|Year : 2013 | Volume
| Issue : 4 | Page : 664-667
A comparison of two intravenous infusion devices in lung carcinoma patients receiving combined radiotherapy and chemotherapy
Xing-Hua Bai1, Shuang Zang2, Ling Yu1
1 Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
2 School of Nursing, China Medical University, Shenyang, China
|Date of Web Publication||11-Feb-2014|
Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang
Source of Support: None, Conflict of Interest: None
Purpose: To investigate the clinical effects of intravenous (IV) devices in the patients with lung cancer undergoing radiotherapy and chemotherapy.
Materials and Methods: A total of 128 patients were divided into two groups : t0 hose who received chemotherapy through a peripherally inserted central catheter (PICC group; n = 64), and those who received therapy through an IV remaining needle (n = 64).
Statistical Analysis: Patient characteristics and complication rates were compared using Fisher's exact tests or the χ2 test. During the treatment times, the time and the average nursing costs for both infusion methods and their complications were compared using the student's t -test. Data is presented as mean ± SEM 0 P value <0.05 was considered significant. Statistical analyses were carried out using SPSS V.12.0 for Windows (SPSS, Inc.).
Results and Conclusions: The non-retention type venous detaining needle appears to be the preferred patient choice for those undergoing combined radiotherapy and chemotherapy.
Keywords: Lung cancer, intravenous infusion device, radiotherapy combined with chemotherapy
|How to cite this article:|
Bai XH, Zang S, Yu L. A comparison of two intravenous infusion devices in lung carcinoma patients receiving combined radiotherapy and chemotherapy. J Can Res Ther 2013;9:664-7
|How to cite this URL:|
Bai XH, Zang S, Yu L. A comparison of two intravenous infusion devices in lung carcinoma patients receiving combined radiotherapy and chemotherapy. J Can Res Ther [serial online] 2013 [cited 2021 Jan 21];9:664-7. Available from: https://www.cancerjournal.net/text.asp?2013/9/4/664/126475
| > Introduction|| |
Concurrent radiotherapy and chemotherapy are essential for the management of lung cancer. However, both treatments are associated with serious side-effects. The main side-effects of chemotherapy are bone marrow depression and gastrointestinal tract toxicity, and there is a high incidence of esophagitis with radiotherapy.  One of the most common side-effects of chemotherapeutic drugs is phlebitis. During treatment with combined radio-chemotherapy, it is the nurses' responsibility to oversee venous drug delivery, to alleviate pain, and to reduce the occurrence of phlebitis and other complications, thus, enhancing the patient's quality of life. Based on individual patient characteristics, our department used two venous infusion methods for patients with lung cancer treated with combined radiotherapy and chemotherapy between 2009 and 2011. The aim of this study was to compare the use of two intravenous (IV) devices in patients with lung cancer undergoing radiotherapy and chemotherapy in our department. This study aimed to identify both the strengths and weaknesses of both venous infusion methods, and establish a method to select the most appropriate venous infusion methods for individual patients.
| > Materials and Methods|| |
Between January 2009 and January 2011, a total of 128 patients with lung cancer received combined radiotherapy and chemotherapy in our department. Age ranged from 45 to 75 years (average 57.3), and there were 88 males and 40 females [Table 1]. Nurses introduced the different methods of venous chemotherapy administration to patients, who then chose the method autonomously. The methods consisted of a peripherally inserted central catheter (PICC; n = 64), or an IV remaining needle (n = 64).
Chemotherapy plan: Navelbine, 25 mg/m 2 on days 1 and 8; Paclitaxel, 80 mg/m 2 on days 1, cisplatin 75 mg/m 2 on day 1 and etoposide 100 mg/m 2 on days 1-3, all patients had a Karnofsy score greater than 80 before chemotherapy, without malignant neoplastic disease, radiotherapy, and chemotherapy history had finished their radio-chemotherapy plan.  The duration of chemotherapy was 5 days and of radio-chemotherapy was 21 days. Patients underwent chest combined radio-chemotherapy treatment. Patients who did not complete the radio-chemotherapy treatment were excluded.
Complications, including phlebitis, the frequency of infection, and costs incurred as a result of complications, were recorded. Patient satisfaction in terms of the mode of infusion was also determined.
The IV remaining needle consisted of a 22-G needle (BD Becton, Dickinson and Company ,USA). A 4-Fr catheter (BD) was used for the PICC method. Chemotherapy apparatus infusions consisted of precise filtration and high performance infusions produced by the Weigao Group Medical Polymer Company. China.
Prior to the infusion, clinical nurse specialists discussed with the included patients all the potential side-effects, including venous damage, which can be caused by chemotherapeutic drugs. In addition, both IV infusion methods, including their advantages and disadvantages were presented. Patients then chose the infusion method based on their economic conditions, receptive abilities, and awareness levels. According to the method chosen, patients were classified into either the remaining needle group (Group A) and the PICC group (Group B).
Phlebitis criteria followed the standard of the American Academy of Nursing.  Phlebitis was diagnosed by the clinical nurse specialist, and was treated with hirudoid and magnesium sulfate. The age, chemotherapy plan, and radiotherapy plan etc. have no significant deviation.
This group used peripheral IV infusion for their entire chemotherapy treatment. The majority of patients were not local citizens, and therefore, PICC dressings were inconvenient. In addition, some patients rejected the PICC or could not afford it. Needle puncture was therefore, used as the method of daily chemotherapy delivery. The IV sites were blocked by heparin sodium after use.  Prior to radiotherapy, nurses advised patients on how to ensure that their IV sites were adequately protected during radiotherapy. The needles were removed daily once chemotherapy had been completed. If phlebitis occurred, nurses administered the appropriate treatment.
This group was receptive to new procedures, and also found it easier to change their dressings. Patients first proceeded to chemotherapy treatment every day. Then nurses blocked the PICC with heparin sodium before radiotherapy treatment. En route to the radiation therapy room, nurses educated patients on how to ensure that the catheters were protected during radiotherapy and how to avoid accidental slips or breaks. Due to postural changes during radiotherapy, catheters were flushed with saline and blocked with heparin sodium after daily chemotherapy treatment.
Dressings were changed every 7 days  by flushing and blocking. Complications such as phlebitis or infection were treated as necessary by the nursing team. When infection occurred, dressings were changed frequently, and in the case of allergic reactions, gauze was applied until recovery.
Patient characteristics and complication rates were compared using the Fisher's exact tests. During the treatment times time and the average nursing costs for of both infusion methods and their complications were compared using the student's t-test. Data is presented as mean ± SEM P < 0 0.05 was considered significant.
| > Results|| |
There were no significant differences in the complication rates between the two groups (χ2 = 0.167, P = 0.683) [Table 2]. Complications occurred in 17 patients in Group A, most of which were phlebitis; the number of patients who have phlebitis in Group A was significantly larger than that in Group B (χ2 = 14.000, P = 0.000). In Group B, the number of patients who have complication was 15. The number of patients who have skin allergies in Group B was significantly larger than that in Group A (χ2 = 9.195 P = 0.002). Overall, it took 4.29 ± 2.09 days to cure phlebitis in Group A, and 5.13 ± 3.04 days to cure local infection and dressing allergies in Group B (t = "0.919; P = 0.365 [Table 3]. There was a significant difference in the number of times patients returned to hospital during the break in chemotherapy and the cost of treating complications between the two groups (t = -4.662; P = 0.039) [Table 3].
There was also a significant difference between the groups in terms of willingness to choose the infusion method once patients were re-admitted to the hospital (χ2 = 54.295; P = 0.000) [Table 2]. The number of satisfaction people of the infusion method + in Group A was also larger than that in Group B (χ2 = 20.700; P = 0.000) [Table 2].
| > Discussion|| |
Both the unreserved IV remaining needle and the PICC provide a convenient method of drug delivery and both reduce the pain of repeated punctures during combined radio-chemotherapy treatment. PICC catheters in particular significantly reduce puncture pain. Despite the fact that the puncture time is reduced when using unreserved IV remaining needles, there is a trend towards an increased puncture time due to extension of chemotherapy cycles, the occurrence of phlebitis, and increased puncture difficulty. Therefore, nurses have to press and block the tubes correctly prior to radiotherapy. Chemotherapy drug administration continues post-radiotherapy. Once the daily drug treatment has been completed, the remaining needle should be removed and pressure placed on the puncture point for 20 min, in an attempt to ensure long-term use of the vein. Clinical nurse specialists play a very important role in managing IV drug delivery, and in ensuring that patients have all the relevant information. In addition, they monitor drug leakage, and are responsible for changing the puncture site once patients notice an abnormal sensation post-puncture, and for managing the site of chemotherapy drug leakage solution.
The unreserved IV remaining needle is convenient for patients undergoing radiotherapy, as patients do not need to visit the hospital for dressing changes, which is necessary with PICC catheter. Hence, patients can spend more time at home. However, this infusion method requires a high level of puncture skill and training in the nursing staff, with a dedicated nursing team designated for overall responsibility of IV drug administration and monitoring. Consequently, in our study, complications were recognized immediately and handled appropriately, and most of the incidences of phlebitis were I or II degree only. In addition, as a result of prompt treatment, the phlebitis healed quickly, allowing chemotherapy to continue smoothly. Patient satisfaction was 95.3%, and Group A did not have the added problem of caring for a catheter, unlike the PICC group.
A particular radiotherapy posture is required when treating those with chest disease, such as patients with lung cancer, who need to keep their upper arm elevated during the radiated oblique portal pass through the arms.  If the transparent film of the puncture point is not firmly fixed, or there is inadvertent excessive force by patients during the treatment process, the PICC catheter may slide out. It affects the catheter position, and makes it more prone to infection. In addition, there are risks of catheter fracture and ectopic placement.  Therefore, it is essential to educate patients on adequate catheter protection. Furthermore, patients need to be advised to pay close attention to their actions, so that they move slowly during radiotherapy and ensure that the puncture point is fixed in order to prevent slipping. Once it appears that the catheter may be sliding or the transparent film is not adequately fixed, the medicines should be changed and the PICC secured, in order to avoid complications.  As a result of treatment, patient immunity may be reduced, and puncture points may become infected or skin allergies may develop. Depending on the individual patient, it may be appropriate to switch to gauze dressings to ease local skin stimulation, and the catheter needs to be prevented from sliding when using gauze instead of 3M dressing. Moreover, when the patient is weak, or finds it inconvenient to change the transparent film at the puncture point, to flush or seal the catheter, they are encouraged to attend their local hospital. If necessary, the patient or family members should change dressings at home. As the patients who undergo radiotherapy had their PICC observed more frequently, they had a greater peace of mind, which may explain why the satisfaction rate was lower in Group B than in Group A.
For combined radio-chemotherapy, the nurse specialist assesses both the patient's economic conditions and vascular conditions, in order to choose the most appropriate venous infusion method for each individual.  Because of lower PICC catheter phlebitis incidence and do not ignore the role of patients in the radiation treatment during chemotherapy tolerance and side effects heavier patients, however, the nursing and related PICC catheter attention will become the burden of the patients and the PICC catheter would cause other risk of complications. Including the changes of position for patients with PICC catheter infections, and the influence of the emergence and the risk of fault and so on, or to hospital again and again change dressing. Meanwhile it could reduce the patients' recuperation time at home and produce certain effect to the patients' mood, energy, and physical condition, even to the extent that reduce their living quality.
Both infusion methods have their own respective advantages. The non-retention type of venous indwelling needle has replaced the steel needle, and more easily pierces blood vessels when patient acting and cause the risk of chemotherapy permeability, avoid transfusion fatigue. Removing the needle after chemotherapy each day reduces the risk of infection. In addition, the total cost of chemotherapy compared with PICC catheters was lower, and also the remaining needle is not affected by posture change during radiation treatment. Furthermore, most patients in Group 1 experienced phlebitis level one, caused by drug stimulation. The nursing staff plays a key role here, in terms of detecting and treating complications such as phlebitis. They also educate patients with phlebitis on how to manage the complication themselves, thus, ensuring faster healing and more smooth continuation of chemotherapy treatment.
Patients with PICCs needed to return repeatedly to the hospital for dressing changes; this reduced the recuperation time at home and increased the risk of complications, such as infection during radiotherapy.  Although, the catheter could prevent chemotherapy phlebitis and could ensure that patients with poor vascular conditions could continue to use and it caused problems in day-to-day living, when radiotherapy still continued. Therefore, nurse should choose an appropriate method of puncture according to patient's symptoms, whether undergoing radiotherapy, as well as vascular conditions, patient's chemotherapy history, location, patient's wishes, and the body condition.
It is not only a guarantee of effective treatment for patients, however, also convenient for patients. It is suggested that the patients should undergo PICC catheter puncture after radiotherapy, in order to reduce complications such as phlebitis during the chemotherapy and ensure appropriate patient follow-up.
In conclusion, it is important to intensify the quality of chemotherapy IV infusion management during radiotherapy treatment.
Good management will ensure that the treatment progresses smoothly and patient quality of life will be improved. The nursing staff needs to assess the most appropriate chemotherapy infusion method for each patient, and devise a management plan based on the individual's needs.
| > References|| |
|1.||Armstrong T, Almadrones L, Gilbert MR. Chemotherapy-induced peripheral neuropathy. Oncol Nurs Forum 2005;32:305-11. |
|2.||Minami-Shimmyo Y, Ohe Y, Yamamoto S, Sumi M, Nokihara H, Horinouchi H, et al. Risk factors for treatment-related death associated with chemotherapy and thoracic radiotherapy for lung cancer. J Thorac Oncol 2012;7:177-82. |
|3.||Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs 2006;29: 1-92. |
|4.||Visser L. Toronto hospital reduces sharps injuries by 80%, eliminates blood collection injuries. A case study: Toronto East General Hospital pioneers healthcare worker safety. Healthc Q 2006;9:68-70. |
|5.||Kida M, Araki M, Miyazawa S, Ikeda H, Takezawa M, Kikuchi H, et al. Comparison of diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration with 22- and 25-gauge needles in the same patients. J Interv Gastroenterol 2011;1:102-7. |
|6.||Leonard L, Joel E.Clinical Radiation Oncology. New York: Oversea Publishing House 2000; 589-600. |
|7.||Matsuzaki A, Suminoe A, Koga Y, Hatano M, Hattori S, Hara T. Long-term use of peripherally inserted central venous catheters for cancer chemotherapy in children. Support Care Cancer 2006;14:155-60. |
|8.||Daneman N, Downing M, Zagorski BM. How long should peripherally inserted central catheterization be delayed in the context of recently documented bloodstream infection? J Vasc Interv Radiol 2012;23:123-5. |
|9.||Nieman CL, Kazer R, Brannigan RE, Zoloth LS, Chase-Lansdale PL, Kinahan K, et al. Cancer survivors and infertility: A review of a new problem and novel answers. J Support Oncol 2006;4:171-8. |
|10.||Uygun I, Okur MH, Otcu S, Ozturk H. Peripherally inserted central catheters in the neonatal period. Acta Cir Bras 2011;26:404-11. |
[Table 1], [Table 2], [Table 3]