The research protocol was based on assigning patients to three different catheter tip groups and then observing the relationship between the tip and catheter-related complications when infusing antimicrobial agents.
A prospective case-control observation study method was adopted. The investigators of each center included patients who met the inclusion and exclusion criteria and were fully informed about the content of the study, possible benefits, and risks. After obtaining informed consent, the patients were included in the method of continuous sampling and convenient sampling. According to the method of random control, the patients were grouped. In the control group, the length of catheter insertion is measured from the pre-puncture point to the shoulder or armpit. In experimental group 1, the catheter insertion length is measured from the pre-puncture point to the midpoint of the clavicle, and in the experimental group, 2 catheter insertion length is measured from the pre-puncture point to the sternoclavicular joint. With a single-blind design, patients do not know the enrollment situation. The catheter was inserted by a full-time specialist nurse of intravenous therapy under ultrasound guidance combined with the modified Seedinger technique. The catheter was inserted according to the length of different measurement methods in different groups. After the catheter was inserted, an X-ray examination was performed to determine the catheter tip position again. Data collection and follow-up observation will be conducted by researchers who have been uniformly trained. Record the baseline data of the patients in the group before catheterization, record the insertion status during catheterization, record the patient's catheter use and catheter sealing frequency every day during catheter placement, and evaluate catheter function and complications until extubation daily.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
330
The procedures ① evaluation and selection of blood vessels: select the puncture vein in the middle of the patient's upper arm, ② Skin disinfection and towel laying: take the supine position, extend the upper limb to be punctured 45 \~ 90 °, disinfect the pre punctured upper limb with 75% alcohol and 5% povidone iodine. ③ Puncture vein: tie a tourniquet to fill the vein. Before puncture, use 0.2 \~ 0.4 ml of 2% lidocaine for local anesthesia. Under the guidance of ultrasound, use the puncture needle in the improved sedinger assembly for puncture. After successful puncture, insert the guide wire. ④ Delivery and confirmation of catheter position: after successful puncture, insert the dilator catheter sheath assembly, withdraw the setinger guide wire, deliver the catheter, after catheter placement, flush and seal the catheter with normal saline, and fix the catheter with sterile dressing.
Zhongshan Hospital Affiliated to Xiamen University
Xiamen, Fujiang, China
Changshu first people's Hospital
Suzhou, Jiangsu, China
Kunshan first people's Hospital
Suzhou, Jiangsu, China
Liaoning Provincial People's Hospital
Shenyang, Liaoning, China
Rate of Phlebitis
Prolonged veins appear red, swollen, hot, and painful, with severe cord-like changes and indurations when touching. Mechanical phlebitis, infectious phlebitis, and thrombophlebitis are collected as phlebitis data
Time frame: through study completion, an average of 4 weeks
Rate of Catheter-related thrombosis
The PICC-related thrombosis in this study refers only to symptomatic thrombi, excluding asymptomatic thrombi. Catheter-related venous thrombosis was diagnosed by color Doppler ultrasound examination when the clinical manifestations were related symptoms such as swelling and pain in the upper arm of the catheterization side.
Time frame: through study completion, an average of 4 weeks
Rate of Occlusion
According to the degree, it is divided into complete occlusion and incomplete occlusion. When there is resistance or difficulty in flushing the tube, poor blood withdrawal or even no blood return can indicate that the catheter is incompletely occlusion; if it is difficult to flush the tube and draw blood, it can indicate that the catheter is completely occlusion.
Time frame: through study completion, an average of 4 weeks
Rate of Catheter-Related Infection
Including local infection of the puncture site and catheter-related blood stream infection (Catheter-Related Blood stream Infection, CRBSI). Local infection refers to redness, swelling and pain around the puncture point, or even pus; Catheter-associated bloodstream infection: refers to patients with indwelling catheters who develop bacteremia and draw blood cultures through peripheral veins for at least one positive result, accompanied by fever (\> 380C), chills, or hypotension. Other clear sources of bloodstream infection.
Time frame: through study completion, an average of 4 weeks
Rate of Bleeding
Bloody fluid still leaks out of catheter puncture 48 hours after catheter insertion
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Zhejiang Second Hospital Affiliated to Medical College of Zhejiang University
Hangzhou, Zhejiang, China
Sir Runrun Shaw Hospital
Hangzhou, Zhejiang, China
Time frame: through study completion, an average of 4 weeks
Rate of Dislodgment
The catheter slipped more than 3cm above the exposed length of the first tube placement
Time frame: through study completion, an average of 4 weeks
Rate of exudation
There is a slight yellow or clear liquid leakage from the catheter puncture site
Time frame: through study completion, an average of 4 weeks
Dwell time
Time from tube insertion to extubation, in days
Time frame: through study completion, an average of 4 weeks
Endometrial conditions
Ultrasound examination of the vascular intima before catheterization and within 24 hours after extubation was performed. No abnormality in the intimal smoothness was negative, and abnormalities in the intimal smoothness and hyperplasia were positive.
Time frame: 24 hours before intubation and after extubation