinical prevention,diagnosis and nursing care of CRT,reduce the incidence and burden of CRT.Methods A retrospective case control study of 320 cancer patients with and without CRT was performed.Using the self-made data collection table and five kinds of thrombosis risk assessment scale to collect data in tumor patients.Patient data include demographics,diagnosis,PICC insertion information,blood coagulation index,thrombosis risk assessment scale assessment etc.Single factor analysis and multiple factor logistic regression analysis were performed to identify the risk factors of CRT.Results 1 The multiple factor logistic regression analysis showed that disability of daily living(OR=13.93,95%CI: 1.66~116.69),infection(OR=4.69,95%CI: 1.74~12.70),a history of cardia-cerebrovascular diseases(OR=6.50,95%CI: 2.18~19.37),metastases(OR=2.06,95%CI: 1.13~3.77),myelosuppression(OR=2.08,95%CI: 1.12~3.89),left-sided insertion(OR=2.00,95%CI:1.16~3.44),withdrawal of catheter(OR=3.45,95%CI: 1.43~8.30),were the significant risk factors for CRT associated with PICC.2 FIB,DD have statistical significance between the two groups.On before,during and after CRT three stages,DD difference was statistically significant in CRT group,DD increased significantly when CRT occured.The area under ROC curve of FIB on before and during stage values were 0.586,0.618 respectively.The area under ROC curve of DD on before and duiring stage values were 0.703,0.729 respectively..3 The score of Autar,Caprini,JFK,and Padua scales were statistically significant between two groups,but the score of the CRT group was generally low;The assessment level difference of the Autar,Caprini,JFK,and Padua scales was statistically significant between two groups,but majority of patients was still in the low and moderate risk stage.The area under ROC curve of the 4scales was less than 0.7.4 29.17% CRT was asymptomatic and 70.83% patients with clinical symptoms and signs,swelling and pain of the puncture limb were the most common symptoms and signs;The occurrence time of CRT was 1-281 days and50.00% occurred within 35 days;Basilic and subclavian vein were the mostfrequently involved vein;68.33% CRT occurred in the hospital and 25.00%outside;38.33% extubation after diagnosis of CRT,8.33% secondary phlebitis,0.83% lead to DVT,25.00% migration occur in the process of CRT,the recurrence rate of CRT was 9.17%.Conclusions For cancer patients with risk factors,medical workers should take timely and effectively measures to reduce the occurrence of CRT associated with PICC and relieve patients pain and burden.The level of DD significantly increased when CRT occurred,DD can be used as one of monitoring index of CRT.Current clinical commonly used assessment of the lower limb VTE can not accurately reflect the extent of the thrombus high-risk groups,lacking sensitivity and specificity.It is necessary to carry out diverse,large-scale to study CRT related risk factors and develop risk assessment scale of PICC associated CRT.Swelling and pain were the most common symptoms and signs,the occurrence rate of CRT was high within 1 months after the puncture,nursing carers need to strengthen health education.