Cross-sectional Investigation And Influencing Factors Analysis Of PICC Catheter-associated Skin Impairment In Patients With Tumor In Jingzhou City

Objectives(1)To develop a current status questionnaire for skin injury associated with Peripherally Inserted Central Catheter;(2)To understand the current situation of PICC catheter-associated skin impairment in some hospitals at all levels in Jingzhou City;(3)To explore the risk factors for PICC catheter-associated skin impairment;(4)Suggestions for the prevention of PICC catheter-associated skin impairment were proposed.Methods On the basis of literature review,the research group discussed the development of a tool for investigating the current situation of catheter-associated skin impairment(CASI).The reliability and feasibility of CASI status questionnaire developed by ourselves was used in the field investigation of some hospitals in Jingzhou.Unified training of data collectors was conducted to determine a unified survey day,survey process and method,and data collection was conducted for patients with PICC catheterization meeting the inclusion criteria.All data results were analyzed by SPSS20.0 statistical software.Measurement data were expressed as mean ± standard deviation,and frequency and percentage of counting data were expressed as measurement data.Univariate analysis was performed by univariate ANOVA and X2 test.The items of univariate analysis results(P<0.05)were set as independent variables,and then the Logistic regression model was introduced to conduct disordered multi-classification Logistic analysis.P<0.05 was considered statistically significant.Results The results of the research tool construction are as follows:(1)The CASI current status research tool includes four first-level indicators;General data,disease data,PICC catheterization and maintenance data,CASI data and 31 secondary indicators.(2)The positive coefficient of Delphi experts in three rounds was 100%(questionnaire recovery rate);The degree of expert authority was 0.81;The Kendall harmony coefficient of the three rounds of expert advice was 0.15(P=0.013)、0.20(P=0.000)、0.18(P=0.001),respectively.The variation coefficient of each index of the first round of expert consultation was 0.00~0.28,the second round was 0.00~0.26,and the third round was 0.00~0.16.Feasibility analysis results: the utility rate and convenience rate were 95.34% and 90.7%,respectively,and the average filling time per questionnaire was(14.44±2.92)min.(3)The results of cross-sectional investigation showed that there were 173 cases of catheter-related skin injury in PICC catheterization patients,among which 97 cases were local infection,accounting for 56.1%.There were 29 cases of puncture site exudation(16.8%),contact dermatitis(21.4%,37 cases of irritant dermatitis,4.6% of allergic dermatitis),mechanical injury(1.2%,2 cases of tension injury).(4)Univariate analysis results showed that patients’ catheterization time,age,underlying disease,skin moisture and sweat,PICC maintenance on time,maintenance hospital grade,and chemotherapy interval were all P<0.05.(5)The results of disorganized multi-classification Logistic analysis showed that PICC catheterization patients with 150~199 days of catheterization,diabetes mellitus,moist and sweaty skin,and intermittent chemotherapy were more likely to develop local infection of CASI(OR>1.0,P<0.05),using puncture site exudes as the reference group.Patients with PICC catheterization with moist and sweaty skin and intermittent chemotherapy were more likely to develop CASI contact dermatitis(OR>1.0,P<0.05).Patients aged 18~69 years were less likely to develop local infection of CASI than patients aged 70~79 years(OR<1.0,P<0.05),and patients aged 70~79 years were more likely to develop local infection of CASI.Conclusions(1)The CASI questionnaire made by ourselves in this study has good reliability and feasibility,and is suitable for the current situation investigation of clinical CASI.(2)The results of cross-sectional survey showed that the incidence of CASI was high in people aged 70 ~ 79 years,and local infection was the most common.Patients with PICC catheterization complicated with diabetes are the high-risk population for CASI.Patients with PICC catheterization with excessive sweating were more likely to develop CASI.The intermittent period of chemotherapy was the frequent occurrence period of CASI.The time spent in tube affects the occurrence of CASI.