Objective: Our object is to study risk factors of tumor patients’ PICC catheter-related blood stream infection. Method: a retrospective analysis of data of 586 PICC catheterized patients was implemented, a univariate analysis of general data and catheterizing data of tumor patients was then carried out, and data of single factors with statistical significance were incorporated into multi-factor Logistic regression model for analysis. Results: PICC catheter-related blood stream infection occurred to 16 patients, and occurrence rate was 2.73%. Multi-factor Logistic regression analysis results showed that number of puncturing times, positioning method and maintenance frequency were risk factors for tumor patients’ peripherally inserted central catheter catheter-related blood stream infection, and odds risk values were respectively 8.762, 9.253 and 10.324. Conclusion: for tumor patients implanted with peripherally inserted central catheters, using ECG positioning during strict sterile operation and catheterizing process to avoid repeated puncturing and increasing maintenance frequency could effectively reduce occurrence of PICC catheter-related blood stream infection.
By virtue of advantages like once implantation with long-term utilization, few complications, possible bedside operation, reduction and prevention of risks caused by drug extravasation, etc., peripherally inserted central catheter (PICC) catheterization has been clinically applied within a large scope [
PICC-catheterized patients in central venous indwelling catheter registration database in one of the level-three class-A hospital from February in 2016 to February in 2017. During this time, a total of 756 patients were applied with a PICC catheterization. For the research purposes, we set up inclusion and exclusion criteria, and inclusion criteria were: 1) more than 18 years old; 2) diagnosed as malignant tumor for the first time through histopathology; 3) implanted with trivalve single-cavity high voltage-resistant PICC catheters by clinical nurse specialists; 4) PICC catheterizing time lasted at least 3 months. Exclusion criteria: 1) patients with preexistence of catheter-related thrombosis, deep venous thrombosis, catheter-related blood stream infection or lymphatic backflow obstruction; 2) Those who don’t have obtain information such as: death, abandon treatment and contact lost were deleted. Diagnostic criteria of PICC catheter-related blood stream infection were subjected to Prevention and Treatment Guidelines of Intravascular Catheter-Related Infection (2007) [
(Gender, age, occupation, degree of education, pathological type, clinical staging, complications, operation history and antibacterial agent application) and catheterizing data (number of puncturing times, positioning method, punctured limbs, catheterizing time, maintenance frequency and maintenance plane) of tumor patients.
Through unified training, 2 postgraduates and PICCC clinical nurse specialists looked up and recorded general data and catheterizing data of research objects who met criteria according to incorporation & exclusion criteria and medical record number.
SPSS 19.0 software was used for statistical analysis, measured data were expressed by x ¯ ± s , enumeration data were expressed by percentages, and comparison of means of two samples was implemented through t test. χ2 test was used for comparison of enumeration data. Logistic regression analysis of dichotomous outcome variables was used for multi-factor analysis.
16 cases among 586 patients suffered from PICC catheter-related blood stream infection, therefore occurrence rate was 2.73%: which was lower than what’s reported in past researches [
Univariate analysis results showed that the differences of PICC catheter-related blood stream infection from pathological type, complications, number of puncturing times, positioning method, maintenance frequency and maintenance place had statistical significance (P < 0.05), but differences of ICC catheter-related blood stream infection from gender, age, occupation, degree of education, clinical staging, operation history, use of antibacterial agents, punctured limbs and catheterizing time didn’t have statistical significance (P > 0.05).
Whether PICC-CRBSI happened was taken as a dependent variable (dependent variable: patients without occurrence of PICC catheter-related blood stream infection
Item | Number of patients without occurrence of the infection | Number of patients with occurrence of the infection | Statistical magnitude | P value |
---|---|---|---|---|
Gender | 0.871 | 0.351 | ||
Male | 384 (67.37) | 9 (56.25) | ||
Female | 186 (32.63) | 7 (43.75) | ||
Age | 61.26 ± 9.87 | 64.76 ± 9.87 | 1.091 | 0.463 |
Occupation | 0.643 | 0.587 | ||
Worker | 112 (19.65) | 5 (31.25) | ||
Peasant | 187 (32.81) | 4 (25.00) | ||
Teacher | 117 (20.53) | 2 (12.50) | ||
Others | 154 (27.02) | 5 (31.25) | ||
Degree of education | 0.448 | 0.503 | ||
Junior high school and below | 367 (64.39) | 9 (56.25) | ||
Senior high school land above | 203 (35.61) | 7 (43.75) | ||
Pathological type | ||||
Leukemia | 112 (19.65) | 12 (75.00) | 25.359 | <0.000* |
Non-leukemia | 458 (80.35) | 4 (25.00) | ||
Clinical staging | 1.952 | 0.162 | ||
I-II | 279 (48.95) | 5 (31.25) | ||
III-IV | 291 (51.05) | 11 (68.75) | ||
Complications | 14.103 | <0.000* | ||
YES | 95 (16.67) | 9 (56.25) | ||
NO | 475 (83.33) | 7 (43.75) | ||
Operation history | 0.143 | 0.202 | ||
YES | 251 (44.04) | 10 (62.50) | ||
NO | 319 (55.96) | 6 (37.50) | ||
Use of antibacterial agents | 0.249 | 0.313 |
YES | 309 (54.21) | 11 (68.75) | ||
---|---|---|---|---|
NO | 261 (45.79) | 5 (31.25) | ||
Number of puncturing times (times) | 20.955 | <0.000* | ||
1 | 421 (73.86) | 3 (18.75) | ||
>1 | 149 (26.14) | 13 (81.25) | ||
Positioning method | 30.027 | <0.000* | ||
Chest radiography | 108 (18.95) | 12 (75.00) | ||
ECG positioning | 462 (81.05) | 4 (25.00) | ||
Punctured limbs | 0.662 | 0.457 | ||
Left forearm | 297 (52.11) | 10 (62.50) | ||
Right forearm | 273 (47.89) | 6 (37.50) | ||
Catheterizing time (months) | 0.240 | 0.624 | ||
≤6 | 130 (22.81) | 5 (31.25) | ||
>6 | 440 (77.19) | 11 (68.75) | ||
Maintenance frequency (times-week) | 38.493 | <0.000* | ||
0 | 96 (16.84) | 13 (81.25) | ||
≥1 | 474 (83.16) | 3 (18.75) | ||
Maintenance place | 13.177 | <0.000* | ||
In the hospital | 389 (68.25) | 4 (25.00) | ||
Out of the hospital | 181 (31.75) | 12 (75.00) |
Note: *represents P < 0.05 representing that the difference has statistical significance.
Independent variable | Assignment method |
---|---|
Pathological type | 0 = non-leukemia; 1 = leukemia |
Complication | 0 = NO; 1 = YES |
Number of puncturing times | 0 = 1 times; 1 ≥ 1 times |
Positioning method | 0 = ECG positioning; 1 = chest radiography positioning |
Maintenance frequency | 0 ≥ 1 (times/week); 1 = 0 (times/week) |
Maintenance place | 0 = in-hospital maintenance; 1 = out-of-hospital maintenance |
Independent variable | B | SE | P | OR | 95%CI |
---|---|---|---|---|---|
Constant term | 13.42 | 4.652 | <0.001 | <0.001 | 4.652 - 23.632 |
Number of puncturing times | 3.782 | 0.746 | <0.001 | 8.762 | 4.053 - 23.685 |
Positioning method | 6.322 | 0.674 | <0.001 | 9.253 | 5.693 - 32.157 |
Maintenance frequency | 5.736 | 0.324 | 0.003 | 10.324 | 2.329 - 24.956 |
= 0, and patients with occurrence of PICC catheter-related blood stream infection = 1) and variables with statistical significance (P < 0.05) in univariate analysis were incorporated into Logistic regression mode, and results showed that number of puncturing times, positioning method and maintenance frequency were risk factors of tumor patients with concurrence of PICC catheter-related blood stream infection. Odds risk values of multiple times of puncturing, chest radiography positioning and low maintenance frequency (≤1 times/week) were respectively 8.762, 9.253 and 10.324.
The study results showed that occurrence rate of symptomatic PICC-CRBSI was 2.73%, which was similar to what’s reported by many of the other scholars. 16 patients with occurrence of PICC-CRDSI in this study experienced obvious clinical symptoms, but PICC-CRBSI without delete typical clinical symptoms might exist in practical work, The occurrence rate of PICC-CRBSI might be far higher than existing reports, which might be related to the fact that high fever occurring in chemoradiotherapy of tumor patients was usually deemed as tumor-related fever without consideration of PICC-CRBSI. This indicated that medical personnel should blindly use antibiotics when faced with high fever of tumor patients carrying catheters not simply considering it as tumor-related fever, but instead, comprehensively considering whether patients had risks of PICC-CRBSI and make etiological quantitative examination when necessary. Antibiotics should be reasonably used according to etiological examination results or optimal intervention measures should be selected according to standard treatment process of PICC-CRBSI to ensure patient safety.
The study results indicated that repeated puncturing was a risk factor of PICC-CRBSI occurrence with similar finding to past studies, all of which believed that the more times of puncturing during catheterizing process, the higher the risks of inducing PICC-CRBSI would be [
Study results found that PICC-CRBSI risk of X-ray chest radiography positioning was 9.253 times of ECG positioning. To reach the effect of once implantation with long-term use, the position of the head of PICC is of vital importance. Nowadays most hospitals in China still take X-ray chest radiograph positioning as the only “gold standard” but its disadvantages have gradually been highlighted with disciplinary progress, The following X-ray chest radiograph and may be used only after catheterization. If PICC catheter head has malposition, then it’s necessary to readjust the catheter or re-implant the catheter after removal. During the process, the catheter exposed in the air has been polluted so that it’s difficult to achieve strict sterilization during catheter debugging process, consequently bacteria adhered onto the catheter will possibly cause bacterial infection [
Risk of PICC-CRBSI occurrence due to irregular maintenance in this study was 10.324 times of regular maintenance. As a new venous treatment means, PICC has been widely carried out in superior hospitals and have penetrated into primary hospitals gradually. At present, most county-level hospitals and all healthy clinics in towns lack personnel mastering PICC maintenance technique due to disadvantages in aspects of hardware and personnel. Consequently, regular maintenance can’t be achieved during therapeutic intermission of many patients so that loose herbal application, bacterial reproduction and infection are then caused. Most research objects selected in this study came from rural areas, great difficulties existed in maintenance per week because of factors like their economic status, traffic condition and scattered regional distribution. Many patients chose self-care at home, which not achieve sterilization and increased infection risk [
Only a retrospective analysis of 586 PICC catheterized patients was made in this study. Logistic regression model was used to analyze risk factors of patients with PICC-CRBSI, but in practical work, many risk factors exist before, in the middle of and after catheterization. No final conclusion has been formed for many potential risk factors and relative risk degree of each risk factor has not been further verified. Therefore, large-sample case-control study should be carried out in future study to accurately explore into risk factors of PICC-CRBSI so as to realize early-stage recognition of risk factors and judge possibility of CRBSI occurrence. Intervention should be made in key link to ensure patient safety.
Song, J., Yan, Y., Yan, H., Wang, C.L. and Hu, J.-E. (2017) Paper Title. Yangtze Medicine, 1, 169-177. https://doi.org/10.4236/ym.2017.13017