癌症患者外周静脉穿刺中心静脉置管相关并发症：一项超过50000导管日的前瞻性研究

Peripherally inserted central catheter-related complications in cancer patients: a prospective study of over 50,000 catheter days.

作者信息

Kang Junren, Chen Wei, Sun Wenyan, Ge Ruibin, Li Hailong, Ma Enling, Su Qingxia, Cheng Fang, Hong Jinhua, Zhang Yuanjuan, Lei Cheng, Wang Xinchuan, Jin Aiyun, Liu Wanli

机构信息

Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China.

Department of Nursing, NanFang Hospital, Southern Medical University, Guangzhou - China.

出版信息

J Vasc Access. 2017 Mar 21;18(2):153-157. doi: 10.5301/jva.5000670. Epub 2017 Feb 8.

DOI:10.5301/jva.5000670

PMID:28218366

Abstract

PURPOSE

To evaluate incidence and risk factors of peripherally inserted central catheter (PICC)-related complications in cancer patients.

METHODS

A prospective, multicenter, cohort study of cancer patients with PICC insertion was performed from February 1, 2013 to April 24, 2014. All patients were monitored in clinic until PICCs were removed. The primary endpoint was PICC removal due to complications. Patient-, catheter- and insertion-related factors were analyzed in univariable and multivariable logistic regression analysis to identify significant independent risk factors for PICC-related complications.

RESULTS

There were 477 cancer patients included, for a total of 50,841 catheter-days. Eighty-one patients (17.0%) developed PICC-related complications, with an incidence of 1.59 per 1000 catheter days. Thirty-six (7.5%) PICCs were removed because of complications. The most common complications were skin allergy (4.6%), catheter occlusion (3.4%) and accidental withdrawal (2.3%). Nine (1.9%) patients developed symptomatic upper extremity deep venous thrombosis (UEDVT) and central line associated bloodstream infection (CLABSI) was shown in six (1.3%) PICCs with an infection rate 0.12 per 1000 catheter days. In multivariable analysis, body mass index (BMI) >25 (odds ratio, 2.09; 95% confidence interval, 1.26-3.47, p = 0.004) was shown to be a significant risk factor for PICC complications.

CONCLUSIONS

Cancer patients with BMI greater than 25 were more likely to have PICC complications.

摘要

目的

评估癌症患者经外周静脉穿刺中心静脉置管（PICC）相关并发症的发生率及危险因素。

方法

对2013年2月1日至2014年4月24日期间行PICC置管的癌症患者进行一项前瞻性、多中心队列研究。所有患者在门诊接受监测，直至拔除PICC。主要终点是因并发症拔除PICC。在单变量和多变量逻辑回归分析中分析患者、导管和置管相关因素，以确定PICC相关并发症的显著独立危险因素。

结果

共纳入477例癌症患者，累计导管留置天数为50841天。81例患者（17.0%）发生PICC相关并发症，发生率为每1000导管日1.59例。36例（7.5%）PICC因并发症被拔除。最常见的并发症是皮肤过敏（4.6%）、导管堵塞（3.4%）和意外拔管（2.3%）。9例（1.9%）患者发生有症状的上肢深静脉血栓形成（UEDVT），6例（1.3%）PICC发生中心静脉导管相关血流感染（CLABSI），感染率为每1000导管日0.12例。多变量分析显示，体重指数（BMI）>25（比值比，2.09；95%置信区间，1.26 - 3.47，p = 0.004）是PICC并发症的显著危险因素。