| Background and Purpose The occurrence of venous thrombosis of the upper extremity is the most common complication after PICC catheterization.Regularly doing the "grip-loose" action by holding the sponge ball is the most common physical method for preventing thrombosis.Some studies have shown that the ball-holding exercise has a positive effect on the prevention of upper extremity venous thrombosis after PICC catheterization.Improper methods of gripping the ball will directly affect the expected effect.After reviewing the literature,it was found that the current research on the ball holding strength and the continuous ball holding time of the functional exercise of the cancer patients placed in the PICC catheter is not deep enough,and the current clinically recommended method of gripping the ball is not uniform and not standardized.Therefore,the purpose of this study is to provide a scientific theoretical basis for the functional exercise of cancer patients placed in PICC catheters by monitoring the effects of different ball holding strength and duration of ball holding on the hemodynamics of upper limbs.Methods This topic is divided into two parts: Part ? Clinical study on the effect of ball holding strength on hemodynamics of iliac vein in tumor patients after PICC catheterization.The electronic grip is used to measure the grip strength,and the portable ultrasound instrument monitors the changes of venous hemodynamics to explore the range of the best grip exercise.This part consists of two studies:(1)Ten cancer patients were enrolled in this part study.Using selfcontrolled pre-and post-study methods,we record the data of the diameter,velocity and pressure of veins in upper extremities with PICC catheter at rest and at 1,5,10,15 and 20 minutes after maximum grip strength,so as to determine how long it takes for venous blood flow to recover to resting state after maximum grip force.(2)Thirty cancer patients were enrolled.Firstly,the maximum grip strength of each patients was measured with an electronic gripper,and 90% MGS,80% MGS,70% MGS,60 MGS,50% MGS,40% MGS,30% MGS,20% MGS and 10% MGS were calculated.It was record that the maximum venous blood flow velocity,blood diameter and blood pressure were measured to determine the best intensity range of ball-holding exercise,that included grip ball before and after,which include MGS,90% MGS,80% MGS,70% MGS,60 MGS,50% MGS,40% MGS,30% MGS,20% MGS and 10% MGS.Part ? Effect of continuous ball holding duration on hemodynamics of upper limb axillary vein in cancer patients after PICC catheterization.According to the results of the first part of the study,the best intensity range of gripping exercise(80% MGS-MGS),the frequency of gripping the ball(25 grips per time and 3 grips per day)were determined by consulting literature.Eighty-five cancer patients were randomly enrolled in this study.The changes of venous blood flow velocity,blood vessel diameter and blood pressure were observed in resting state and after each grip(holding 1s,2s,3s,4s,5s,6s,7s,8s,9s,10s),so as to determine the optimal grip duration.Result Part ? The first part is composed of two studies.According to the principle of small sample test,10 patients and 30 patients were included.(1)Interval time: A total of 10 cancer patients were enrolled in this part study,including 2 males and 8 females,aged(34-66)years,mean(51 ± 9.5)years.Statistical analysis showed that,compared with resting state,there was no significant difference in the diameter of venous vessels with the extension of rest time after maximum grip strength(P > 0.05),and the changes of venous blood flow velocity and vascular pressure had statistical significance(P < 0.05).When the rest time was more than 10 minutes,there was no significant difference in vessel diameter,blood flow velocity and blood pressure(P > 0.05).(2)Grasp strength:.A total of 30 cancer patients were enrolled in this part study,including 13 males and 17 females,aged()years with an average age of(54 ± 12)years.Statistical analysis showed that there was no significant difference in venous blood flow velocity and pressure compared with resting state(F = 1.417,P > 0.05).There was statistical difference in venous blood flow velocity and pressure at 80% MGS compared with resting state(all P < 0.05).Part ? A total of 85 cancer patients were enrolled in this part study,including 35 males and 50 females,with an average age of(52.11 ± 10.59)years.Statistical analysis showed that compared with resting state,the effects of different grip duration on vessel diameter,blood flow velocity and vascular pressure were statistically significant(P < 0.05),and the diameter of venous vessels is(4.36 ± 0.68)mm at 1s,the maximum blood flow velocity was(23.17 ±7.09)cm/s at 2s,and the highest vein pressure is(0.17 ± 0.13)mm Hg at 2s.Conclusion The correct method of ball-holding exercises can effectively promote the venous blood circulation of the upper limb in patients with PICC catheterization.The cnacer patients who are placed in the PICC catheter perform the ball-holding exercise according to the method of "80% MGS-MGS" and "2s loose 2s" is best for the venous blood vessels.The results provide a scientific theoretical basis for clinical guidance of PICC catheterized patients for upper limb functional exercise. |
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