Occurrence of PICC/CVC-Related Skin Impairment in Patients With Hematopoietic Stem Cell Transplantation Analysis of Current Situation and Influencing Factors.

PURPOSE: To investigate the current status and influencing factors of PICC/CVC-related central vascular access device-associated skin impairment (CASI) in patients undergoing hematopoietic stem cell transplantation (HSCT).

METHODS

A convenience sampling method was used to recruit 207 patients undergoing HSCT at our center between August and October 2019. The occurrence of CASI, including noninfectious exudation, puncture-site infection, skin irritation, and skin injury, was recorded, and its influencing factors were analyzed statistically.

RESULTS

Among the 207 patients, 80 cases developed CASI, with the an incidence density of 18.3 per 1,000 catheter-days, including 48 cases of exudation (non-infection) (10.9 per 1,000 catheter-days), 13 cases of puncture point infection (3.0 per 1,000 catheter-days), and 1 case of skin injury (0.2 per 1,000 catheter-days) and skin irritation in 18 cases (.1 per 1,000 catheter-days). Logistic regression analysis results showed that the influencing factors of CASI are: compared with PICC, CVC increases puncture-site infection (OR = 17.76, 95% CI: 3.15-100.11, P = 0.001) and skin irritation(OR = 4.68, 95% CI: 1.36-16.08, P = 0.014) risk; compared with catheterization for more than 2 weeks, skin irritation within 2 weeks of catheterization(OR= 0.87,95% CI: 0.86-0.890, P = 0.016)and extravasation (non-infectious) (OR = 1.58, 95% CI: 1.23-11.01, P = 0.045) increased risk, while patients with catheterization for more than 2 weeks had an increased risk of infection (OR = 0.81, 95% CI: 0.810-0.949, P =0.042); exudation (non-infectious) occurred before transplantation (OR = 0.13, 95% CI: 0.06-0.29, P ＜ 0.001), puncture point infection (OR = 0.11,95% CI: 0.04-0.29, P = ＜ 0.001) and skin irritation (OR = 0. 20, 95% CI: 0.08-0.49, P = ＜ 0.001) were higher than those after transplantation.

CONCLUSION

Among HSCT patients, the risk of indwelling PICC to prevent CASI is lower than that of CVC. It is also recommended that medical staff strengthen assessment during the immune deficiency period and within 2 weeks of catheterization, and standardize CVAD maintenance process to reduce the incidence of CASI and improve continuous treatment of patients.