Objective To compare the incidence of complications of two maintenance modes caused by peripherally inserted central catheter (PICC) in discharged patients with tumor, in order to provide a clinical evidence for the selection of appropriate maintenance mode of PICC for such patients.Methods We enrolled 217 tumor patients placed PICC who were discharged from Oncology Department, the First Affiliated Hospital of Guangxi Medical University after receiving inpatient treatment between May 2015 and July 2016 and divided them into the control group (136 cases) and the observation group (81cases) according to the wishes of the patients and their family members. Both groups received the conventional hospital-based maintenance of PICC, the observation group additionally received home-based maintenance of PICC (PICC line flushing and sealing, replacement of dressing, heparin cap or needle-free connector) carried out by patient's family members. Comparisons of the incidence of PICC-related complications (e.g. catheter-related bloodstream infection, tension blisters, catheter dislodgement, allergic dermatitis, puncture site infection, deep venous thrombosis, and catheter blockage) of two groups were performed.Results After excluding the dropouts, the data of 127 patients in the control group and 75 patients in the observation group were collected in the study. The comparisons indicated that the incidence of catheter dislodgement and tension blisters were lower in the control group than in the observation group (P<0.05); in addition, the incidence of allergic dermatitis in the observation group was lower than that in the control group (P<0.05). In the first three times of catheter maintenance, the control group showed a significantly lower incidence of tension blisters, catheter dislodgement and puncture site infection compared with the observation group (P<0.05), whereas there were no catheter-related bloodstream infection, deep venous thrombosis, and catheter blockage in the two groups. From the fourth time of catheter maintenance to the end of this study, the incidence of allergic dermatitis in the observation group was significantly lower than that in the control group (P<0.05).Conclusion This study indicates that home-based maintenance of PICC for discharged tumor patients placed PICC implemented by patient's family members can reduce the incidence of catheter-induced allergic dermatitis without increasing the incidence of catheter associated bloodstream infection, deep venous thrombosis, and catheter blockage. However, this maintenance mode of PICC needs to be further improved in a variety of ways such as strengthening the related training and assessment of the performance of patients and their family members before real operation, in order to reduce the incidence of PICC-related complications and ensure patient safety.%目的 比较经外周静脉置入中心静脉导管(PICC)带管肿瘤出院患者两种导管维护方式并发症的发生情况,为PICC带管肿瘤出院患者选择合适的维护方式提供理论支持.方法 选取2015年5月—2016年7月在广西医科大学附属第一医院肿瘤科住院的217例PICC带管肿瘤出院患者,按照患者及其家属意愿将其分为对照组(n=136)和观察组(n=81).对照组常规返院进行导管维护;观察组在此基础上由患者家属进行导管维护(冲管及封管、敷料的更换、肝素帽或无针接头的更换).比较两组患者置管至拔管期间PICC导管相关并发症(导管相关性血流感染、张力性水泡、导管脱出、过敏性皮炎、穿刺口感染、深静脉血栓、导管堵塞)发生情况.结果 剔除脱落患者,最终对照组127例、观察组75例完成研究.置管至研究结束,对照组张力性水泡、导管脱出发生情况好于观察组(P<0.05);观察组过敏性皮炎发生情况好于对照组(P<0.05).前3次导管维护中,两组均未发生导管相关性血流感染、深静脉血栓、导管堵塞;对照组张力性水泡、导管脱出、穿刺口感染发生情况好于观察组(P<0.05).观察组第4次导管维护至拔管期间过敏性皮炎发生情况好于对照组(P<0.05).结论 由家属对PICC带管肿瘤出院患者进行导管维护可以降低导管相关的过敏性皮炎发生率,且不增加导管相关性血流感染、深静脉血栓、导管堵塞的发生率;但家属进行导管维护的方式需进一步完善,尤其加强对患者及其家属前期培训及考核,进而减少并发症的发生,保证患者安全.
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