Safety and Efficacy of Peripherally Inserted Central Catheters in Terminally Ill Cancer Patients: Single Institute Experience
Journal of Hospice and Palliative Care 2014³â 17±Ç 3È£ p.179 ~ p.184
¹Ú±Ç¿À(Park Kwon-Oh) - KEPCO Medical Center Department of Internal Medicine
(Lim Hyoung-Gun) - KEPCO Medical Center Department of Radiology
È«Áö¿¬(Hong Ji-Yeon) - KEPCO Medical Center Department of Internal Medicine
¼ÛÇåÈ£(Song Hun-Ho) - Hallym University College of Medicine Kangdong Sacred Heart Hospital Department of Internal Medicine
Abstract
¸ñÀû: ÀÌ ¿¬±¸´Â ÀÓÁ¾±â ¾ÏȯÀڵ鿡¼ ¸»ÃÊ»ðÀÔÁ᫐ Á¤¸ÆÄ«Å×ÅÍ(peripherally inserted central catheters, PICC)ÀÇ ¾ÈÁ¤¼º ¹× È¿°ú¿¡ ´ëÇØ È®ÀÎÇÏ°íÀÚ ÇÑ´Ù.
¹æ¹ý: 2013³â ÇÑ ÇØ µ¿¾È ÇÑÀüº´¿ø¿¡ È£½ºÇǽº ¿ÏÈÀǷḦ ¸ñÀûÀ¸·Î ÀÔ¿øÇÑ È¯ÀÚµé Áß, ¸»ÃÊ»ðÀÔÁß½ÉÁ¤¸ÆÄ«Å×Å͸¦ ½ÃÇà ¹ÞÀº ȯÀÚµéÀ» ´ë»óÀ¸·Î ÈÄÇâÀûÀ¸·Î Àǹ« ±â·Ï °üÂûÇÏ¿´´Ù. ¸ðµç ¸»ÃÊ»ðÀÔÁß½ÉÁ¤¸ÆÄ«Å×ÅÍ´Â ÁßÀçÀû ¹æ»ç¼±Àǻ翡 ÀÇÇØ »ðÀԵǾú´Ù.
°á°ú: ¾ð±ÞÇÑ ±â°£ µ¿¾È 30¸íÀÇ ÀÓÁ¾±â ȯÀÚ¿¡¼ ¸»ÃÊ »ðÀÔÁß½ÉÁ¤¸ÆÄ«Å×ÅÍ°¡ ½ÃÇàµÇ¾ú°í, ±×µé Áß 1¸íÀÇ È¯ÀÚ¿¡¼ 2ȸÀÇ »ðÀÔÀÌ ÀÌ·ïÁ®, ÀüüÀûÀ¸·Î 31ȸÀÇ ¸»ÃÊ»ðÀÔÁß½ÉÁ¤¸ÆÄ«Å×ÅÍ »ðÀÔ È½¼ö¿Í 571ÀÏÀÇ °ÅÄ¡±â°£(PICC days)ÀÌ ºÐ¼®µÇ¾ú´Ù. ¸»ÃÊ»ðÀÔÁß½ÉÁ¤¸ÆÄ«Å×ÅÍ °ÅÄ¡±â°£(PICC days)ÀÇ Áß¾Ó°ªÀº 14.0ÀÏ(¹üÀ§, 1~90ÀÏ)À̾ú´Ù. 25¿¹´Â °èȹµÈ ½Ã±â(Åð¿ø, Àü¿ø, »ç¸Á µî)±îÁö À¯ÁöÇÏ¿´À¸³ª, 6¿¹¿¡¼´Â ¿©·¯ ÀÌÀ¯·Î °èȹµÈ ½Ã±âº¸´Ù Á¶±â¿¡ PICC¸¦ Á¦°ÅÇÏ¿´´Ù(PICC Á¶±â Á¦°ÅÀ², 19%; 10.5/1000 PICC days). µû¶ó¼, Ä«Å×ÅÍ À¯Áö ¼º°ø ºñÀ²(catheter maintenance success rate)Àº 81%¿´´Ù. PICC Á¶±â Á¦°Å 6¿¹ Áß, ¼¶¸Á µî¿¡ ÀÇÇÑ ½º½º·Î Á¦°ÅÇÑ °æ¿ì°¡ 4¿¹¿´°í(13%; 7.0/1000 PICC days), Ä«Å×ÅÍ °ü·Ã Ç÷¾× °¨¿° ¹× Ç÷ÀüÁõÀÌ °¢°¢ 1¿¹¾¿ ÀÖ¾ú´Ù(3%; 1.8/1000 PICC days). Á¶±â PICC Á¦°Å¸¦ Æ÷ÇÔÇÑ ÃÑ ÇÕº´Áõ ¹ß»ýÀº 8¿¹¿¡¼ ÀÖ¾ú´Ù(26%; 14.1/1000 PICC days). ÇÕº´Áõ ¹ß»ý±îÁö ±â°£Àº Áß¾Ó°ª 7ÀÏÀ̾ú´Ù(±â°£, 2~14ÀÏ). ¸»ÃÊ»ðÀÔÁß½ÉÁ¤¸ÆÄ«Å×ÅÍ °ü·Ã ÇÕº´Áõ¿¡ ÀÇÇÑ »ç¸ÁÀº ¾ø¾ú´Ù.
°á·Ð: ÁÁÁö ¾ÊÀº Àü½Å »óÅÂ, ÀÛÀº ½Ã¼ú ÇÕº´Áõ¿¡µµ Ãë¾àÇÔ, Á¦ÇÑµÈ ¿©¸íµî°ú °°Àº ÀÓÁ¾±â ¾ÏȯÀÚÀÇ Æ¯Â¡À» °í·ÁÇÒ ¶§, PICC´Â ÀÓÁ¾±â ȯÀÚ¿¡¼ ¾ÈÀüÇÑ Ç÷°ü Á¢±Ù ¹æ¹ýÀÌ µÉ ¼ö ÀÖ´Ù.
Purpose: We investigated the safety and efficacy of peripherally inserted central catheters (PICCs) in terminally ill cancer patients.
Methods: A retrospective review was conducted on patients who underwent PICC at the hospice-palliative division of KEPCO (Korea Electric Power Corporation) Medical Center between January 2013 and December 2013. All PICCs were inserted by an interventional radiologist.
Results: A total of 30 terminally ill cancer patients received the PICC procedure during the study period. Including one patient who had had two PICC insertions during the period, we analyzed a total of 31 episodes of catheterization and 571 PICC days. The median catheter life span was 14.0 days (range, 1~90 days). In 25 cases, catheters were maintained until the intended time (discharge, transfer, or death), while they were removed prematurely in six other cases (19%; 10.5/1000 PICC days). Thus, the catheter maintenance success rate was 81%. Of those six premature PICC removal cases, self-removal due to delirium occurred in four cases (13%; 7.0/1000 PICC days), and catheter-related blood stream infection and thrombosis were reported in one case, each (3%; 1.8/1000 PICC days). Complication cases totaled eight (26%; 14.1/1000 PICC days). The time to complication development ranged from two to 14 days and the median was seven days. There was no PICC complication-related death.
Conclusion: Considering characteristics of terminally ill cancer patients, such as a poor general condition, vulnerability to trivial damage, and a limited period of survival, PICC could be a safe intravenous procedure.
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¸»ÃÊ»ðÀÔÁß½ÉÁ¤¸ÆÄ«Å×ÅÍ, ÀÓÁ¾±â ¾ÏȯÀÚ, È£½ºÇǽº, ¿ÏÈÀÇ·á
Peripheral venous catheterization, Central venous catheterization, Hospice care, Terminal care, Palliative care
KMID :
0856920140170030179
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