Prevention and Nursing Research of PICC Catheter-Related Complications in Patients with Digestive System Malignant Tumor Based on Smart Medical Block Chain

Malignant tumors of digestive system mainly include gastric cancer, colorectal cancer, and esophageal cancer, which generally need chemotherapy. PICC refers to peripherally inserted central venous catheter, which plays an important role in the treatment of malignant tumor patients with chemotherapy, and it has the characteristics of high success rate of puncture and reducing the pain of patients. Its principle is to use PICC catheter for drug delivery, which can effectively reduce the pain of tumor patients for multiple puncture, and also can avoid drug extravasation or local stimulation of drugs. However, PICC catheter-related complications cannot be ignored, to some extent, directly affect the treatment effect of patients, and increase the pain and burden of patients. Therefore, this paper proposes a study of PICC catheter-related complications and protective nursing for patients with digestive system cancer based on smart medical block chain. First of all, using the method of literature, this paper deeply studied the combination of smart medicine and block chain and further strengthened the research on PICC catheter-related complications. Based on this, we designed a study on the prevention and nursing of PICC catheter-related complications in patients with digestive system cancer. Before the implementation of nursing, the incidence of complications in patients with digestive system cancer was 17.35%; after the implementation of nursing, the incidence of complications decreased to 4.08%. The purpose of this study is to analyze the causes through clinical research and put forward the protective nursing measures of related diseases, so as to reduce the incidence of PICC-related complications.

Spontaneous fragmentation and embolization of chemoport catheter- a case report

Central venous access devices are commonly utilized in cancer patients. These devices include central venous catheters, peripherally inserted central catheter (PICC line), Hickman catheter and totally implantable central venous devices of the port-a-cath type (chemoport). These devices can be retained for a long time and may be used for administration of chemotherapy, blood products, total parenteral nutrition and frequent blood sampling. Complications associated with chemoport include vascular injury, hemothorax, pneumothorax, local site infection, sepsis, catheter thrombosis, drug extravasation and mechanical malfunction. Spontaneous fragmentation of chemoport catheter is a rare complication. We report a case of spontaneous fragmentation of chemoport catheter from its midway and its migration into the lower lobar branch of left pulmonary artery. It was retrieved using percutaneous endovascular approach under fluoroscopic guidance.

Comparison of Care Outcomes Between Two Methods of Drug Injection Through Ports and Peripheral Veins in Patients Undergoing Chemotherapy

Background: One of the common treatments for cancer is chemotherapy that is usually done by intravenous injection. Central catheters and portholes are used for the intravenous administration of chemotherapy drugs through peripheral vessels. Objectives: This study aimed to compare the caring outcomes of the two methods of drug injection through the peripheral vessels and ports in patients undergoing chemotherapy. Methods: In this descriptive study, 68 cancer patients admitted to the Hematology and Oncology Wards of Shahid Baghaei Hospital 2 in Ahwaz during three months were evaluated in two groups of 34 patients receiving chemotherapy (one group via ports and one group via peripheral blood vessels). Data were collected by a questionnaire consisting of two parts: demographic information (sex, age, and type of disease) and information about the patient's condition (drug injection method, serum, and catheter number), and an observational checklist including inflammation rate, drug extravasation, limitation of patient movement, medical expenses, and patient satisfaction. Data were analyzed using SPSS version 24 software. Results: According to the results of the study, the two groups were compared in terms of inflammation (P = 0.0001, T = 4.908), drug extravasation (P = 0.0001, T = 3.872), movement limitation P = 0.000, T = 4.922) the cost of treatment (P = 0.0001, χ2 = 56.973, P = 0.000, and patient satisfaction (P = 0.0001, T = -23.66). Conclusions: Performing chemotherapy through the port has fewer side effects and brings more comfort to the patients.

Upper limb extravasation of cytotoxic drugs: results of the saline washout technique in children

Purpose Extravasation of cytotoxic vesicant drugs is a surgical emergency (within six hours) since this incident can lead to severe skin and soft-tissue damage. Outcomes after the saline washout procedure have been extensively described in adults, but rarely in children. The aim of this study was to evaluate the outcome of early saline washout procedure for upper limb cytotoxic drug extravasation in children. Methods All consecutive children with vesicant drug extravasation were retrospectively reviewed. The saline washout procedure was performed. Cosmetic aspect, residual pain and range of movement were analyzed as well as time to surgery and chemotherapy resumption at last follow-up. Results Between 2014 and 2018, 13 cytotoxic vesicant drug extravasations occurred (mean age 8 years (sem 5)), including 11 treated by the saline washout procedure. At mean follow-up of 11 months (sem 7), the patients had no or low pain and ranges of movement were fully conserved. Two patients (one within the six hours’ delay) had soft-tissue necrosis leading to extensive reconstructive surgery. Conclusion The saline washout procedure is safe and easy and significantly reduces the incidence of extensive skin damage. Early referral to a specialized department is essential. However, the key parameter remains prevention by educating medical staff and nurses about these injuries and by training them for early and urgent management. Level of Evidence IV

Utility of Magnetic Resonance Imaging in the Surgical Management of Drug Extravasation: A Case Report

We report a case of phenytoin extravasation complicated by eschar formation. Pre-operative MRI study showed a large non-enhancing area over the dorsum of the imaged right wrist and hand corresponding with the site of phenytoin extravasation and raising the suspicion of subcutaneous tissue necrosis. The MRI findings correlated well with the intra-operative findings. We believe that pre-operative MRI in drug extravasation cases can characterise the type of soft tissue injury and define the extent of injury. This helps the surgeon in the surgical approach and treatment options.