Effects of different exercise modes of ball-holding on venous flow and related thrombus in patients with peripherally inserted central catheter

Objective To explore the effects of different exercise modes of ball-holding on preventing peripherally inserted central catheter (PICC) related thrombus, so as to provide a basis for formulating scientific nursing intervention. Methods From June to November 2017, this study selected 86 cancer patients with chemotherapy through PICC of Oncology Department in First Affiliated Hospital of PLA General Hospital by purposive sampling. All of the patients from two wards of Oncology Department were divided into the experimental group and the control group by tossing a coin. Patients of the experimental group carried out ball-holding 25 times to 30 times after 3 meals each day with clenching for 10 seconds, loosening 10 seconds and grip strength according to that the ball was compressed to one half. Patients of the control group accepted conventional nursing that ball-holding was implemented 3 times, a total of 500 times. Color Doppler ultrasound was used to dynamically observe the blood flow velocity, incidence, formation position, formation time and classification of thrombus as well as other complications after indwelling catheter. The SAS 9.4 was used to statistical analysis. Results This study involved 42 patients in the experimental group and 41 patients in the control group after removing missing patients. The maximum velocity of axillary vein of patients in experimental group before and 1, 3, 7, 14, 21, 28 days after indwelling catheter was (16.12±3.62) , (15.83±3.07) , (15.69±3.01) , (15.05±2.49) , (14.46±3.85) , (15.47±2.95) and (14.75±2.91) cm/s respectively. There was no significant difference in blood flow velocity before indwelling catheter between two groups (t=-0.54, P=0.594 5) . But, there were significant differences in blood flow velocity 21 and 28 days after indwelling catheter between two groups (t=-5.00, -4.69; P<0.000 1) . The difference of the maximum velocity in interaction between groups and different time points was significant (F=22.23, P<0.000 1) . The average velocity per unit time of axillary vein of experimental group before indwelling catheter and 1, 3, 7, 14, 21, 28 days after indwelling catheter was (9.97±3.01) , (9.69±2.61) , (9.72±2.49) , (8.88±1.47) , (8.55±2.20) , (9.48±2.71) , (9.26±2.73) cm/s respectively. There was no significant difference in average velocity before indwelling catheter between two groups (t=0.07, P=0.945 9) . After indwelling catheter, there were significant differences in average velocity 21 and 28 days after indwelling catheter between two groups (t=-4.60, -4.48; P<0.000 1) . There was also a significant difference in average velocity per unit time of axillary vein among the interaction between groups and different points (F=9.84, P<0.000 1) . The flow velocity of axillary vein of two groups declined over time 14 days before indwelling catheter. The flow velocity of experimental group gradually rose over time 14 days after indwelling catheter and was with a fall after rise 21 days after reaching peak value; the flow velocity of control group remarkably slowed over time. A significant difference was found in incidence of catheter related thrombus between two groups (P<0.05) . The incidence of thrombus of control group constantly rose over time (χ2=6.158, P=0.013) . There was also significant difference in incidence of other catheter related thrombus complications between two groups (χ2=5.760, P=0.016) . Conclusions The modes of ball-holding of experimental group can make the flow velocity of axillary vein in a high level and be propitious to prevent blood stagnation, reduce the incidences of thrombus and other catheter related thrombus complications. It is worth to be used in clinical application. Key words: Nursing care; Venous thrombosis; Ball-holding sport; Peripherally inserted central catheter; Catheter-related thrombus; Venous flow velocity