| ObjectiveTo investigate the risk factors of PICC-related venous thrombosis(PICC-related VT)in evidence-based nursing.It will also present the upper limb exercises scheme for preventing PICC-related VT.Futhermore,this research is planned to evaluate the effects of the upper limb exercises scheme for patients with PICC.catheterization,and explore the relation between its effects and the incidence of PICC-related VT.Methods1.Application of Systematic Review:The literature was retrieved from 9 full-text databases in both Chinese and English,which was evaluated by the Cochrane collaboration literature evaluation system.What's more,Revman 5.3 software was adopted to complete the Meta analysis of data and obtain the independent risk factors and the risk ratio of PICC-related VT.2.Implementation of Systematic Review and Content Analysis:In the first stage,we retrieved and collected the relevant data such as prevention guidelines,systematic evaluation,randomized controlled trials and clinical controlled trials about upper limb exercises scheme for preventing PICC-related VT from 7 guidelines websites and 10 full-text databases in both Chinese and English.At the same time,we evaluated those articles about randomized controlled trials and clinical controlled trials systematically.In the end,we integrated these two parts to construct upper limb exercises scheme for the patients with PICC.3.Application of Clinical Controlled Trials:A total of 135 cancer patients with PICC were enrolled in this study by convenience sampling,who were selected based on convenience sampling method.They were divided into experimental group and control group according to the order of admission.In the experimental group,the patients would follow the exercises scheme to exercise their upper limbs,while the control group would adopt the routine method to take exercises.Relevant parameters such as the blood flow velocity,PICC-related VT incidence and its formation position,formation time,classification as well as other complications would be observed on the 1st,3rd,7th,14th,21st,28th day within a month after indwelling catheter and the result of both groups would be compared and analysed.Results1.The risk factors of PICC-related VT from systematic reviews:There were 40 kinds of PICC-related VT from 24 included studies that have been reviewed in this study.The results showed that there are 17 factors that were found to be related to the formation of PICC-related VT,which were the body mass index(BMI?25),less activity,previous history of thrombosis,central venous catheter,the history of the use of erythropoietin,use of antiplatelet,anticoagulation and lower than normal hemoglobin and tumor metastasis,hypertension,diabetes,tumor type,number of puncture>1,catheter tip position does not reach the superior vena cava 1/3,catheter vein,catheter related infection and ectopic cannula and the relation had statistical significance.2.The analysis result of the combination of the effects of upper limb exercise and relevant literature;Guidelines and the evidence from systematic review evidence recommended patients to start upper limb exercises as early as possible.The results of 8 studies showed that the effective upper limb exercises had significant effect on the prevention of thrombosis in PICC catheter patients[RR=0.25,95%CI(0.14,0.43),P<0.0001].Meta analysis results of two RCTs showed that the ball-holding exercises could increase the velocity of auxiliary vein and continuous taking ball-holding exercise for 30 times was believed to have the best effect[MD=-2.21,95%CI(-3.80,-0.62),P=0.007].According to the above results combined with clinical practice,the upper limb exercises scheme for patients with PICC catheterization was established.Patients were advised to start the exercise 24h after the catherization and encouraged to increase oral water intake.At the same time,their daily activities remained unchanged.Patients were required to take 1 group ball-holding exercise 3 times daily after meals.There was the instruction of theball-holding exercise.Firstly,patients need to stretch their arms with PICC,form a 30-60-degree angle with the body and hold the ball on their hand.Then,they need to grip and pinch the ball to 1/2 and hold it for 10s to 1/2 then release the ball for 10s,so that the peripheral blood circulation could be maintained sufficiently in this 20s 30 consecutive sets in 1 group and patients need to take 3 groups daily observing the puncture site bleeding,catheter side arm swelling,pain,skin got red to assess the catheter after the exercise.3.The clinical effect of the upper limb exercises scheme for patients with PICC catheterization:This study involved 66 patients in experimental group and 64 patients in control group after removing missing patients.There were significant differences in maximum velocity of axillary vein 21 and 28 days after indwelling catheter between two groups(t=-5.00,-4.69;P<0.01).There was also a significant difference in maximum velocity of axillary vein among the interaction between groups and different points(F=22.23,P<0.0001).There was significant difference in average velocity per unit time of axillary vein 21 and 28 days after indwelling catheter between two groups(t=-4.60,-4.48;P<0.01).There was also a significant difference in average velocity per unit time of axillary vein among the interaction between groups and different points(F=9.84,P<0.0001).A significant difference was found in the incidence of PICC-related VT between two groups(x2=6.4229,P=0.0113).The incidence of thrombus of control group constantly rose over time(x2=6.1232,P=0.0133).There were also significant differences in incidences of other catheter related th complications between two groups(x2=7.6954,P=0.0055).Conclusions1 There were 17 independent risk factors of PICC-related VT of which reduced activity is the short-term controllable factor in nursing intervention.2.People with PICC catheterization should start upper limb exercises 24 hours after catheterization,continuous ball-holding exercise 30 times after each meal,pinching the ball size as small as 1/2 power and holding for 10s each time,then released for 10s to maintain the blood fully refluxing.3.The upper limb movement scheme could maintain the flow velocity of axillary vein in a high level,prevent blood stagnation effectively,and reduced the incidences of thrombus and other catheter related complications. |
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