Nakano Yoshihisa, Kondo Takahisa, Murohara Toyoaki, Yamauchi Kazunobu
Toin Hospital, Toin-cho, Japan.
Nagoya University Graduate School of Medicine, Japan.
Gerontol Geriatr Med. 2020 Feb 18;6:2333721420906922. doi: 10.1177/2333721420906922. eCollection 2020 Jan-Dec.
Peripherally inserted central catheters (PICCs) facilitate the treatment of several diseases. Here, we assessed the clinical course of elderly patients with dementia using PICCs. This retrospective observational study was conducted at a single dementia treatment center. PICCs were used in elderly inpatients with dementia who required (a) intravenous therapy, supplemental parenteral nutrition, and dysphagia rehabilitation during acute illness; (b) end-of-life care; (c) total parenteral nutrition (TPN); or (d) an alternative to peripheral vascular (PV) access. Fifty-nine patients were enrolled (83.5 ± 6.9 years): 61% were in the acute treatment group, and 17% were in the end-of-life care group. The median catheter lifespan was 42 (23-87.5) days. The incidence of catheter-related bloodstream infection was 0.22 per 1,000 PICC-days, and that of deep venous thrombosis was 0.66 per 1,000 PICC-days. Among the patients in acute treatment group, 19% resumed sufficient oral intake after the treatment using PICC, and 36% resumed oral intake of gelatin-like food. Among the patients in the end-of-life care group, 91% received intravenous fluids continuously until death by initially inserted PICC. In elderly patients with dementia, PICCs might be one of the options during the treatment of acute illness as well as for prolonged support during end-of-life care.
经外周静脉穿刺中心静脉导管(PICC)有助于多种疾病的治疗。在此,我们评估了使用PICC的老年痴呆患者的临床病程。这项回顾性观察研究在一个单一的痴呆治疗中心进行。PICC用于患有痴呆的老年住院患者,这些患者需要:(a)在急性疾病期间进行静脉治疗、补充肠外营养和吞咽困难康复;(b)临终关怀;(c)全胃肠外营养(TPN);或(d)作为外周血管(PV)通路的替代方案。共纳入59例患者(83.5±6.9岁):61%在急性治疗组,17%在临终关怀组。导管中位使用寿命为42(23 - 87.5)天。导管相关血流感染的发生率为每1000个PICC日0.22例,深静脉血栓形成的发生率为每1000个PICC日0.66例。在急性治疗组的患者中,19%在使用PICC治疗后恢复了充足的经口摄入量,36%恢复了明胶样食物的经口摄入。在临终关怀组的患者中,91%通过最初插入的PICC持续接受静脉输液直至死亡。在老年痴呆患者中,PICC可能是急性疾病治疗期间以及临终关怀期间长期支持的选择之一。