INVESTIGATION OF FACTORS AFFECTING THROMBOSIS IN ATHLETIC PATIENTS AFTER PICC PLACEMENT AND NURSING STRATEGIES

Abstract

Objective: To comprehensively and meticulously investigate and analyze the influencing factors of thrombus in athletic patients after PICC catheterization, to put forward a more targeted, scientific and feasible clinical nursing prevention strategy, and to strive to maximize the reduction of the incidence of thrombus, so as to provide a reliable theoretical basis and implementation strategy for the nursing practice of hospital nursing staff in caring for PICC catheterized athletic patients. Methods: 1. Based on the content and purpose of this study, the prospective observational study method will be selected. A total of 228 athletic patients who were received and given PICC catheterization therapeutic measures between March 2020 and March 2023 in First People's Hospital of Longquanyi District were selected. The follow-up survey was completed with the help of color Doppler ultrasound monitoring and venography to clarify the specifics of the occurrence of thrombus events within three months in athletic patients with PICC placement. With full reference to the data obtained from the follow-up survey, the athletic patients were divided into groups according to whether thrombus occurred or not, which were the group with thrombus and the group without thrombus, and the factors affecting the occurrence of thrombus in the athletic patients with PICC catheterization were analyzed in comparison between the two groups. According to the median time point of the occurrence of thrombus after PICC catheterization, athletic patients with blocked PICC catheters were selected to be included in the observation group, and at the same time, athletic patients with unobstructed PICC catheters were included in the control group, so as to compare and analyze the changes of blood indexes of the two groups of athletic patients with PICC catheterization before receiving PICC catheterization and at the median time point of the occurrence of PICC thrombus. 2. The selected outcome indicators were the incidence of occlusion events in athletic patients with PICC placement, the time of occurrence of thrombus events, the specific site of thrombus in athletic patients with PICC placement, and the clinical signs and symptoms in athletic patients with PICC placement. Results: The incidence of blockage events in athletic patients with PICC placement was (51.32%); The occurrence of blockage events in athletic patients with PICC placement occurred throughout the entire process of investigation and follow-up work practice, the earliest blockage event occurred within 24 hours after patient placement, with a median value of 14.37 days for survival analysis, and the cumulative incidence of thrombus events gradually increased in the event of prolongation of the time of patient placement; Of the 117 athletic patients with thrombus events after PICC placement, only 28 athletic patients with PICC placement had occlusion at the catheter, and the remaining 89 patients with PICC placement had occlusion that required statistical analysis of the site of thrombus involvement; The clinical signs and symptoms of thrombus in patients with PICC catheterization included swelling, pain, and impaired mobility; Univariate analysis of the thrombus event occurrence group and the thrombus event non-occurrence group showed that the differences were statistically significant (P < 0.05) in terms of age, BMI, pathological stage, combined diabetes mellitus, combined hypertension, distant metastasis, surgery, chemotherapy regimen, arm of placement, puncture vein, number of puncture attempts, number of tube adjustments, intravascular diameter, FIB, PLT, and D-dimer; Survival analysis of factors that may affect the occurrence of thrombus events in patients after PICC placement, age, BMI, hypertension, diabetes mellitus, placement limb, puncture vein, number of punctures, number of adjustments to the optimal number of punctures, D-dimer > 500 ng/ml, FIB > 400mg/dl, platelets > 300 × 10⁹/L, a total of 11 influencing factors, were statistically significant (P < 0.05); Multifactorial analysis of the occurrence of thrombus events in athletic patients after PICC placement, in which BMI, combined diabetes mellitus, D-dimer>500ng/ml, PLT>300×10⁹/L, FIB>400mg/dl were the relevant influencing factors for the occurrence of thrombus events (P<0.05); Changes in blood indexes related to thrombus in patients before and after PICC tube placement, D-dimer and FIB in athletic patients receiving PICC tube placement measures within the observation group and control group before tube placement, the difference was statistically significant (P < 0.05); PT, D-dimer and FIB in athletic patients with PICC tube placement within the observation group and control group after tube placement, the difference was statistically significant (P < 0.05); Before and after the implementation of PICC cannulation measures, the TT, FIB, D-dimer levels of athletic patients within the observation group were significantly higher than before cannulation, and the difference was statistically significant (P < 0.05). Conclusion: The incidence of thrombus after PICC placement is more than 50%, and the time of occurrence of the event is mainly concentrated in the first two weeks. After the implementation of PICC placement measures, it is necessary to pay close attention to various clinical symptoms and signs of athletic patients with PICC placement, and flexibly use color Doppler ultrasound or venography to complete the follow-up investigation, and timely treatment and means of obstruction management are provided to the athletic patients with PICC placement. Athletic patients with PICC thrombus should be treated promptly with the occlusion treatment program and means. Especially for PICC catheterization patients with abnormal BMI, combined diabetes mellitus, D-dimer＞500ng/ml, PLT＞300×10⁹/L, FIB＞400mg/dl, hospital medical and nursing staff need to raise the degree of attention to this type of PICC catheterization patients, and strictly detect the changes of FIB and D-dimer in PICC catheterization athletic patients, so that early prevention of thrombus can be realized. Early prevention and nursing management of thrombus.