Objective This study aimed to quantitatively investigate the preferences and willingness of patients with breast cancer to pay for central venous access and to provide implications for the clinical selection of appropriate chemotherapy pathways. Methods A discrete-choice experiment survey was conducted to elicit the preferences for central venous access in three hospitals in east, middle and west China. The conditional logit model was used to analyse the relative importance of six central venous access-related attributes: risk of thrombosis, risk of infections, restriction of daily activities, maintenance interval, catheter incision size and out-of-pocket costs. Results The valid data for a total of 103 patients was collected from three hospitals. All six attributes significantly influenced patients’ preferences for central venous access. The risk of thrombosis (RIS=26.0%) and risk of infections (RIS=24.3%) were the top two attributes influencing patients’ preferences for central venous access. To reduce the risk of thrombosis and infection from 12% and 8% to 1%, patients were willing to pay 14 861.2 yuan and 13 907.2 yuan, respectively. The catheter incision size was of least concern (RIS=4.6%); the patients were only willing to pay 2 653.6 yuan for smaller catheter incisions. Conclusion Thrombosis and infection are the primary factors that affect the choice of central venous access for patients with breast cancer. Patients have a sensitive trade-off between safety and out-of-pocket costs; with the change in thrombosis and infection risk, patients’ willingness to pay changes accordingly.
Objective To observe the effectiveness of IMPACT management mode on self-care and management abilities of breast cancer patients undergoing chemotherapy with implantable venous access port (VAP). Methods Breast cancer patients who underwent chemotherapy with VAP at Shangjin Hospital, West China Hospital, Sichuan University between March 2020 and June 2021 were prospectively included. IMPACT mode was used for self-management training guidance. The patient self-care abilities before training and at 1 month, 2 months, and 3 months of training were compared, and the patient self-management abilities at 1 month and 3 months of training were compared. Results A total of 74 patients with breast cancer undergoing chemotherapy with VAP were included. The total score of self-care ability of patients before training and at 1 month, 2 months, and 3 months of training was 112.11±14.63, 123.20±15.73, 127.95±13.89, and 131.92±13.60, respectively, and all the between-time-point differences were statistically significant (P<0.05). In terms of self-concept score, all the between-time-point differences were statistically significant (P<0.05) with increasing score over time, except the difference between the score at 3 months of training and that at 2 months of training (P>0.05). In terms of self-responsibility and self-care skill scores, all the between-time-point differences were statistically significant (P<0.05) with increasing scores over time, except the difference between the score at 2 months of training and that at 1 month of training (P>0.05). In terms of health knowledge level, the scores at 1 month, 2 months, and 3 months of training were higher than that before training (P<0.05), and the score at 3 months of training was higher than that at 1 month of training (P<0.05). The self-management ability scores in all dimensions at 3 months of training were higher than those at 1 month of training, and the differences were statistically significant (P<0.05). Conclusion The IMPACT management mode can effectively improve the self-care and management abilities of breast cancer patients undergoing chemotherapy with VAP, thereby ensuring the normal use of VAP, reducing the occurrence of complications, and reducing the burden on families and society.
The study aims to investigate the effect of the ratio of long axis to short axis (RLS) of upright polypropylene infusion bag on discharging process and to search the best RLS. Aiming at five different RLS (1.5:1, 2:1, 3:1, 4:1 and 5:1, respectively) with the volume of 100 mL, 250 mL and 500 mL, respectively, based on finite element method, analyzing the variation of stress distribution, emptying rate, drugging space and steadiness coefficient, etc. For the bags of the same volume, emptying rate increased with increasing of RLS, but the steadiness coefficient decreased with increasing of RLS. The specific increasing amplitude of emptying rate and decreasing range of steadiness coefficient were as follows: 20% and 49% for 100mL infusion bag, 9% and 51% for 250 mL infusion bag, and 11% and 46% for 500 mL infusion bag, respectibvely, when RLS increased from 1.5:1 to 5:1. Comparatively speaking, the increasing amplitude of the emptying rate is remarkably less than the decreasing range of the steadiness coefficient. By comprehensive consideration of both emptying rate and steadiness coefficient, lower RLS is recommended for upright polypropylene infusion bag.
ObjectiveTo investigate and analyze the strategies for choosing venous access devices for critically ill patients. MethodsThe medical staffs in ICU were required to fulfill a questionnaire on the knowledge and application of venous access devices in critically ill patients in May 2015.A descriptive statistical analysis was carried out on the answers generated from the questionnaire using SPSS 19.0 software. ResultsA total of 50 questionnaires were distributed randomly and 46 valid questionnaires were recovered.The effective response rate was 92.0%.The proportion of junior, intermediate and senior medical staffs was 80.4%, 13.0% and 6.6%, respectively.The proportion of doctors and nurses was 39.1% and 60.9%, respectively.The average seniority was (5.7±4.9)years.The proportion of ICU medical staffs who were acquainted with PIV, ACVC, PICC, TCVC, PORT and Midline was 100.0%, 100.0%, 100.0%, 69.6%, 43.5% and 13.0%, respectively.The proportion of ICU medicial staffs who would take the styles of drug, the time of treatment, the patients' condition and the costs into consideration when choosing venous access devices was 100.0%, 100.0%, 64.0% and 18.0%, respectively.91.3% and 39.1% of ICU medical staffs would choose PIV and ACVC respectively if the time of treatment was less than 1 week.56.5%, 69.6% and 26.1% of ICU medical staffs would choose PIV, ACVC and PICC respectively if the time of treatment was between 1 and 4 weeks.30.4%, 39.1%, 82.6% and 32.6% of ICU medical staffs would choose PIV, ACVC, PICC and PORT respectively if the time of treatment was more than 4 weeks.52.2% of ICU medical staffs were acquaint with the styles and the indication of antibiotic coating central venous catheter.The main reasons for infusion failure were poor vascular condition (91.3%), old age (52.2%), skin lesions (39.1%) and pipeline plugging (26.1%).The main reasons for choosing the peripheral vein were lower risk of infection (87.0%), short-term treatment (82.6%), common transfusion (78.3%) and antibiotic treatment (47.8%).The main reasons for choosing central venous infusion were irritant drugs (82.6%), peripheral vascular puncture difficulty (69.6%), long-term infusion (65.2%) and hemodynamic monitor (56.5%). ConclusionsIt is difficult to establish a vascular access for critically ill patients.The ICU medical staffs are experienced to PIV, ACVC and PICC but not to Midline, TCVC and PORT.A comprehensive evaluation is essential to choose a suitable and reliable venous access device for critically ill patients.
Persistent left superior vena cava (PLSVC) with absence of right superior vena cava (SVC), also known as isolated PLSVC, is a relatively rare type of congenital body venous malformation. Isolated PLSVC is asymptomatic, however, it will bring clinical difficulties to the implantation of the totally implantable venous access port (TIVAP). We reported a 41 years, male patient with esophageal cancer, who needed neoadjuvant chemoimmunotherapy. Through doppler ultrasonography, computed tomography (CT) and vascular 3D-reconstruction, we found him to be a patient with PLSVC with absence of right SVC before the insertion of TIVAP. Hence, we chose the left approach in which the needle was inserted into the sternocleidomastoid clavicular head lateral notch in left supraclavicular fossa as the puncture point. The depth of the catheter tip from the root of the neck to the puncture point was 21.5 cm and the catheter tip was located at the junction of the PLSVC and the right atrium, at the dilated coronary sinus. The procedure was successful and the patient received expected neoadjuvant chemotherapy combined with immunotherapy after operation, and anticoagulant therapy was performed to prevent thrombosis in coronary sinus and superior vena cava. There was no major catheter-related complication during the period of TIVAP.
目的 调查临床护士对静脉输液治疗相关知识的知晓度，分析存在的问题，以便有针对性地进行专业指导和培训。 方法 2011年8月，自制静脉输液治疗相关知识知晓度的调查问卷，利用护士参加医院集体培训的机会对158名临床护士进行问卷调查。 结果 ① 70.3%的护士静脉输液治疗知识主要来源于医院培训，护士对静脉输液治疗知识的内涵认识欠全面。② 44.2%护士对留置针的规范化固定及冲、封管方法了解不充分，仅约1/3的护士了解留置针A-C-L维护法，规范维护管理知识掌握不充分。③ 护士对静脉输液常见并发症认识欠深入，认为常见并发症发生的主要原因与患者的血管有关（静脉炎占78.5%，渗出占83.5%，导管堵塞占81.0%）。④ 9%的护士发生针刺伤后不能正确处理，护士对针刺伤原因认识清晰，处理方法还需加强培训。 结论 临床护士对静脉输液治疗相关知识的掌握欠全面性、系统性和专业性，需要对护士采取多种形式、多种途径的专业指导和培训，才能使临床护士全面掌握静脉输液治疗相关知识，促进静脉输液治疗规范化和专业化，有效保障护理质量和安全。