癌症治疗期间外周静脉导管失败的固有和可修改风险因素：一项前瞻性队列研究。
Inherent and modifiable risk factors for peripheral venous catheter failure during cancer treatment: a prospective cohort study.
机构信息
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.
Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
出版信息
Support Care Cancer. 2021 Mar;29(3):1487-1496. doi: 10.1007/s00520-020-05643-2. Epub 2020 Jul 24.
PURPOSE
To identify modifiable and non-modifiable risk factors for peripheral intravenous catheter (PIV) failure among patients requiring intravenous treatment for oncology and haematology conditions.
METHODS
A single-centre prospective cohort study was conducted between October 2017 and February 2019. Adult in-patients requiring a PIV for therapy were prospectively recruited from two cancer units at a tertiary hospital in Queensland, Australia. The primary outcome was a composite of complications leading to PIV failure (local and bloodstream infection; occlusion; infiltration/extravasation; leakage; dislodgement; and/or phlebitis). Secondary outcomes were (i) PIV dwell time; (ii) insertion and (iii) failure of a CVAD; (iv) adverse events; (v) length of hospital stay. Outcomes were investigated using Bayesian multivariable linear regression modelling and survival analysis.
RESULTS
Of 200 participants, 396 PIVs were included. PIV failure incidence was 34.9%; the most common failure type was occlusion/infiltration (n = 74, 18.7%), then dislodgement (n = 33, 8.3%), and phlebitis (n = 30, 7.6%). While several patient and treatment risk factors were significant in univariable modelling, in the final multivariable model, only the use of non-sterile tape (external to the primary dressing) was significantly associated with decreased PIV dislodgement (hazard ratio 0.06, 95% confidence interval 0.01, 0.48; p = 0.008).
CONCLUSION
PIV failure rates among patients receiving cancer treatment are high, the sequelae of which may include delayed treatment and infection. Larger studies on risk factors and interventions to prevent PIV failure in this population are needed; however, the use of secondary securements (such as non-sterile tape) to provide further securement to the primary PIV dressing is particularly important.
TRIAL REGISTRATION
Study methods were registered prospectively with the Australian New Zealand Clinical Trials Registry on the 27 March 2017 (ACTRN12617000438358); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372191&isReview=true.
目的
确定需要接受肿瘤和血液学治疗的患者外周静脉导管（PIV）失败的可改变和不可改变的危险因素。
方法
本研究为 2017 年 10 月至 2019 年 2 月在澳大利亚昆士兰州一家三级医院的两个癌症病房进行的单中心前瞻性队列研究。前瞻性招募需要 PIV 治疗的成人住院患者。主要结局是导致 PIV 失败的并发症的综合表现（局部和血流感染；阻塞；浸润/外渗；渗漏；脱位；和/或静脉炎）。次要结局包括（i）PIV 留置时间；（ii）插入和（iii）CVAD 失败；（iv）不良事件；（v）住院时间。使用贝叶斯多变量线性回归模型和生存分析研究结局。
结果
200 名参与者中，纳入 396 例 PIV。PIV 失败发生率为 34.9%；最常见的失败类型是阻塞/浸润（n = 74，18.7%），其次是脱位（n = 33，8.3%）和静脉炎（n = 30，7.6%）。虽然在单变量模型中，一些患者和治疗危险因素具有统计学意义，但在最终的多变量模型中，只有使用非无菌胶带（位于主要敷料外部）与 PIV 脱位减少显著相关（风险比 0.06，95%置信区间 0.01，0.48；p = 0.008）。
结论
接受癌症治疗的患者中 PIV 失败率较高，其后果可能包括治疗延迟和感染。需要更大规模的研究来确定该人群中 PIV 失败的危险因素和干预措施；然而，使用二级固定装置（如非无菌胶带）对 PIV 敷料进行进一步固定尤为重要。
试验注册
研究方法于 2017 年 3 月 27 日在澳大利亚和新西兰临床试验注册中心（ACTRN12617000438358）进行了前瞻性注册；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372191&isReview=true。
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