PICC.ppt

1、An Overview of PICCs,Why we should need PICCs?,Continue around 6 periods,Phlebitis Thrombus clotting Repeat puncture,But decrease cancer patients quality of life,Antineoplastic agents,Chemotherapy increase cancer patients survival rate,pain,51-62% cancer patients occur pain, 10% are therapy-related

2、pain, caused by such as, chemotherapy,Why we should need PICCs?,Discomfortable Painful Decrease QOL Prolong duration Increase medical finance Add the burden for nurses,Phlebitis Repeat the puncture Thrombus clotting,Brief Introduction,PICCs first popular in the 1980s in US In 1992, 3 million PICCs (

3、Raad I,1992) By 1996, 5 million PICCs (Herbst,1996),Brief Introduction,PICCs- Peripherally Inserted Central Catheters Reliable central venous access devices (VADs),PICCs,Inserted point- inserted into the peripheral vasculature A vein in the arm Basilica vein Cephalica vein Median cubital vein Saphen

4、ous vein ( for infants),PICCs,Terminated point-central vessels Inserted in the veins in arm Superior vena cava Inferior vena cava Proximal right atrium Inserted in saphenous vein Inferior vena cava above the level of the diaphragm,PICCs,Used for any infusate Osmolarity Antineoplastic drugs TPN (tota

5、l parenteral nutrition) et.al Blood flow 2L/minute,Reliable VADs,Compare with the traditional Central Inserted Catheters (CICs),Satisfy long-term vascular needs,Higher success of insertion,registered nurses,Quietly convenient for home care,Substantially reduced cost,Lower rate of infection,Dwell tim

6、e,Peripheral venous acess,Peripherally inserted central catheters,Subclavian and internal jugular central catheters,5 days to 1 year,Less than 72 hours,1 week to 4 weeks,Published rates of complication,A cohort study -NG,PHILIP K.MD, 1997,HIV,organ transplantation,ICU(1,000),96.3% insertion success,

7、83.5% successful completion,1.1 per 1,000 catheter days of confirmed infection,1.Completion of therapy 2. Patient died of other illness, but of a PICC complication,1.cellulites 2.fever(38.3) 3.leukocytosis (wbc11109/L) 4.positive blood culture 5.no other source of infection,Cancer patients -Louise J

8、, 2002,Infection rate of PICCs, 2.5 per 1,000 catheter-days 115(33%) of 351 PICCs removed before successful completion 7.4% of PICCs removal caused by infection,Different patient population, insertion technique. Definitions of infection are not same, neither are the standards of PICCs removal,Grosho

9、ng PICCs,3-way Groshong valve,Close between 7 and 80 mm Hg ( central venous 0 to 5 mm Hg),Open outward under positive pressure (gravity,pump,syringe),Open inward under negative pressure ( aspiration),Benefits,Increased safety Elimination of heparin Reduced flushing ( per 7 days, sterile normal salin

10、e),Contraindications,Allergic to materials (silica gel) Past irradiation Previous venous thrombosis or vascular surgical,Contraindications,Effective arm after mastectomy Device related infection No proper peripheral vein Severe coagulopathy,Nonvalved versus valved -Eric K,1999,*p0.05,Breast cancer p

11、atients,Breast cancer patients,Malpractice regulations,Leak out : Skin ulceration Skin necrosis Bone necrosis Joint necrosis,Breast cancer patients,Peripheral veins are quitely limited,Protect the affected upper extremity,Lower extremity not advocated to use,Nursing experts suggest to use the centra

12、l veins when chemotherapy in breast cancer patients.,In ward of breast surgery,49 breast cancer patients received chemotherapy through peripheral veins, 2004. 3 patients occurred drugs leaking.,6.12%,In ward of breast surgery,40 breast cancer patients are inserted with PICCs since 2003.,0 patient oc

13、curred drugs leaking, 0 patients suffer from infections.,conclusion,PICCs are quitely useful for patients who need a long-term therapy.,Reference,1 Eric k. Hoffer, John Borsa, Patricia Santulli, Robert Bloch, Arthur B.Fontaine. Comparison of valved versus nonvalved peripherally inserted central vern

14、 catheters.AJR, 1999,173:1393-1398. 2 Louise J. Walshe, Sharp F. Malak, Janet Eagan, Kent A. Sepkowi. Complication Rates Among Cancer Patients With Peripherally Inserted Central Catheters .Journal of Clinical Oncology, 2002. 20(15):3276-3281. 3 NG, PHILIP K. MD, AULT, MARK J. MD. Peripherally Inserted Central Catheters in General Medicine.Mayo Foundation for Medical Education and Research, 1997,72(3): 225-233 4 Jay R. Grove, MD and William C. Pevec, MD.Journal