Department of Nursing, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China.
Division of Abdominal Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province, P.R. China.
BMC Cancer. 2023 Sep 22;23(1):894. doi: 10.1186/s12885-023-11413-0.
The incidence of peripherally inserted central catheter (PICC)-related complications is higher in cancer patients than in noncancer patients. However, the pattern of specific complication occurrence over time remains unclear. The purpose of this study was to investigate the clinical characteristics of PICC-related complications in cancer patients undergoing chemotherapy.
This prospective, observational study was conducted at a university-affiliated hospital in Western China. Cancer patients undergoing PICC insertion for anticancer treatment were recruited and followed up until the first week after catheter removal. Any complications, including occurrence time and outcomes, were recorded. The trajectory of specific PICC-related complications over time were identify based on the Kaplan‒Meier curve analysis.
Of the 233 patients analyzed, nearly half (n = 112/233, 48.1%) developed 150 PICC-related complication events. The most common were symptomatic catheter-related thrombosis (CRT) (n = 37/233, 15.9%), medical adhesive-related skin injury (MARSI) (n = 27/233, 11.6%), and catheter dislodgement (n = 17/233, 7.3%), accounting for 54.0% (n = 81/150, 54.0%) of total complications events. According to Kaplan‒Meier curve analysis, symptomatic CRT, pain, phlebitis, and insertion site bleeding were classified as the "early onset" group mainly occurring within the first month post-insertion. Catheter fracture and catheter-related bloodstream infection were classified as the "late onset" group occurring after the second month post-insertion. MARSI, catheter dislodgement, occlusion, and insertion site infection were classified as the "persistent onset" group persistently occurring during the whole catheter-dwelling period. Among the 112 patients with PICC-related complications, 50 (44.6%) patients had their catheters removed due to complications, and 62 (55.4%) patients successfully retained their catheters until treatment completion through conventional interventions. The major reasons for unplanned catheter removal were catheter dislodgement (n = 12/233, 5.2%), symptomatic CRT (n = 10/233, 4.3%), and MARSI (n = 7/233, 3.0%), accounting for 58.0% (n = 29/50, 58.0%) of the total unplanned catheter removal cases. Catheter dwelling times between patients with complications under successful interventions (130.5 ± 32.1 days) and patients with no complications (138.2 ± 46.4 days) were not significantly different (t = 1.306, p = 0.194; log-rank test = 2.610, p = 0.106).
PICC-related complications were pretty common in cancer patients undergoing chemotherapy. The time distribution of PICC-related complications varied, and medical staff should develop time-specific protocols for prevention. Because more than half of the patients with PICC-related complications could be managed with conventional interventions, PICCs remain a priority for cancer patients undergoing short-term chemotherapy. The study was registered in 02/08/2019 at Chinese Clinical Trial Registry (registration number: ChiCTR1900024890).
与非癌症患者相比，癌症患者外周中心静脉置管（PICC）相关并发症的发生率更高。然而，特定并发症随时间发生的模式仍不清楚。本研究的目的是调查接受化疗的癌症患者中 PICC 相关并发症的临床特征。
这项前瞻性观察性研究在我国西部的一所大学附属医院进行。招募接受 PICC 置管以进行抗癌治疗的癌症患者，并在导管移除后的第一周进行随访。记录任何并发症，包括发生时间和结局。根据 Kaplan-Meier 曲线分析确定特定 PICC 相关并发症的随时间变化轨迹。
在分析的 233 名患者中，近一半（n=112/233，48.1%）发生了 150 次 PICC 相关并发症事件。最常见的是有症状的导管相关血栓形成（CRT）（n=37/233，15.9%）、医用胶粘剂相关皮肤损伤（MARSI）（n=27/233，11.6%）和导管移位（n=17/233，7.3%），占总并发症事件的 54.0%（n=81/150，54.0%）。根据 Kaplan-Meier 曲线分析，有症状的 CRT、疼痛、静脉炎和置管部位出血被归类为“早期发作”组，主要发生在置管后第一个月内。导管骨折和导管相关性血流感染被归类为“晚期发作”组，发生在置管后第二个月后。MARSI、导管移位、阻塞和置管部位感染被归类为“持续发作”组，在整个导管留置期间持续发生。在 112 名有 PICC 相关并发症的患者中，50 名（44.6%）患者因并发症而拔除导管，62 名（55.4%）患者通过常规干预成功保留导管直至治疗结束。计划外导管拔除的主要原因是导管移位（n=12/233，5.2%）、有症状的 CRT（n=10/233，4.3%）和 MARSI（n=7/233，3.0%），占总计划外导管拔除病例的 58.0%（n=29/50，58.0%）。成功干预的并发症患者（130.5±32.1 天）和无并发症患者（138.2±46.4 天）的导管留置时间无显著差异（t=1.306，p=0.194；log-rank 检验=2.610，p=0.106）。
在接受化疗的癌症患者中，PICC 相关并发症相当常见。PICC 相关并发症的时间分布不同，医务人员应制定特定时间的预防方案。由于超过一半的 PICC 相关并发症患者可以通过常规干预措施进行管理，因此 PICC 仍然是接受短期化疗的癌症患者的首选。该研究于 2019 年 2 月 8 日在中国临床试验注册中心（注册号：ChiCTR1900024890）注册。
