| Objective:To investigate the current situation of the application of intravenous infusion device in clinical inpatients and the occurrence of related complications in four Third-Grade Class-A Hospitals in a certain city,analyze the influencing factors of the main complications,and provide theoretical basis for the formulation of preventive measures.Methods:From January 20,2019 to January 20,2020,the clinical data of the central venous infusion device for tumor patients in four Third-Grade Class-A Hospitals in a certain city were analyzed retrospectively.The main contents of the questionnaire include the general situation of patients,the types of intravenous infusion device,the choice of vein,the occurrence of major complications,the causes of catheter removal and the time.The final collected data is entered and sorted out by Excel.Spss22.0 statistical software was used for final data entry and statistical description and analysis.According to whether the quantitative data conform to normal distribution,t-test or nonparametric statistical test was conducted,and analysis of variance was used for comparison between groups.Qualitative data are tested by X test or Fisher exact probability test.Logistic regression analysis was used to analyze the related factors of complications.Results:(1)The study included data among the 1290 patients from tumor patients in 10 different departments of 4 Third-Grade Class-A Hospitals in a certain city.Amongthem,515 were in the PICC group,accounting for 40%,591 in the CVC group,accounting for 46%,and 184 in the TIVAP group,accounting for 14%.general surgery and thoracic surgery department included the largest number of catheters.According to the research results,PICC catheter is the most widely used in gynecology and obstetrics,accounting for 15.9%,while it is basically the same in oncology and radiotherapy,accounting for 11.7%,and it is the least used in tumor surgery,only 4.9%;CVC catheter is the most widely used in general surgery,as high as 40.4%,while it is less used in gastroenterology and Gynecology and Obstetrics;TIVAP catheter is basically the same in all departments,and should be used in neurosurgery Relatively less,accounting for 4.3%.(2)The results showed that among the 1290 patients included in the study,485 patients had complications,the total incidence of complications was 37.6%,among which allergy(166 cases),thrombus(106),infection(66)were the main complications.The incidence of complications in PICC group(36.1%)and CVC group(44.3%)was higher than that in TIVAP Group(20.1%).The complications of subclavian vein and cephalic vein were 42.6% and 44.4% respectively.The complications of basilic vein,internal jugular vein and brachial vein were 36.2%,35.7% and 35.7% respectively.(3)The results showed that there was no significant difference in allergic reactions among different indwelling,the incidence of thrombus and re indwelling catheter in one month was higher,60.4% and 52.6% respectively;the incidence of phlebitis gradually increased with the prolongation of indwelling time,as shown in table 3.6 and Figure 3.2;the incidence of infection,catheter rupture / TIVAP exposure and redness in one month was more serious,respectively 48.5%,45.0%and 66.7% respectively.We found that the incidence of catheter blockage decreased with the prolongation of catheter retention time,which may be related to catheter maintenance and sample collection.(4)In this study,167 patients were extubated due to complications.The incidence of unplanned extubation was 12.9%.Among the three kinds of central venous catheters,thrombus and infection were the main causes of unplanned extubation,among which CVC catheters had the highest rate of extubation due to infection,reaching 6.9%.(5)The results of this study through logistic single factor regression analysisshow that the catheterization season and catheter type are the influencing factors of catheter-related complications.See table 3.9 for details.Further multivariate analysis showed that catheterization in autumn(OR= 0.607,95% CI: 0.439,0.840)and TIVAP catheter(OR = 0.345,95% CI: 0.219,0.543)were protective factors for catheterrelated complications.The main results are shown in table 3.11.The results showed that spring(OR = 0.476,95% CI: 0.252,0.899)and autumn(OR = 0.194,95% CI:0.109,0.345)were the protective factors of allergy,while summer catheterization(OR = 2.710,95% CI: 1.005,7.309)was the risk factors of allergy.(6)Female,winter catheterization and catheter indwelling for more than one month are the influencing factors of catheter-related thrombus,and the main results are shown in table 3.13.The results showed that male(OR = 1.630,95% CI:1.065,2.496)and basilic vein(OR = 74.477,95% CI: 16.438,34.504)were the risk factors of catheter-related thrombus;autumn catheterization(OR = 0.512,95% CI:0.273,0.961),PICC catheterization(OR = 0.000,95% CI: 0.000,0.000),catheter retention for one month(OR = 0.459,95% CI: 0.253),0.831)is the protective factor of catheter-related thrombus.(7)There was a correlation between the period of catheterization and the occurrence of phlebitis.The main results are shown in table 3.15.The results showed that the risk factors of phlebitis were indwelling catheter in summer,indwelling catheter for more than one month,choosing expensive catheter,and there were no other complications and PICC catheter(OR = 0.000,95% CI: 0.000,0.000)was the protective factor of phlebitis.(8)The influencing factors of catheter-related infection were analyzed,and it was found that patients with allergic history,choice of catheterization in cephalic vein and one month of catheterization were the influencing factors of catheter-related infection;the results of multi factor analysis showed that patients without other complications,no history of allergy and choice of brachial vein catheterization were the protective factors of catheter-related infection,while the time of catheterization was one week Risk factors of catheter-related infection.Conclusions:(1)In this study,through the analysis of the current situation of the intravenous infusion device and the influencing factors of the main complications,CVC catheter is still the main way of inpatients in tumor patients.But compared with the other twokinds of catheter,the complications of CVC catheter are significantly higher.In clinical,the choice of catheter should be based on the wishes of patients and the judgment of clinicians.(2)The complications of different central venous catheters are relatively complex,and the types of complications are different.However,phlebitis,infection and thrombus are still the main complications of central vein catheterization,and also the main cause of unplanned extubation.Therefore,it is suggested that regular follow-up or follow-up should be carried out to strengthen the maintenance and management of catheters for high-risk population.(3)The main influencing factors of catheter-related complications were catheter season,catheter type,complications,history of allergy,selection of vein and catheter time. |
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