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ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 1  |  Page : 90-93

Risk analysis on infection caused by peripherally inserted central catheter for bone tumor patients


1 Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
2 Department of Intervention Therapy, The Affiliated Hospital of Southwest Medical University, Luzhou, China

Date of Web Publication8-Mar-2018

Correspondence Address:
Mrs. Kui He
Department of Bone and Joint Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_777_17

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 > Abstract 

Objective: The aim of this study is to explore the related factors affecting infection risk caused by peripherally inserted central catheter (PICC) for bone tumor patients.
Method: A retrospective analysis was performed for 223 bone tumor patients who received PICC and were admitted to our hospital from 2004 to 2017. A total of 18 cases (infection group) with PICC catheter-related infections and 205 cases without infection (noninfection group) were studied. First, factor analysis of variance or Chi-square test was applied to compare independent risk factors for PICC catheter-related infections, between bone tumor patients with catheter-related infections and those without catheter-related infections.
Results: This retrospective analysis involved a total of 18 patients with PICC infections and 205 patients without infections. The infection rate was 8.07%. Factor analysis of variance showed that many factors were related to PICC catheter-related infections, including experience of operator (χ2 = 3.48, P < 0.05), catheter retention time (χ2 = 7.478, P < 0.05), receiving chemotherapy or not (χ2 = 2.43, P < 0.05), Karnofsky Performance Scale scores (χ2 = 2.19, P < 0.05) and the frequency of replacing pad pasting on the point of puncture (χ2 = 2.23). Logistic regression analysis showed that PICC catheter retention time (odds ratio [OR] = 4.21, P < 0.05) and operator experience (OR = 2.80, P < 0.05) were independent factors affected PICC catheter-related infections.
Conclusion: Catheter-related infections were related to experience of PICC operatorand length of catheter retention time.

Keywords: Bone tumor, catheter-related infection, logistic regression, risk factors


How to cite this article:
He K, Wan Y, Xian S. Risk analysis on infection caused by peripherally inserted central catheter for bone tumor patients. J Can Res Ther 2018;14:90-3

How to cite this URL:
He K, Wan Y, Xian S. Risk analysis on infection caused by peripherally inserted central catheter for bone tumor patients. J Can Res Ther [serial online] 2018 [cited 2019 Nov 15];14:90-3. Available from: http://www.cancerjournal.net/text.asp?2018/14/1/90/226763


 > Introduction Top


Primary malignant bone tumors have been common in clinics, including osteosarcoma, chondrosarcoma, fibrosarcoma, and so on.[1],[2],[3] Clinically, most primary malignant bone tumor patients were necessary to adopt combined therapy covering surgery, radiotherapy and chemotherapy, biological treatment, and other treatment approaches. Even with these treatment options, the prognosis of the patient was often poor. Most patients with bone tumors were generally in bad conditions. Some of them required long-term intravenous infusion of related drugs, including chemotherapy drugs. Therefore, peripherally inserted central catheter (PICC) treatment was necessary for most patients. PICC was able to provide safe and convenient vein access for tumor patients, safely inject stimulated drugs, protect blood vessels, and relieve pain.[4] Furthermore, it was easy to operate. However, PICC was inserted into blood vessels, which may result in catheter-related infections and lead to severe complications. In this study, logistic regression was applied to explore the related factors affecting infection risk caused by PICC for bone tumor patients. The related risk factors would be taken into account for formulating a targeted treatment. This study provided a certain basis for reducing PICC catheter-related infections.


 > Methods Top


Patients

A retrospective analysis was performed on 223 bone tumor patients who received PICC and were admitted to our hospital from July 2004 to February 2017. A total of 18 cases (Infection group) with PICC catheter-related infections and 205 cases without infection (Non-infection group) were included. The inclusion criteria were: (1) bone tumor patients with pathological diagnosis; (2) patients receiving PICC; (3) meeting the diagnosis criteria of PICC catheter-related infections; (4) patients with complete clinical data. The exclusion criteria: (1) patients with no bone tumors; (2) patients with bone metastatic tumors; (3) unclear diagnosis of PICC catheter-related infections; (4) HIV-positive patients.

Screening of risk factors

According to the previous literature [5],[6],[7] and clinical working experience, a retrospective analysis was performed onclinical data of patients in two groups, including age, gender, distant metastasis, receiving chemotherapy, catheter retention time, operator experience, and the frequency of replacing pad pasting. It aimed to explore differences in above factors between the infection and noninfection groups.

Logistic regression analysis assignment

A dependent variable Y was set in accordance with the occurrence of PICC catheter-related infections (Y1 = yes, Y0 = no). The remaining potential risk factors were set to be independent variables X1, X2…and so on. After assignment, the above independent variables were putin a logistic regression equation to calculate the independent risk factor of PICC catheter-related infections. The assignment method is shown in [Table 1].
Table 1: Assignment of independent variables and dependent variables in logistic regression equation

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Statistical analysis

Classified variable data were represented by relative numbers. Chi-square test was applied for the comparison among groups. Factor analysis of variance was first performed. Clinical variables with statistically significant differences by single-factor analysis were put in the logistic regression equation to screen independent risk factors. The related assignment method was shown [Table 1]. If P ≤ 0.05, the difference was statistically significant. All statistical analyses were performed with SPSS 17.0 software (SPSS, Inc., Chicago, IL, USA).


 > Results Top


Peripherally inserted central catheter infection rate

In this study, 223 patients with PICC were enrolled, of whom 18 were infected with PICC and 205 were not infected. The infection rate was 8.07%.

Univariate analysis of infection risk

Univariate analysis showed that many factors were related to PICC catheter-related infections, including the operator experience (χ2 = 3.48, P < 0.05), catheter retention time (χ2 = 7.478, P < 0.05), chemotherapy (χ2 = 2.43, P < 0.05), Karnofsky Performance Scale score (χ2 = 2.19, P < 0.05), and puncture point film replacement frequency (χ2 = 2.23, P < 0.05) [Table 2].
Table 2: Single factor analysis of peripherally inserted central catheter-related infection

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Logistic regression analysis

Logistic regression analysis showed PICC catheter retention time (odds ratio [OR] =4.21, P < 0.05) and operator experience (OR = 2.80, P < 0.05) were independent factors for PICC catheter-related infection [Table 3].
Table 3: Independent factor analysis of peripherally inserted central catheter-related infection by logistic regression analysis

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 > Discussion Top


PICC has become a mature technology and played important roles in long-term infusion, chemotherapy, and emergency treatment for cancer patients.[8],[9],[10] Even though, the materials and types of the catheter and indwelling method for PICC were constantly improved, catheter-related infections still cannot be avoided completely. Previous studies have shown that the infection would be affected by many factors, which were not only related to the experience levels of operators and catheter nursing staff but also related to the patient's immunity and basic diseases. Furthermore, they were closely related to the skills of staff performing catheter insertion, catheter care, catheter situations in blood vessel, indwelling position, and retention time.

This study analyzed the factors affecting PICC catheter-related infections for patients with malignant bone tumor and corrected the confounding factors with logistic multi-factor analysis. The results showed that the retention time of PICC catheter (OR = 4.21, P < 0.05) and the experience of operator were independent factors affecting PICC catheter-related infections. If the operator was not skilled enough, repeated puncture would result in damage to the inner wall and the subcutaneous tissue of the blood vessel. Thus, the time for local tissue repair would be prolonged, resulting in bacterial infection. In operation, if sterile items were exposed for too long, and these items may be contaminated before the catheter being inserted into the body. Therefore, the probability of catheter-related infections would be increased when the puncture was performed by an inexperienced nurse. Several studies reported that, operators who inserted a catheter in subclavian vein <50 times would lead to 2 times higher risk of catheter-related sepsis than that of skilled operators. The OR value of operators who performed PICC operation <30 times was 2.80. It revealed that the infection risk after inserting a catheter by inexperienced operators was 2.8 times that of experienced operators. An inexperienced operator was a significant risk factor leading to catheter-related infections. Therefore, PICC operation admittance system should be implemented.[11] The incidence of catheter-related infections can be reduced by establishing a PICC consultation group for PICC catheterization applications, PICC implementation, preventive treatment of catheter-related complications. A quality management team could deal with the main related factors for PICC catheter-related infections.[12] This technique was also an effective method to reduce catheter-related infections.

Catheter retention time was one of the major risk factors affecting central venous catheter-related infections.[13] If catheter retention time was longer, the incidence of infection was even higher. The risk of retention time ≥30 days was 4.21 times that of retention time <30 days. In general, after a catheter was placed for 24–48 h, a fibrous sheath surrounding the duct was observed, forming a fibrous membrane which became a good parasitic site for microorganisms. Bacteria reproduce, migrate, and adhere to the catheter, and are less susceptible to host phagocytes and antibiotics. Therefore, if catheter retention time was longer, the fixed rate of bacteria on the catheter was higher. Therefore, catheter indwelling time should be minimized to achieve the treatment goal. The catheter should be removed as early as possible to reduce the retention time once the conditions of patients become better.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Weber K, Damron TA, Frassica FJ, Sim FH. Malignant bone tumors. Instr Course Lect 2008;57:673-88.  Back to cited text no. 1
    
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Gibbs CP Jr., Weber K, Scarborough MT. Malignant bone tumors. Instr Course Lect 2002;51:413-28.  Back to cited text no. 2
    
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Kharb S, Kumar S, Kundu ZS. Homocysteine, a biomarker of osteosarcoma. J Cancer Res Ther 2015;11:51-3.  Back to cited text no. 3
    
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Yuan L, Li R, Meng A, Feng Y, Wu X, Yang Y, et al. Superior success rate of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in patients with cancer: A randomized open-label controlled multicenter study. PLoS One 2017;12:e0171630.  Back to cited text no. 4
    
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Zhou L, Wang M, Li A. Analysis of risk factors of peripherally inserted central catheter induced catheter-related infection in patients with leukemia. Iran J Public Health 2017;46:485-90.  Back to cited text no. 5
    
6.
Rangel UV, Gomes Junior SC, Costa AM, Moreira ME. Variables associated with peripherally inserted central catheter related infection in high risk newborn infants. Rev Lat Am Enfermagem 2014;22:842-7.  Back to cited text no. 6
    
7.
Garland JS, Alex CP, Sevallius JM, Murphy DM, Good MJ, Volberding AM, et al. Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. Infect Control Hosp Epidemiol 2008;29:243-9.  Back to cited text no. 7
    
8.
Gao Y, Liu Y, Ma X, Wei L, Chen W, Song L, et al. The incidence and risk factors of peripherally inserted central catheter-related infection among cancer patients. Ther Clin Risk Manag 2015;11:863-71.  Back to cited text no. 8
    
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Liu Y, Gao Y, Wei L, Chen W, Ma X, Song L, et al. Peripherally inserted central catheter thrombosis incidence and risk factors in cancer patients: A double-center prospective investigation. Ther Clin Risk Manag 2015;11:153-60.  Back to cited text no. 9
    
10.
Song L, Li X, Guo Y, Ye M, Ma Y, Guo M, et al. Malposition of peripherally inserted central catheter: Experience from 3012 cancer patients. Int J Nurs Pract 2014;20:446-9.  Back to cited text no. 10
    
11.
Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128:489-95.  Back to cited text no. 11
    
12.
Yi XL, Chen J, Li J, Feng L, Wang Y, Zhu JA, et al. Risk factors associated with PICC-related upper extremity venous thrombosis in cancer patients. J Clin Nurs 2014;23:837-43.  Back to cited text no. 12
    
13.
Milstone AM, Sengupta A. Do prolonged peripherally inserted central venous catheter dwell times increase the risk of bloodstream infection? Infect Control Hosp Epidemiol 2010;31:1184-7.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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