Discomfort related to Peripherally Inserted Central Catheters in Cancer Patient

Misun Yi; Im-Ryung Kim; Eun-Kyung Choi; Seyoung Lee; Mikyong Kwak; Juhee Cho; Jin Seok Ahn; In Gak Kwon

doi:10.5388/aon.2017.17.4.229

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Yi, Kim, Choi, Lee, Kwak, Cho, Ahn, and Kwon: Discomfort related to Peripherally Inserted Central Catheters in Cancer Patient

Original Article

Asian Oncol Nurs 2017;17(4):229-236.

Published online: 5 December 2017

DOI: https://doi.org/10.5388/aon.2017.17.4.229

Discomfort related to Peripherally Inserted Central Catheters in Cancer Patient

Misun Yi¹, Im-Ryung Kim², Eun-Kyung Choi², Seyoung Lee¹, Mikyong Kwak¹, Juhee Cho^2,³, Jin Seok Ahn^2,⁴, In Gak Kwon^1,⁵

¹Department of Nursing, Samsung Medical Center, Seoul, Korea

²Cancer Education Center, Samsung Medical Center, Seoul, Korea

³Department of Clinical Research Design and Evaluation, SAHIST, Sungkyunkwan University, Seoul, Korea

⁴Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

⁵Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Korea

Address reprint requests to: Kwon, In Gak Graduate School of Clinical Nursing Science, Sungkyunkwan University, 81 Irwon-ro Gangnam-gu. Seoul 06351, Korea Tel: +82-2-3410-2904 Fax: +82-2-3410-6616 E-mail: ingak.kwon@samsung.com

Received 19 Aug 201710 Oct 2017 Accepted 24 Nov 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

This study aimed to assess the discomfort and factors influencing the discomfort of cancer patients with peripherally inserted central catheters (PICC).

Methods

A cross-sectional survey was conducted at a tertiary university-based hospital in Seoul in 2013. Subjects were eligible if patients were diagnosed with cancer and four weeks had passed since the PICC was inserted. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) and discomfort was assessed with 8 questions developed through qualitative interviews and a literature review. Questions were about pain, interruption of daily activity or leisure, satisfaction, usefulness and feelings towards the PICC.

Results

Total 111 patients participated in the study. Over 75% of patients reported annoy-ance with PICC line. There was low positive correlation between discomfort due to PICC and anxiety. In anxious patients, patients discomfort was significantly higher than that of non-anxious patients. Significant factors influencing discomfort were gender, age, education level, PICC complications and anxiety.

Conclusion

Patient engagement in selecting the type of catheter and individualized care considering the level of anxiety and patient demographics might help to reduce discomfort in cancer patients.

Keywords: Anxiety, Neoplasms, Patient Comfort, Vascular Access Devices

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Table 1.

Characteristics of Study Participants (N =111)

Characteristics	Categories	n (%) or M ± SD	Range
Age (year)		51.3 ± 11.0	24~74
Gender	Male	28 (25.2)
Gender	Female	83 (74.8)
Marital status∗	Married	91 (83.5)
Marital status∗	Unmarried (divorced/separated/widowed/single)	18 (16.5)
Education∗	High school graduate	71 (65.7)
Education∗	≥ College	37 (34.3)
Employment∗	Housewife	54 (49.1)
	Employed/self-busineess/leave of absence	39 (35.5)
	Unemployed/retired	17 (15.4)
Primary cancer site	Breast Lung	72 (64.9)
	Lung	13 (11.7)
	Esophageal Others	16 (14.4)
	Others	10 (9.0)
Stage	I	21 (18.9)
	II	45 (40.6)
	III	25 (22.5)
	IV	20 (18.0)
Place for PICC management	Treating center	47 (42.3)
Place for PICC management	Local clinic	64 (57.7)
Complications of PICC∗	Yes	48 (43.6)
Complications of PICC∗	No	62 (56.4)

PICC= Peripherally inserted central catheter;

^∗ Missing data excluded.

Table 2.

Discomfort due to PICC (N =111)

Items	Not at all	Just a little	Quite a lot	Very much	Presence of discomfort*	Range	Min	Max	M ± SD
Items	n (%)	n (%)	n (%)	n (%)	n (%)	Range	Min	Max	M ± SD
Total discomfort^†						0~24	1	23	13.28 ± 4.62
Does the PICC cause pain?	41 (38.3)	40 (37.4)	26 (24.3)	-	26(24.3)
Do you often think about the PICC?	7(6.5)	20(18.5)	66(61.1)	15(13.9)	81(75.0)
Do you consider the PICC as a disturbing foreign body?	6 (5.6)	27 (25.0)	58 (53.7)	17 (15.7)	75 (69.4)
Are you unsatisfied with the cosmetic result?	4 (3.7)	39 (36.5)	50 (46.7)	14 (13.1)	64 (59.8)
Do you feel discomfort during daily activities?	8(7.3)	27(24.8)	60(55.1)	14(12.8)	74(77.9)
Do you feel discomfort during leisure?	7 (6.6)	28 (26.4)	50 (47.2)	21 (19.8)	71 (67.0)
Do you feel that you disabled at work by the PICC?	9(8.3)	33(30.3)	52(47.7)	15(13.8)	67(61.5)
Do you feel that you are hindered in sports by the PICC?	8 (7.3)	31 (28.4)	48 (44.0)	22 (20.2)	70 (64.2)

PICC= Peripherally inserted central catheter; *Sum of ‘quite a lot'and ‘very much’; ^† For calculation of mean, values are assigned to categories as follows: “not at all= 0, just a little= 1, quite a lot= 2, very much= 3”. Thus, higher score means higher discomfort.

Table 3.

Correlations between Discomfort due to PICC and Anxiety (N =111)

Variables	Discomfort due to PICC
Variables	r	p
Anxiety	0.32	＜.001

PICC= Peripherally inserted central catheter.

Table 4.

Comparison of Discomfort due to PICC by Participants’ Characteristics (N =111)

Characteristics	Categories	Discomfort due to PICC* M ± SD	t or F	p
Gender	Male	11.0 ± 4.29	-2.78	.006
Gender	Female	13.9 ± 4.52
Age (year)	≤50	14.3 ± 4.51	2.17	.032
Age (year)	＞50	12.3 ± 4.55
Marital status	Married	13.2 ± 4.62	0.13	.897
Marital status	Unmarried (divorced/separated/widowed/single)	13.1 ± 4.70
Education	High school graduate	12.4 ± 4.94	-2.22	.029
Education	≥ College	14.5 ± 3.86
Employment	Housewife	13.3 ± 4.65	1.77	.176
	Employed/self-business/leave of absence	14.0 ± 4.58
	Unemployed/retired	11.3 ± 4.46
Primary cancer site	Breast	14.0 ± 4.56	2.23	.089
	Lung	12.7 ± 5.68
	Esophageal	11.4 ± 4.20
	Etc.	11.4 ± 3.13
Stage	I	15.2 ± 3.44	2.24	.089
	II	13.6 ± 5.11
	III	12.1 ± 4.42
	IV	12.0 ± 4.20
Place for PICC management	Treating center	13.6 ± 4.58	0.71	.478
Place for PICC management	Local clinic	13.0 ± 4.66
Complications of PICC	Yes	15.4 ± 3.95	-4.26	＜.001
Complications of PICC	No	11.8 ± 4.50
Anxiety^†	No	12.7 ± 4.68	-2.67	.008
Anxiety^†	Yes	15.7 ± 3.49

PICC= Peripherally inserted central catheter; *For calculation of mean, values are assigned to categories as follows: “not at all= 0, just a little= 1, quite a lot= 2, very much= 3”. Thus, higher score means higher discomfort;

^† We dichotomized patients'anxiety status (measured by Hospital Anxiety and Depression Scale) as yes (score of 11 or above) or no (score of 0~10).

Table 5.

Factors Influencing Discomfort due to PICC of the Subject (N =111)

Variables	B	SE	β	t	p	Collinearity		R²
Variables	B	SE	β	t	p	Tolerance	VIF	R²
Complication of PICC (Ref: no) Yes	3.69	0.86	.34	4.27	＜.001	0.84	1.18	0.15
Anxiety (Ref: no) Yes	3.36	0.87	.18	3.88	.004	0.81	1.24	0.19
Education (Ref: high school graduate)≥ College	2.15	0.87	.19	2.47	.015	0.76	1.32	0.24
Age, year	-0.06	0.04	-.12	-1.47	.044	0.74	1.35	0.24
Gender Female (Ref: male)	0.62	1.18	.06	0.53	.030	0.74	1.36	0.26
Gender Female (Ref: male)	Adj. R²=0.23, F=8.19, p＜.001

PICC= Peripherally inserted central catheter; VIF= Variation inflation factor; Ref.= Reference.

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