Chinese Journal of Modern Nursing October 26, 2020, Volume 26, Issue 30 Chin J Mod Nurs, October 26, 2020, VoL26, No. 30
Effects of smart stress balls in functional exercise of patients with midline catheters
Bai Xia, Yuan Yuan, Xu Zhenzhen, Cai Libai, Ding Juan, Liu Yuanmeng
No. 5 Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Corresponding author: Ding Juan, Email: firstname.lastname@example.org
[Abstract ] Objective To explore the effects of smart stress balls on the compliance of functional exercise and the incidence of complications in patients with midline catheters. Methods By convenient sampling, totally 59 patients who received midline catheterization in the Department of Gastroenterology at the First Affiliated Hospital of Zhengzhou University from June to August 2019 were selected as the control group, while 58 patients who underwent midline catherization between October and December 2019 were selected as the observation group. Patients in the control group used traditional stress balls in function exercise after catherization, whereas patients in the observation group used smart stress balls in function exercise. The compliance of functional exercise and incidence of catheter-related complications after catherization were compared between the two groups of patients. Results The functional exercise compliance score in the observation group was(39.66 ± 2.62), higher than (18.58 ± 6.37)in the control group, and the difference was statistically significant [=-50.470, P <. 0.01). The total incidence of complications in the observation group was 3.4%(2/58), lower than 15.3%(9/59) in the control group, and the difference was statistically significant (P V 0.05). Conclusions The use of smart stress balls can improve the functional exercise compliance and reduce the incidence of catheter-related complications after catheterization in patients with midline catheters, which is worth promoting in clinical practice.
[Key words ] Midline catheter; Smart stress ball; Functional exercise; Compliance; Complication
Fund program: The Medical Science and Technology Research Project of Henan Provincial Health and
Family Planning Commission(SBGJ2018004)
DOI: 10.3760/cma.j.cnl 15682-20200303-01308
Midline catheter (1) is a peripheral venous catheterization tool with a length of 8-20 cm. It is usually punctured from the cephalic vein of the upper arm elbow, the expensive vein or the median elbow vein. The puncture point is located at the cubital fossa or around the upper arm with the tip Located at or below the axillary vein, the indwelling time is 1 to 7 weeks. A medium-length catheter can reduce the irritation of drugs to blood vessels and relieve the pain of repeated puncture. Compared with other infusion tools, it has the advantages of low price, simple operation, fewer complications, etc. (2), and has a wide range of clinical applications. Common complications after the insertion of a medium-length catheter include phlebitis, catheter blockage, thrombosis, etc., so the regular functional exercise of patients after catheter insertion is particularly important to prevent the occurrence of related complications. 0 Corrective research reports, patient hand grip exercise It can enhance the afterload of the upper arm muscles during contraction, promote venous blood and lymphatic return, improve blood circulation, and reduce the occurrence of complications⑹. However, the traditional form of the power ball is single, the patient's compliance is poor, and the motivation to exercise is low. With the development of information technology, the advancement of smart phones and modern software, smart grip balls have been used clinically. The smart grip ball has game and recording functions, which can accurately record the strength, frequency, duration and daily times of exercise. The supporting APP software is rich in content, which increases the fun of exercise and helps to improve the quality and quality of functional exercise after the patient is placed in the tube. Positivity⑺. However, there are few studies on the effects and effects of smart grip balls on the functional exercise of patients with medium-length catheters. In this study, a smart grip ball was used to intervene in functional exercises for patients with medium-length catheter placement, and good practical results have been achieved. The report is as follows.
I. Objects and methods
(1) Research objects: 59 cases of mid-length catheterization patients in the Department of Gastroenterology, First Affiliated Hospital of Zhengzhou University from June to August 2019 were selected as the control group, and 58 cases of mid-length from October to December 2019 were selected as the control group. Patients with catheterization were the observation group. Inclusion criteria: (1) Patients with medium length catheterization for the first time; (2) The duration of catheterization> 7 days; (3) The age of 18 ~ 60 years; (4) Those who have a smart phone and master basic application methods; (5) Conscious and capable Those with general communication skills. Exclusion criteria: (1) Patients with severe limb dysfunction; (2) Patients with severe heart, liver, kidney and other important organ dysfunctions; (3) Those who did not succeed in a single puncture during the insertion of a medium and long catheter; (4) The blood coagulation function was normal, the international standardized ratio, 3; ⑸Patients who use anticoagulant or procoagulant drugs or stop the drug for VI weeks. There was no statistically significant difference between the two groups of patients in general data such as gender, age, BMI, education level, marital status, and family monthly income per capita (P> 0.05), and they were comparable. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (batch number: 2019-KY-180), and all patients and their families signed an informed consent form.
- Intervention method: Explain the relevant knowledge of the medium-length catheter to the patient before intubation, sign the consent form for the catheterization, and issue the "Middle-length Catheter Health Education Manual". A catheterization specialist nurse qualified for static therapy will perform the catheterization operation after evaluating the patient. The selected catheters are all single-lumen three-way valve catheters, and the blood vessels inserted are all important veins (8). After the catheterization is completed, record the insertion length and provide follow-up catheter maintenance. Two professionally trained and qualified rehabilitation functional exercise specialist nurses will provide post-insertion functional exercise guidance, and follow up on the implementation of functional exercise daily. For patients who do not take regular exercise, timely communication and guidance are provided. (1) Control group. Instruct the patient to use the traditional grip ball for making fists on the puncture side 24 hours after the catheter is placed, 3 times per day, 20 to 30 minutes each time. The specific method is to firmly grasp the grip ball with the side hand of the tube. Each time the grip ball is squeezed to reduce its volume by more than 1/2. It is advisable to make a fist for 5 s each time, and then relax. The grip loose ratio is 1: 1, repeat Take exercise. (2) Observation group. Instruct the patient to use the smart grip ball for exercise on the puncture side 24 hours after the catheter is placed, and teach the patient to use the smart grip ball. ①Test the grip strength through the Bluetooth connection with the mobile phone, which can visually monitor the grip strength value, and set the effective grip strength to 2~3 kg/time. ②B. Set the training plan through the mobile phone APP, 3 times a day, 1 time in the morning, midnight and evening (8:00, 12 : 00 and 17:00), 30 minutes each time; ③The exercise mode can be selected from self-grip training mode, game mode, online teammate grip competition mode, etc., according to the patient’s preferences; ④Daily WeChat check-in and share to functional exercise WeChat Group, APP records daily exercise data, including exercise date, exercise content, training method and time, and whether the functional exercise meets the standard; turn on the APP reminder function, the dialog box will pop up on the mobile phone if the exercise does not meet the standard, and the functional exercise specialist nurse will pay attention to the group dynamics in time. Communicate and supervise patients who have not completed the check-in in a timely manner.
- Evaluation indicators: (1) Functional exercise compliance. Based on the literature review and the results of patient interviews, the research team established a questionnaire pool of functional exercise compliance for patients with medium-length catheters. The questionnaire contains 16 items in four dimensions: grip exercise compliance, exercise monitoring compliance, active seeking help compliance, and exercise precautions compliance. Using Likert's 4-level scoring method, "it can't be done at all" is. The score is 1 point for “Occasionally Can”, “Basically Can” is 2 points, and “Completely Can” is 3 points. The total score of the questionnaire is 0 to 48. The higher the score, the better the patient's compliance with functional exercise. Using the expert consultation method, we consulted 10 medical and nursing experts from tertiary A hospitals in Beijing, Shanghai, Henan and other places. After consultation with experts, the items in the questionnaire that were ambiguous in semantics and difficult to answer were revised to form a formal questionnaire. Selecting patients for a pre-test showed that the questionnaire has good reliability and validity, with a content validity index of 0.879 and Cronbach's a coefficient of 0.965. (2) Incidence of catheter-related complications. ① Phlebitis: judge according to the phlebitis scale. Asymptomatic grade 0 phlebitis; erythema at the puncture site with or without pain is grade I phlebitis; erythema or edema at the puncture site, with pain as grade E phlebitis; erythema or edema at the puncture site with pain, forming Streaks, palpable venous cords are in-grade phlebitis; erythema or edema at the puncture site, accompanied by pain, forming streaks, palpable venous cords> 1 inch in length, with purulent secretions as field-grade veins inflammation. ②Conduit blockage: the infusion rate slows down or stops, the blood cannot be drawn back, and the tube cannot be flushed. ③Venous thrombosis dish: swelling of the limbs in the catheter, redness of the puncture port, oozing and bleeding, and even elevated skin temperature and side limbs The vein is dilated, and the presence of vein-related thrombosis is confirmed by vascular color Doppler ultrasound. During the catheterization period, the static therapy specialist nurse 51 will evaluate and record the occurrence of catheter-related complications of the patient, and observe whether the puncture point and surrounding tissues are red or swollen daily , Heat, pain, etc.; observe the swelling, peripheral circulation, skin temperature, etc. of the limbs on the side of the puncture; before each infusion, flush the catheter and withdraw blood to evaluate the catheter function 3), closely observe the infusion speed and other conditions.
- Data collection method: Two trained researchers use a unified instruction to explain the purpose and significance of the study to the patient. The general information questionnaire will be issued on the day the catheterization is completed, and the patient's function of the mid-length catheterization catheter will be issued on the day the patient is discharged from the hospital. Exercise compliance questionnaire and guide it to fill out.
- Statistical method: using SPSS 23.0 statistical software for data analysis, the measurement data are in accordance with the normal distribution, using the mean ± standard deviation & ± s) to express, using the I test for comparison; counting data using the number of cases and percentage (%) means that the comparison uses X 2 test. PV0.05 was considered statistically significant.
1. Comparison of the functional exercise compliance of the two groups of patients: see Table 1. After the intervention, the functional exercise compliance scores of the observation group were higher than those of the control group, and the differences were statistically significant (P v 0.01).
Comparison of the incidence of catheter-related complications between the two groups: see Table 2. The total incidence of complications during the catheterization period in the observation group was lower than that in the control group, and the difference was statistically significant (PV0.05).
Discussion The smart grip ball can effectively improve the functional exercise compliance of patients with medium-length catheters. The results of this study showed that the patients in the observation group had higher compliance with functional exercise after catheter placement than in the control group. The survey found that through health education, most patients can understand the importance of functional exercise, but the compliance of patients in clinical application is low. The reason for the analysis is that patients lack the grasp of specific exercise intensity, frequency, duration and daily frequency "3", which leads to their failure to complete exercise regularly. Some patients forget or give up due to complex exercise requirements, and exercise quality is low. In the traditional grip ball, due to the uncontrollable strength of the fist, the force is insufficient or excessive, and the lack of relevant positive feedback causes the patient's autonomy and enthusiasm for fist exercise to decrease. In addition, some patients have mastered the methods of rehabilitation exercises after they are discharged from treatment, but they lack effective supervision and active participation awareness, often forget or relax exercises, and their compliance is reduced. Some scholars believe that the greatest feature of functional exercise is that patients must actively participate, and its effect is closely related to the patient’s subjective efforts. By allowing patients to participate in the analysis and evaluation of functional exercise programs, they can be more aware of their own risks and benefits. It is more conducive to persuade yourself to change their behavior™. The literature reports that the compliance of functional exercise is 70%-85% for patients with regular guidance from professionals; while the compliance of functional exercise is 45%-55% for patients without regular guidance. 3-Hu. Therefore, functional exercise of intubated patients not only requires professional guidance, but also depends on the patient's good self-management behavior. Traditional grip ball training requires the joint supervision of medical staff and family members to achieve regular exercise, and there is a lack of records of the exercise process, the nursing staff cannot fully understand the exercise situation, and the supervision of patients lacks basis. Smart grip ball is not only a new type of exercise tool, it can also effectively record the patient's exercise process. The client in the mobile APP has powerful functions, and sports games can increase the interest of the patients to exercise, so as to prevent the patients from giving up due to exercise fatigue; the online interconnection function can play games and competitions with other patients, which promotes the enthusiasm and initiative of the patients to exercise to a certain extent It improves the patient’s compliance behavior; the WeChat check-in function facilitates regular supervision of patients and invites family members to assist in the supervision, which improves the compliance of patients with functional exercise. In addition, the smart grip ball can automatically record data such as exercise time, whether it is up to standard, etc., while giving full play to the autonomy of the patient, it is convenient for nursing staff to provide reference. In order to encourage both the nurse and the patient to jointly explore the reasons, analyze and solve the problem, and improve the nurse-patient coordination of functional exercise.
The smart grip ball can reduce the incidence of complications after a medium-length catheter is placed. The results of this study show that the use of smart grip balls for puncture measurement of limb function exercise can effectively reduce the incidence of phlebitis, catheter blockage and thrombosis, which is consistent with the results of related studies at home and abroad (S-22). After a medium-length catheter is placed, the patient’s arm on the puncture side will be completely immobilized, which will affect the local blood flow, resulting in mechanical phlebitis or swelling of the limb on the puncture side. Appropriate functional exercise can reduce the incidence of related complications (mm). In this study, the incidence of catheter-related complications in the observation group was lower than that in the control group, and exercise effects were better. The reason for the analysis is: the traditional grip strength ball cannot evaluate the depth of grip strength, the intensity of training is relatively random, the time of fisting is short, the pain or fatigue during the fisting process, the withdrawal or laziness in the middle of the fist, the degree of muscle contraction is not reached, and the desired effect is not obtained. ; The frequency of fisting does not meet the requirements, and the effect of vascular squeezing during muscle contraction is not obvious; individual patients have poor compliance. The smart grip ball conforms to ergonomic design and is more suitable for functional exercises of the hands. The size and frequency of the grip strength will be displayed on the screen of the mobile phone when the patient uses the smart grip ball for exercise, and the strength and frequency of the training can be precisely controlled during exercise. The strong grip of the patient’s exercise enhances the afterload of the upper arm muscles during contraction, increases blood circulation and lymphatic drainage, improves local microcirculation, speeds up blood circulation, and also repairs the damaged venous intima. Effectively reduce the incidence of complications after intubation.
In summary, the results of this study show that the use of smart grip balls can effectively improve the compliance of patients with medium-length catheters in functional exercise and reduce the incidence of catheter-related complications. It is worthy of clinical application. Due to time and manpower constraints, this study was only carried out in the gastroenterology department of a tertiary hospital with a small sample size; there was no long-term yoke for functional exercise of patients, and follow-up observations could be carried out in depth. Conflict of interest All authors declare that there is no conflict of interest. The author's contribution statement is designed by Bai Xia and Yuan Yuan, research implementation and data collection are Liu Yuanmeng and Cai Libai, the paper is written as Bai Xia, the paper is revised as Xu Zhenzhen, and Ding Juan is reviewed.
 Hu Mingming, Shen Xiaofang, Gu Ping, et al. Application research and enlightenment of medium-length catheters abroad [J]. Journal of Nursing, 2015, 22(12): 33-35. D0I: 10.16460/ j.issnl008-9969.2015. 12.033.
Hu MM, Shen XF, Gu P, et al. Application research and enlightenment of medium length catheter in foreign countries] J ]. J Nurs, 2015,22(12): 33-35.
 Liu Jiajia, Zhang Juan, Tan Lei. Comparison of the application of modified medium length catheter and PICC in the perioperative period of patients with gastrointestinal tumors[JL Nursing Practice and Research, 2018, 15(7): 143-145. DOI: 10.3969/j.issn. 1672-9676. 2018.07.057.
Liu JJ, Zhang J, Tan L. Comparison on the application of modified midline catheters and PICC applied in patients with gastrointestinal tumors in perioperative period [J ]. Nurs Pract Res, 2018,15(7): 143-145.
 Ma CCC, Sanz MM, Ma ACP. Medial venous catheter or midline (MVC)
[J]. Rev Enferm, 2014, 37(1): 36-41.
 Anderson J, Greenwell A, Louderback J, et al. Comparison of outcomes of extended dwell/midline peripheral intravenous catheters and peripherally inserted central catheters in children [J].J Assoc Vase Access, 2016,21(3):158 -164. DOI: 10.1016/ j.java.2016.03.007.
 Yu Rui, Chen Lifen. Meta analysis of factors affecting PICC catheter-related venous thrombosis in tumor patients[J]. Chinese Nursing Management, 2016, 16⑹: 738-743. DOI: 10.3969/j.issn.l672-1756.2016.06.005
Yu R, Chen LY. Risk factors of venous thromboembolism associated with peripherally inserted central catheters among cancer patients: a Meta-analysis[ J ]. Chin Nurs Manag, 2016, 16(6): 738-743.
 Zhang Min, Fang Xiuxin, Li Ming'e, etc. The effect of different fist exercise modes on blood flow velocity and vascular inner diameter of expensive veins before and after PICC[J]. Chinese Journal of Practical Nursing, 2015, 31(2): 94-98 DOI: 10.3760/cma.j.issn.l672-7088.2015. 02.005.
Zhang M, Fang XX, Li ME, et al. Effect of handgrip exercise on blood flow velocity and blood vessel diameter changes of basilic vein in patients with peripherally inserted central catheter] J ]. Chin; Pract Nurs, 2015, 31 ⑵: 94 -98.
 Zhang Xiaowu, Zheng Zefeng, Huang Miaoxin, etc. A device with interactive functions of games and massage: China, CN201610048765.1 [P].2016-05-04.
 Nicholson J. Royal college of nursing rs standards for infusion therapy: an overview[ J ]. Br J Nurs, 2018, 27(2): S12-S14. DOI: 10.12968/bjon.2018.27.2.S12.
 Cao Yi, Ma Jun, Jin Yanping. Combined use of wet and hot compresses to reduce the occurrence of mechanical phlebitis caused by central venous catheterization via peripheral venipuncture[J]. Journal of Nursing of the People's Liberation Army, 2015, 32(11): 55- 57. DOI: 10.3969/j.isan.1008-9993. 2015.11.017.
Cao Y, Ma J, Jin YP.Hydropathic and hot compress combined grip in reducing the Incidence of mechanical phlebitis caused by peripherally inserted central venous catheter] J ]. Nurs J Chin PLA, 2015,32(11): 55-57.
 Zhao Gaiting, Li Bin, Qi Xinrong, et al. Clinical study on vein injury and recovery caused by peripheral vein indwelling needle[J]. Chinese Journal of Modern Nursing, 2019, 25(29): 3733-3738. DOI: 10.3760/cma. j.issn.l674-2907.2019.29.006.
Zhao GT, Li B, Qi XR, et al. Venous injury caused by peripheral intravenous indwelling catheter and recovery [J ]. Chin J Mod Nurs, 2019, 25(29): 3733-3738.
 Gorski LA. The 2016 infusion therapy standards of practice[ J ]. Home Healthcare Now, 2017, 35(1): 10-18. DOI: 10.1097/ NHH.0000000000000481.
 Hu Meng. Analysis of the incidence of deep vein thrombosis and related risk factors of upper extremity after PICC catheterization [D]. Tianjin: Tianjin Medical University, 2015. DOI: 10.7666/ d.D798421.
 Lin Haili, Lin Haiyan, Wang Qin, et al. The effect of different catheter-catheter-venous diameter ratios on PICC-related thrombosis in patients with hypercoagulability[J]. Guangdong Medicine, 2019, 40(12): 1806-1809. DOI : 10.138207j.cnki.gdyx.20184203.
Lin HL, Lin HY, Wang Q, et al. Effect of different diameter ratio of catheters on PIGG related thrombosis in patients with hypercoagulable state[ J] .Guangdong Medical Journal, 2019, 40 (12): 1806-1809.
 Liu Wanli, He Lianxiang. The status and prospects of PICC specialist nurse training [J]. Chinese Journal of Modern Nursing, 2015, 21(6): 630-633. DOI: 10.3760/cma. j.issn.1674-2907.2015.06.004 .
Liu WL, He LX. Status Quo and prospect of PICC specialist
nurse training J] .Chin J Mod Nurs, 2015,21 ⑹:630-633.
 Li Li. Tips for handling poor blood withdrawal from PICC tube[J]. Chinese Journal of Modern Nursing, 2016, 22(3): 410. DOI: 10.3760/cma.j.issn.1674-2907. 2016.03.107 .
Li L. Treatment skills of blood withdrawal obstruction of PICC tube[ J].Chin J Mod Nurs, 2016, 22(3): 410.
 Zhou Xinyu. The effect of different postoperative functional exercise modes on the hemodynamics of PICC catheterization side [D]. Jinan: Shandong University, 2019.
 Dai Feng. The effect of holding ball strength and duration on the hemodynamics of upper limb axillary veins in patients with PICC catheterization tumor [D]. Hefei: Anhui Medical University, 2019.
 Liang Yueying, Xie Xiaoxia, Wu Shuwen, et al. The role of nurse-patient cooperative quality control group activities in improving compliance with functional exercises of patients with head, face and neck burns[J], Chinese Journal of Nursing, 2013, 48(8): 682 -684. DOI: 10.3761/j.issn.0254- 1769.2013.08.002.
Liang YY, Xie XX, Wu SW, et al. Effect of a nurse-patient collaborative quality control program on improving rehabilitation compliance in patients with faciocervical bums[ J ]. Chin J Nurs, 2013,48(8): 682-684.
 Jeflfe E, Wiseman T. Randomised controlled trial to determine the benefit of daily home-based exercise in addition to self-care in the management of breast cancer-related lymphoedema: a feasibility study[ J ]. Support Care Cancer, 2013 , 21(4): 1013-1023. DOI: 10.1007/s00520-012-1621-6.
 Kwan ML, Cohn JC, Artner JM, et al. Exercise in patients with lymphedema: a systematic review of the contemporary literature [J]. J Cancer Surviv, 2011, 5(4): 320-336. DOI: 10.1007 / si 1764-011-0203-9.
 Appleton ND, Corris A, Edwards C, et al. A dedicated peripherally inserted central catheter (PICC) line service: 2 yearreview[j].Int JSurg, 2013, 11(8): 649. DOI: 10.1016/ j .ijsu.2013.06.334.
 Zhang Ying, Li Aimin, Guan Chenyang, etc. Evaluation of the effect of different activities in preventing PICC catheter-related thrombosis[J]. Chinese Journal of Nursing, 2019, 54(9): 1390-1393. DOI: 10.3761/j.issn .0254-1769.2019.09.021.
Zhang Y, Li AM, Guan CY, et al. Effect of different exercise modes on preventing catheter related thrombosis in cancer patients with peripherally inserted central catheterf J ]. Chin J Nurs, 2019,54(9): 1390-1393.
 Bertoglio S, Faccini B, Lalli L, et al. Peripherally inserted central catheters (PICCs) in cancer patients under chemotherapy: a prospective study on the incidence o£ complications and overall failures] J ]. J Surg Oncol, 2016, 113(6): 708-714. DOI: 10.1002/jso.24220.
Liu K, Ye Z, Xie W, et al. Handgrip exercise reduces peripherally-inserted central catheter-related venous thrombosis in patients with solid cancers: a randomized controlled trial [J ]. Int J Nurs Stud, 2018, 86: 99-106. DOI: 10.1016/ j.ijnurstu.2018.06.004.
 Dai Feng, Su Xun, Wang Lei, et al. Research progress in functional exercise of PICC catheterization patients[J]. Chinese Journal of Modern Nursing, 2019, 25(14): 1845-1848. D0I: 10.3760/cma.j. issn.l674-2907.2019.14.032.
Dai F, Su X, Wang L, et al. Research progress of functional exercise in patients with catheterization by PICC [J]. Chin J Mod Nurs, 2019, 25(14): 1845-1848. DOI: 10.3760/cma. j .issn.1674-2907.2019.14.032.
 Li Xuejiao, Pi Hongying. The influence of upper limb compression and fisting exercise program on the hemodynamics of PICC catheterization patients[J]. Chinese Journal of Modern Nursing, 2018, 24(27): 3259-3262. DOI: 10.3760 /cma.j.issn.1674-2907.2018.27.009.
Li XJ, Pi HY. Effects of upper limb compression and clench fist movement on hemodynamics among patients with peripherally inserted central catheterf J ]. Chin J Mod Nurs, 2018, 24(27): 3259-3262.