Chang Li-Xian, Chen Yu-Wen, Wang Meng-Chuan, Zhao Su-Yu, Wang Min, Tian Yang, Tang Li, Wang Jun-Xia, Yang Miao-Miao, Zhu Xiao-Fan, Zhang Hui-Min
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
Ann Palliat Med. 2021 Mar;10(3):2971-2978. doi: 10.21037/apm-20-1771. Epub 2021 Mar 12.
Although the peripherally inserted central catheter (PICC) has been widely utilized, there is still a lack of large sample size-based relevant risk factor investigation for the children with blood diseases in a single center of China.
We performed a retrospective cohort study through including a total of 2,974 cases aged 0-18 years with blood diseases and PICC insertion. Success rates of different PICC operation techniques were compared. Targeting the common PICC-related complications, we performed the univariate and multivariate logistic regression analyses. Then, based on the screened risk factors, the prediction modeling analysis of binary logistic regression was conducted.
The "B-ultrasound plus Seldinger technology" showed a higher success rate of PICC placement than the "non-assistive blind insertion". The catheter type was closely linked to the occurrence of catheter occlusion. The age, insertion site, and catheter type might be the risk factors of phlebitis, while the insertion site, operation season, and catheter type might be associated with catheter fracture. Furthermore, based on these risk factors, we established the nomogram prediction models of phlebitis, rash occurrence, and catheter fracture, respectively, which shows a good predictive ability and a moderate level of predictive accuracy.
Our findings first shed new light on the preoperative estimation of the risk factors of PICCrelated complications for the children with blood diseases in China.
尽管经外周静脉穿刺中心静脉置管(PICC)已被广泛应用,但在中国单一中心,仍缺乏针对血液病患儿基于大样本量的相关危险因素调查。
我们进行了一项回顾性队列研究,纳入了总共2974例年龄在0至18岁的血液病患儿且进行了PICC置管。比较了不同PICC操作技术的成功率。针对常见的PICC相关并发症,我们进行了单因素和多因素逻辑回归分析。然后,基于筛选出的危险因素,进行了二元逻辑回归的预测模型分析。
“超声引导下塞丁格技术”显示PICC置管成功率高于“非辅助盲穿”。导管类型与导管堵塞的发生密切相关。年龄、置管部位和导管类型可能是静脉炎的危险因素,而置管部位、操作季节和导管类型可能与导管断裂有关。此外,基于这些危险因素,我们分别建立了静脉炎、皮疹发生和导管断裂的列线图预测模型,其显示出良好的预测能力和中等水平的预测准确性。
我们的研究结果首次为中国血液病患儿PICC相关并发症危险因素的术前评估提供了新的思路。