BACKGROUND:The risk factors for skin injuries remain poorly understood in cancer patients with peripherally inserted central catheters (PICC). We herein aimed at exploring the effect of clinical factors on the risk of PICC-related skin injuries. METHODS:We included 1245 cancer patients with PICC from 16 hospitals in Suzhou, China. The study outcome was in-hospital skin injuries, including contact dermatitis, skin (epidermal) stripping, tension injury, allergic dermatitis, skin tear, maceration, folliculitis, and pressure injury. RESULTS:During hospitalization, 274 patients (22.0%) developed skin injuries after prolonged use of an indwelling catheter. Univariable logistic regression analysis identified several risk factors for PICC-related skin injuries; multivariable logistic regression analysis showed that the following factors independently and significantly (p < 0.05) associated with the risk of PICC-related skin injuries: body mass index (BMI, >25 kg/m2 versus <18.5 kg/m2: odds ratio (OR), 1.79; 95% confidence interval (CI), 1.03-3.11), skin condition (humid vs normal: OR, 2.96; 95% CI, 1.62-5.43), skin indentation (OR, 4.67; 95% CI, 3.31-6.58), allergic history (OR, 2.11; 95% CI, 1.21-3.66), history of dermatitis (OR, 3.05; 95% CI, 1.00-9.28), history of eczema (OR, 3.36; 95% CI, 1.20-9.43), catheter insertion site (under elbow vs. upper arm: OR, 3.32; 95% CI, 1.12-9.90), and PICC maintenance interval (4-5 days vs ⩽3 days: OR, 0.06; 95% CI, 0.01-0.50; 5-7 days vs ⩽3 days: OR, 0.07; 95% CI, 0.02-0.31; 7-9 days vs ⩽3 days: OR, 0.10; 95% CI, 0.02-0.57). CONCLUSIONS:BMI, skin condition, skin indentation, allergic history, history of dermatitis, history of eczema, catheter insertion site, and PICC maintenance interval were independent risk factors for PICC-related skin injuries in cancer patients. This knowledge will guide future studies with formulating optimal treatment strategies for improving the skin health of cancer patients with PICC.

AIMS AND OBJECTIVES:This systematic review and meta-analysis aimed to compare the incidence of PVC-related complications between catheterisation in the forearm and back of the hand in adult patients. BACKGROUND:A peripheral intravenous catheter (PVC) is often inserted as part of care during patients' hospitalisation. The catheter is typically inserted in the forearm or at the back of the hand in usual practice. Studies have not yet reached a consensus on the optimal insertion site in any clinical setting. DESIGN:We performed a systematic review and meta-analysis based on PRISMA guidelines. METHODS:We searched the following electronic databases: PubMed, Cochrane Library, Embase, and CINAHL. Randomised controlled trials, cohort studies, case-control studies and cross-sectional studies from inception to July 2021 reporting the incidence of PVC-related complications at the forearm and back of the hand were included. Fixed-effects models and random-effects models were used to derive the pooled risk ratios. RESULTS:Twenty-four studies involving 16562 PVCs met our inclusion criteria. The meta-analysis showed that compared with PVC placement in the back of the hand, placement in the forearm was associated with a higher incidence of total complications and infiltration/extravasation. However, the differences between the PVC indwelling sites were not significant (total complications: P = 0.43; phlebitis: P = 0.35; infiltration/extravasation: P = 0.51). Both incidence of total complications and infiltration/extravasation analyses showed high heterogeneity (total complications: I2  = 60%; infiltration/extravasation: I2  = 58%). CONCLUSION:Available evidence suggests that there is no significant difference between PVC placement in the forearm and at the back of the hand in terms of the incidence of complications, thus making both approaches suitable. RELEVANCE TO CLINICAL PRACTICE:For patients who need indwelling PVC, medical staff can choose the best indwelling site, and both forearm and back of the hand are suitable.

目的 探讨中心静脉通路装置(central venous access device,CAVD)相关性皮肤损伤(CAVD-associated skin impairment,CA-SI)预防方案在门诊经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)患者中的应用效果.方法 便利抽样法选取苏州市、无锡市 8 所三级综合医院门诊行PICC维护的 1043 例患者为研究对象并采用整群随机对照试验.其中 4 所医院为对照组,给予PICC常规护理;4 所医院为试验组,在常规护理基础上予以CASI预防方案.干预 6 个月后,比较两组患者CASI发生率、医用粘胶相关性皮肤损伤(medical adhesive-related skin injury,MARSI)及医疗器械相关压力性损伤(medical device related pressure ul-cers,MDRPU)发生率和严重程度、血管导管相关感染率和非计划拔管率的差异.结果 试验组CASI、MARSI及MDRPU发生率均低于对照组(均P＜0.05),两组MARSI、MDRPU严重程度及非计划拔管率无统计学差异(均P＞0.05).两组均未发生血管导管相关感染.结论 实施CASI预防方案有利于降低PICC门诊患者CASI的发生率,为临床护士预防CASI提供实践指导.

通过综述中心静脉通路装置相关性皮肤损伤的国内外研究进展,从皮肤损伤的评估、预防和治疗措施3个方面分析和总结当前研究中存在的问题并提出相应建议,以期为中心静脉通路装置相关皮肤损伤的规范化管理提供参考。