目的:肿瘤患者外周置入中心静脉导管(PICC)相关并发症的发生率高于非肿瘤患者。然而,随着时间的推移,具体并发症的发生模式尚不清楚.目的探讨肿瘤化疗患者PICC相关并发症的临床特点。
方法:这种前瞻性,观察性研究在中国西部一所大学附属医院进行。招募接受PICC插入抗癌治疗的癌症患者,并随访至导管移除后第一周。任何并发症,包括发生时间和结果,被记录下来。根据Kaplan-Meier曲线分析确定特定PICC相关并发症随时间变化的轨迹。
结果:在分析的233例患者中,近一半(n=112/233,48.1%)发生了150起PICC相关并发症事件.最常见的是有症状的导管相关血栓(CRT)(n=37/233,15.9%),医用粘合剂相关皮肤损伤(MARSI)(n=27/233,11.6%),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,插入部位出血被归类为“早发型”组,主要发生在插入后的第一个月内。导管骨折和导管相关血流感染被归类为“迟发性”组,发生在插入后第二个月。MARSI,导管移位,遮挡,和插入部位感染被归类为在整个导管留置期间持续发生的“持续发作”组。112例PICC相关并发症患者中,50例(44.6%)患者因并发症而拔除导管,62例(55.4%)患者通过常规干预措施成功保留导管直至治疗完成.非计划拔除导管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%),占计划外拔除导管病例总数的58.0%(n=29/50,58.0%)。有并发症的患者在成功干预(130.5±32.1天)和无并发症的患者(138.2±46.4天)之间的导管留置时间没有显着差异(t=1.306,p=0.194;log-rank检验=2.610,p=0.106)。
结论:PICC相关并发症在接受化疗的癌症患者中相当常见。PICC相关并发症的时间分布各异,医务人员应制定针对特定时间的预防方案。因为超过一半的PICC相关并发症患者可以通过常规干预措施来治疗,PICC仍然是接受短期化疗的癌症患者的优先事项。该研究于2019年2月8日在中国临床试验注册中心注册(注册号:ChiCTR1900024890)。
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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).