经外周中心静脉置管化疗后置管侧上肢静脉血栓形成分析及对策

目的分析恶性肿瘤患者经外周中心静脉置管(PICC)化学治疗后置管侧上肢静脉血栓发生原因并提出防治对策。方法观察160例经PICC化疗的不同恶性肿瘤患者置管侧上肢静脉血栓发生数及发生时间,分析血栓形成的可能原因并提出防治对策。结果本组共发生置管侧上肢静脉血栓4例,其中肺肿瘤患者2例,胃肠道肿瘤患者2例。PICC上肢静脉血栓发生率2.5%。血栓发生时间多数在化疗后7~14 d。结论 PICC化疗后,7~14 d是置管侧上肢静脉血栓发生的高危期。肿瘤及化疗药物、穿刺血管损伤、导管头端异位、上肢活动是血栓形成的主要原因。因此,合理地选择穿刺血管、准确定位,肿瘤患者治疗全过程的严密观察和化疗后凝血指标的监控,以及出院后的随访,能够有效预防置管侧上肢静脉血栓的发生。     

头颈部肿瘤患者PICC相关性上肢静脉血栓危险因素的前瞻性研究

目的探讨头颈部肿瘤患者PICC相关性上肢静脉血栓形成的发生率和危险因素,为预防血栓形成提供依据。方法采用前瞻性队列研究,采用便利抽样法选择2016年1月—2018年3月行PICC置管的1137例头颈部肿瘤患者进行B超随访检查上肢静脉血栓发生情况。采用单因素和多因素Cox回归确定PICC相关性上肢深静脉血栓危险因素。结果3.6%(41/1137)患者发生PICC相关性上肢静脉血栓。多因素Cox回归分析显示:年龄越大(RR=1.04,95%CI:1.01~1.07,P=0.013)、有PICC置管史(RR=3.22,95%CI:1.53~6.77,P=0.002)、送管次数越多(RR=1.98,95%CI:1.30~3.00,P=0.001)是PICC相关性上肢静脉血栓形成的独立危险因素。结论头颈部肿瘤患者PICC相关性上肢静脉血栓形成的发生率相对较低,年龄大、有PICC置管史、送管次数多是头颈部肿瘤患者PICC相关性上肢静脉血栓形成的独立危险因素,针对该类患者采取积极的干预措施,有望降低PICC相关性血栓的发生率。     

肿瘤患者行PICC置管后并发静脉血栓的原因及护理对策

目的:总结肿瘤患者行经外周静脉穿刺中心静脉(PICC)置管后并发静脉血栓的原因,以探讨防治静脉血栓的护理对策。方法:回顾性分析2012年1月-2014年4月我科住院的254例行PICC置管的肿瘤患者中并发静脉血栓9例的临床护理资料。结果:本组254例肿瘤患者中,PICC置管后并发静脉血栓率是3.5%(9/254)例;9例并发静脉血栓中,肺癌5例,乳腺癌2例,食管癌、胃癌各1例;9例中7例拔除PICC管,2例予抗凝、祛聚、降纤等治疗后好转,无需拔除PICC管。结论:肿瘤患者行PICC置管后并发静脉血栓的原因可能与其高凝状态、化疗药物、置管等因素有关;早期预见性的评估和判断静脉血栓的发生,预防性使用抗凝、祛聚药物及正确的护理等综合措施可减少静脉血栓的发生。     

肘上置人PICC导管的临床效果观察

目的 明确肘上置入PICC导管的优点,为临床护理工作提供参考依据.方法 采用方便抽样的方法,将100例置管患者分为两组.对照组选择肘下两横指处为穿刺点置管,实验组选择肘上2～3 cm为穿刺点置管.结果实验组穿刺点渗血、静脉炎、导管移位及非计划性拔管的发生率明显低于对照组(P＜0.05).结论肘上2～3 cm置入PICC导管方法优于肘下两横指处穿刺点置管法.在临床护理工作中,应该大力提倡肘上2～3 cm置人PICC导管的方法.     

湿热敷预防PICC置管患者静脉炎的效果

目的探讨湿热敷对PICC置管患者发生静脉炎的预防。方法选取2013年1—12月收治入院的行PICC置管肿瘤患者200例,随机分为观察组与对照组,每组100例。对照组实施常规护理,观察组在此基础上给予湿热敷,在确定置管后24 h后无渗血、红肿后,于穿刺点上方近心端2~20 cm处给予50~60℃湿毛巾绕手臂环热敷,通过替换毛巾保持湿敷温度,每次20 min,每日2次,共1周。通过手触和外观确定穿刺静脉走形方向是否存在红、肿、条索结节判断静脉炎发生。观察2组患者静脉炎发生次数和发生比例。结果观察组患者静脉炎发生率显著低于对照组为（2%比10%,P〈0.05）,2组比较差异具有统计学意义。结论对肿瘤患者PICC置管后给予湿热敷护理,能够减少肿瘤患者PICC置管后静脉炎的发生,提高患者依从性,增加患者对护理服务的满意度。     

上肢PICC穿刺外测量置管长度方法研究

[目的]探讨经外周静脉置入中心静脉导管(PICC)置入长度的最佳测量方法。[方法]选择2009年4月—2012年11月行PICC置管的肿瘤病人227例,随机分为两组,对照组按照PICC常规操作步骤进行测量,观察组采用改良"一"字法:采用外测量时从右上肢预穿刺点沿静脉走向到对侧(即左侧)胸锁关节外侧缘加1cm;从左上肢预穿刺点沿静脉走向到对侧(即右侧)胸锁关节外侧缘加2cm。比较两组PICC导管置入上腔静脉的成功率、置管长度、外测量时间、置管后病人的心脏不良反应等。[结果]观察组置管达上腔静脉成功率高于对照组;观察组较对照组的置管长度短、测量时间少、置管后心脏不良反应少。[结论]改良"一"字法是PICC置管至理想位置的最佳测量方法。     

肿瘤化疗患者PICC相关性上肢静脉血栓形成的危险因素分析

目的探讨肿瘤化疗患者经外周静脉置入中心静脉导管(PICC)相关性上肢静脉血栓形成的危险因素。方法选取2015年1月~2016年12月218例肿瘤化疗PICC患者为调查对象,观察患者上肢静脉血栓发生情况,并对上肢静脉血栓发生原因进行单因素及Logistic多因素分析。结果 218例肿瘤化疗PICC患者中上肢静脉血栓发生率为23.85%,经单因素分析显示,年龄>60岁、静脉血栓形成史、使用抗凝药物、化疗补液时间<3d、临床分期为Ⅲ~Ⅳ期、置管前D-二聚体值(D-D)>0.5mg/L、传统穿刺、穿刺静脉为贵要静脉、近期手术外伤史、慢性肾功能不全的患者PICC相关性上肢静脉血栓发生率较高(P<0.05)。经Logistic多因素分析显示,年龄>60岁、静脉血栓形成史、D-D>0.5mg/L、传统穿刺、穿刺静脉为贵要静脉、慢性肾功能不全是肿瘤化疗患者PICC相关性上肢静脉血栓形成的危险因素,而使用抗凝药物、化疗补液时间<3d则是保护因素。结论对于老年、静脉血栓形成史、D-D水平升高、慢性肾功能不全的肿瘤化疗PICC患者置管期间应采取行之有效的预防措施,以降低PICC相关性上肢静脉血栓的发生。     

银离子敷料在预防肿瘤患者PICC穿刺点出血中的效果观察

目的探讨银离子敷料不同时效的应用在预防肿瘤患者PICC穿刺点出血中的应用效果。方法选择2016年6月至2017年2月在我科行PICC置管的80例肿瘤患者,将其随机分为观察组和对照组,各40例。观察组置管后穿刺点置1 cm×1 cm银离子敷料,第7天给予导管维护,对照组同样使用银离子敷料,第3天给予导管维护。比较两组PICC穿刺点出血及伤口愈合情况。结果观察组有效率95.0%(38/40)、对照组有效率72.5%(29/40),两组有效率对比差异有统计学意义(P0.01)。结论肿瘤患者PICC置管穿刺点使用银离子敷料,延长导管维护时间至7 d,可以有效预防PICC穿刺点出血,提高伤口愈合率,减少患者治疗费用及护士工作量,值得临床应用。     

PICC置管长度体外测量改良方法的临床效果探讨

目的探讨成年患者经外周静脉穿刺置入中心静脉导管(PICC)置管长度外测量改良方法的临床效果。方法将126例经右侧上肢或左侧上肢行PICC置管患者126例按置管顺序分为观察组和对照组各63例。观察组采用改良传统法(四点法):穿刺侧上肢与躯体在同一水平面并且成30°角,取穿刺点、穿刺侧上肢与躯体成30°角的顶点、同侧锁骨中点的下缘、右侧第三肋间隙(此点与右胸锁关节在一条直线上),用软尺依次测量所得三个测量值之和为置管长度;置管后拍X胸部正位片时同样采取:置管侧上肢与躯干成30°角的体位。对照组采用传统法(横L法)进行测量,比较两组PICC导管置管长度、导管尖端最佳位置率等。结果四点法测量长度(45.3±2.4)cm;传统方法测量长度(49.6±2.8)cm,两组比较差异有统计学意义,u=9.38,P0.01。观察组导管尖端一次到达上腔静脉最佳位置率90.4%,对照组为44.4%,两组比较有统计学意义,χ2=30.41,P0.01。结论成年患者行PICC置管时,应用改良传统法(四点法)外测量置管长度,杜绝了因置管侧上肢与躯干所成的角度不统一而导致的导管尖端位置的改变;能显著提高导管尖端一次到达上腔静脉最佳位置率。     

两种体表测量法在PICC置管深度评估中的效果比较

目的探讨PICC导管末端置于体内最适位置的最佳体外测量方法。方法将86例行PICC置管患者随机分为观察组和对照组各43例。观察组采用从右上肢穿刺点至右胸锁关节＋4cm,或者从左上肢穿刺点至右胸锁关节＋4cm的测量法,对照组采用从穿刺点至右胸锁关节,再向下反折至第3肋间的测量法,置管到达测量长度后,摄胸部X线片定位。比较两组PICC导管末端置入上腔静脉及置于最适位置的成功率、置管长度。结果观察组置入最适位置36例,成功率92．31％,置入上腔静脉39例,成功率90．70％;对照组置入最适位置12例,成功率38．71％,置入上腔静脉31例,成功率72．09％。观察组PICC导管置入上腔静脉及最适深度的成功率显著高于对照组,差异有统计学意义（χ^2分别为3．785,4．572;P〈0．05）,观察组和对照组两组测得置管长度分别为（48．43±3．20）,（50．46±3．20）cm,与实际置管长度差异无统计学意义（t分别为1．024,1．509;P〉0．05）。结论采用从右上肢穿刺点至右胸锁关节＋4cm,从左上肢穿刺点至右胸锁关节＋4cm的测量方法准确,可提高PICC置管的成功率。     

预测肿瘤患者PICC相关性上肢静脉血栓风险诺谟图模型的外部验证

目的 验证预测肿瘤患者PICC相关性上肢静脉血栓风险诺谟图模型的准确性及临床效益,为临床应用提供理论支撑.方法 采用前瞻性研究收集数据,分析行PICC置管的790例肿瘤患者临床资料,应用构建的诺谟图对患者进行上肢静脉血栓风险预测,模型预测准确性采用受试者工作特征曲线下面积检验,模型临床应用价值采用决策曲线分析.结果 诺...     

超声下不同部位下肢静脉血栓与肺栓塞发生的相关性分析

目的:通过下肢静脉超声检查结果分析不同部位下肢静脉血栓与肺栓塞(pulmonary embolism,PE)之间的关系,为PE患者的病情评估以及治疗方案提供参考。方法:回顾性分析2018年1月至2019年12月上海交通大学附属胸科医院心内科收治的312例患者临床资料。患者均行CT肺动脉造影及下肢静脉超声检查,按照检查结果分为PE组和非PE组,根据超声检查结果及病史资料的差别作单因素和多因素相关性分析。结果:2组患者的性别构成比、年龄、肺癌合并情况、下肢静脉血栓发生情况及部位均存在显著差异(P0.05)。PE组肌间静脉、股静脉、腘静脉、胫后静脉和腓静脉血栓发生率均显著高于非PE组(P0.05)。多因素Logistic回归分析结果表明,存在下肢静脉血栓与肺栓塞的发生有显著关联(OR=8.344,95%CI 4.867～14.304),其中存在肌间静脉血栓(OR=2.996,95%CI 1.630～5.509)、腘静脉血栓(OR=5.536,95%CI 1.646～18.623)、胫后静脉血栓(OR=6.685,95%CI 1.789～24.990)均与更高的PE发生率显著相关。结论:下肢静脉血栓患者发生PE的风险显著增加,肌间静脉血栓、腘静脉血栓、胫后静脉血栓均为PE的独立危险因素。     

基于风险评估的分级护理干预对PICC患者上肢静脉血栓发生率的影响

目的探讨基于PICC相关性上肢静脉血栓风险评估的分级护理干预措施对预防血栓形成的影响。方法将符合纳入条件的560例PICC患者按随机数字表法分为对照组和观察组,两组均使用PICC相关性上肢静脉血栓风险评估表分为高危、中危和低危患者。对照组采用常规护理措施,观察组采用分级护理干预,比较两组患者两周内静脉血栓发生率。结果分级护理干预两周后,观察组静脉血栓发生率1.43%明显低于对照组5.71%(P=0.006)。结论根据评估表筛查出高危、中危和低危患者,采取分级护理干预能够降低PICC相关性上肢静脉血栓发生率。     

国内成人肿瘤患者PICC相关性血栓发生率的Meta分析

目的 系统评价国内成人肿瘤患者PICC相关性血栓的发生率.方法 计算机检索PubMed、Embase、The Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据库和维普数据库,收集关于国内成人肿瘤患者PICC相关性血栓发生率的文献,检索时限为建库至2021年5月....     

经外周中心静脉置管患者发生相关性上肢静脉血栓风险评估表的研制

目的构建适用于经外周中心静脉置管(peripherally inserted central catheter,PICC)患者发生相关性上肢静脉血栓的风险评估表。方法通过文献回顾,形成专家咨询表,采用德尔菲法和层次分析法进行指标筛选,确定指标权重,并根据组合权重赋分。结果两轮咨询的积极系数分别为100.0%和95.0%。构建的PICC相关性上肢静脉血栓风险评估表,包括7个一级指标和34个二级指标,其中1分指标2个、2分指标9个、3分指标16个、4分指标7个。结论构建形成的PICC相关性上肢静脉血栓风险评估表可用于筛查PICC患者发生相关性上肢静脉血栓的风险,值得推广。     

Venous sonography for the diagnosis of asymptomatic deep vein thrombosis in patients with cancer undergoing chemotherapy.

OBJECTIVE: Early detection of asymptomatic deep vein thrombosis by venous sonography may identify patients who may benefit from anticoagulant therapy and thus may prevent morbidity and mortality associated with deep vein thrombosis. The aim of this study was to examine the prevalence of deep vein thrombosis by venous sonography in asymptomatic ambulatory patients with cancer undergoing chemotherapy and to evaluate the correlation between procoagulant activity and asymptomatic deep vein thrombosis. METHODS: The study population included 62 patients (32 with lung cancer and 30 with lymphoma) receiving chemotherapy with an ambulatory performance status and without clinical evidence of deep vein thrombosis. Bilateral venous sonographic studies of the lower extremities were performed, covering the femoropopliteal venous system. The D-dimer level and acquired activated protein C resistance were determined in the patients and in 30 healthy control subjects. RESULTS: Sonographic evidence of deep vein thrombosis on the femoropopliteal axis was found in 0 (0%) of 62 patients (1-sided 95% confidence interval, 0%-4.8%). Acquired activated protein C resistance prevalence and D-dimer levels were increased in study patients compared with control subjects (34% versus 0%; P < .003; median, 0.72 versus 0.25 mg/L; P < .0001, respectively). CONCLUSIONS: Despite the procoagulant tendency, venous sonography did not detect asymptomatic deep vein thrombosis in patients with cancer undergoing chemotherapy. Thus, screening by venous sonography is not justified in this patient population.     

血栓弹力图在预防PICC相关性静脉血栓中的作用

目的探讨血栓弹力图(TEG)在预防肿瘤患者经外周置入中心静脉导管(PICC)相关性静脉血栓中的作用。方法将符合纳入、排除标准的217名患者随机分为观察组112名和对照组105名。观察组患者分别于PICC置管前、置管后监测TEG,并根据TEG参数提示的凝血状态指导口服阿司匹林预防血栓治疗。对照组患者按常规PICC置管。两组患者分别于PICC置管后6周内每周1次,行血管超声检查,比较观察组血液高凝状态者口服阿司匹林干预前及干预1周后TEG变化情况和2组PICC相关性静脉血栓发生率。结果观察组26例血液高凝状态者口服阿司匹林干预后,TEG各项指标与干预前比较,均P<0.01,差异有统计学意义;观察组与对照组PICC相关性静脉血栓发生率分别为0.89%(1/112)、20.95%(22/105),2组静脉血栓比较,差异有统计学意义(χ^2=23.014,P<0.001)。结论 TEG可有效预测PICC相关性静脉血栓的形成,为患者建立个体化的防治血栓的措施。     

Prevalence of upper extremity deep venous thrombosis diagnosed by color Doppler duplex sonography in cancer patients with central venous catheters.

OBJECTIVE: The purpose of this study was to review the literature concerning upper extremity deep venous thrombosis (UEDVT) diagnosed by color Doppler duplex sonography (CDDS) in cancer patients with indwelling central venous catheters (CVCs). METHODS: From computerized databases (MEDLINE and Ovid), relevant publications regarding CDDS of the upper limb veins in cancer patients with CVCs were reviewed. RESULTS: Patients with malignancy have a higher rate of thrombosis, which is increased by the presence of CVCs. Screening CDDS in asymptomatic patients showed CVC-related UEDVT in 11.7% to 44% of patients. In symptomatic cancer patients, the range was similar to the asymptomatic ones, 6.7% to 48%. The presence of a CVC almost doubled the incidence of UEDVT in symptomatic patients. Color Doppler duplex sonography is an accurate examination for the diagnosis of UEDVT, with sensitivity ranging from 78% to 100% and specificity ranging from 82% to 100%. The main obstacle for the diagnosis of UEDVT is the presence of overlying bones, making it difficult to visualize and impossible to directly assess by compression techniques. Color and spectral Doppler sonography and the use of small transducers aid in the diagnosis. When several parameters are evaluated in combination, CDDS is a reliable method for diagnosing CVC-related thrombosis. CONCLUSIONS: Great variability in the prevalence of catheter-related thrombosis in cancer patients has been reported, although it is uniformly higher compared with patients without cancer. Color Doppler duplex sonography is the modality of choice for the diagnosis of CVC-related UEDVT in symptomatic cancer patients and for screening for asymptomatic thrombosis in this specific population.     

Clinical experience with upper extremity venous sonography in a high-risk cancer population.

OBJECTIVE: To determine the frequency of sonographically evident upper extremity venous thrombosis in symptomatic cancer patients with and without central venous catheters. METHODS: Retrospective review of 573 consecutive upper extremity venous sonographic reports from a 26-month period was performed. Findings including distribution of venous thrombosis, the presence of a central line, cancer type, and miscellaneous findings were recorded. RESULTS: Overall, 514 studies (90%) had satisfactory visualization of all upper extremity vessels; 53 (9%) had limited visualization of 1 or more vessels; and 6 (1%) were inconclusive. Venous thrombosis was present in 227 (40%) of 573 studies. Of the studies with positive findings, there were 186 acute, 13 chronic, 19 fibrin sheath versus nonocclusive, and 9 superficial thromboses. Central venous catheters were present in 325 (57%) of 573 studies. Sonographically evident thrombosis was present in 157 (48%) of 325 studies with central catheters versus 70 (28%) of 248 studies without central venous catheters (P = .001) CONCLUSIONS: Upper extremity venous thrombosis is common (40%) in symptomatic cancer patients and is nearly twice as frequent in cancer patients with indwelling central venous catheters.     

Regular sports activities decrease the risk of venous thrombosis

BACKGROUND: Stasis of the blood has been postulated as a major cause of venous thrombosis. However, little is known about the effect of stimulating the blood flow in order to prevent venous thrombosis through, for example, sports activities. OBJECTIVES: In a large population-based case-control study (MEGA study), we studied whether participating in sports activities on a regular basis was associated with venous thrombosis risk. PATIENTS/METHODS: Consecutive patients with a first venous thrombosis of the leg or a pulmonary embolism, and control subjects, consisting of partners of the patients and randomly selected control subjects from the general population, were asked to participate. Sports activities and other risk factors for venous thrombosis were reported in a standardized mailed questionnaire. Participants with malignancy were excluded. RESULTS: Out of 3608 patients, 1136 (31.5%), and of our 4252 control subjects 1686 (39.7%), participated in sports activities. Participating in sports activities reduced the risk of venous thrombosis compared with not participating in sports activities [odds ratio (OR) 0.64; 95% CI 0.58-0.71]. Risk reductions were similar after adjustment for sex, age and body mass index (OR(adj) 0.71; 95% CI 0.64-0.78) and when the analysis was restricted to healthy individuals (OR(adj) 0.67; 95% CI 0.58-0.78). No differences in risk were found for various frequencies, intensities and types of sport. CONCLUSION: Regular sports activities reduce the risk of venous thrombosis.