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Objective: Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and death. Empathy is a prerequisite cognitive reaction for CF. Nurses with greater empathy levels are more prone to develop an emotional connection with patients. However, it is this kind of close bonds that led nurses to experience a deep sense of grief. Cumulative grief may eventually develop into CF. This study examined the levels of grief, empathy and CF, evaluated the correlation among empathy, grief and CF, and verified the role grief as a mediator of the relationship between empathy and CF. Methods: Participants were 794 Chinese oncology nurses in a cross‐sectional study. We measures consisted a demographic questionnaire, the Interpersonal Reactivity Index, the Texas Revised Inventory of Grief‐Present, and the Professional Quality of Life Scale. Results: Oncology nurses showed moderate levels of empathy and grief, moderate to high levels of CF. Perspective taking was negatively related to grief and secondary traumatic stress (STS). Empathic concern was negatively related to burnout (BO). Personal distress was positively related to grief, STS and BO. Grief was positively related to STS and BO. Grief played a partial mediating role between empathy and STS. Conclusions: Oncology nurses commonly experience CF. There is a need to provide interventions and effective supports for oncology nurses to improve their empathy ability, and help them cope with grief and CF. Key points: Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and deathChinese oncology nurses showed moderate levels of empathy and grief, moderate to high levels of CFEmpathy was positively related to grief and CF. Grief was positively related to CF. Grief played a partial mediating role between empathy and secondary traumatic stress [ABSTRACT FROM AUTHOR]

To delineate the clinical topography of peripherally inserted central catheter (PICC)-related thrombosis in cancer patients. Most of the clinical features of PICC-related thrombosis are based on a single follow-up, which is insufficient to reflect the full topography of a thrombosis. This is an observational study conducted at West China Hospital, according to the STROBE guidelines. Cancer patients scheduled for PICC placement were potentially eligible; patients with contraindications to PICC placement or existing diseases affecting blood flow were excluded; and those who later withdrew or did not reply to our contact request during the follow-up period were eliminated from this study. Ultrasound was used to detect thrombosis from the insertion site, proximal insertion site, axillary vein to the subclavian vein once every two days for two weeks post insertion. The thrombosis and its involved venous segments, onset time and symptoms and signs were recorded. Among the 173 included patients, 126 (72.8 %) were identified as having thrombosis. Specifically, 113 and 126 patients were identified as having thrombosis within the first three days and the first week post insertion, respectively. In the 126 patients, thrombosis occurred at the insertion site (72.8 %) concurrently with thrombosis at the proximal insertion site (n = 120, 69.4 %), thrombosis in the axillary vein (n = 94, 54.3 %), and/or thrombosis in the subclavian vein (n = 41, 23.7 %). The log-rank test demonstrated that thrombosis in these four venous segments decreased significantly from the distal to the proximal central vein (log-rank test = 117.128, P <.001). Of 31 patients (17.9 %) who presented symptomatic thrombosis, only five patients experienced obvious swelling in the upper arm, and the other 26 patients exhibited atypical symptoms, such as soreness, tightness, numbness, tingling, or other discomforts in the palm, arm, armpit, and/or shoulder. In some thrombotic cases, ultrasonic assessment of PICC-related thrombosis did not parallel clinical symptoms and signs. PICC-related thrombosis is common and can occur very early post insertion in cancer patients, and most thromboses present atypical symptoms. More than half of the cases with thrombosis evaluated involve multiple venous segments, and the farther the venous segments are from the central vein, the higher the incidence of thrombosis tend to be and the earlier the onset time are. The results highlight the importance that medical staff pay particular attention to patients with catheters in the first week post insertion and be alert to thrombosis presenting atypical symptoms while keeping in mind that clinical symptoms and signs are not reliable for diagnosing thrombosis. Clinical Trials ChiCTR1900024890. • Sequential ultrasound scan can obtain date on PICC-related thrombosis in a dynamic pattern. • PICC-related thrombosis is very common and can occur early post-insertion. • Frequency and onset of PICC-related thrombosis are variable in different venous segments. • Clinical manifestations of PICC-related thrombosis are not parallel to ultrasonic assessment. [ABSTRACT FROM AUTHOR]

The negative synergistic effect of cancer and a peripherally inserted central catheter could significantly increase the incidence of thrombosis. Rather than identifying risk factors for peripherally inserted central catheter–related thrombosis, exploring the effect of these risk factors might be a promising method to improve the outcomes of thrombosis. To analyze the effect of systemic and local risk factors on triggering peripherally inserted central catheter–related thrombosis in the first two weeks post–insertion in cancer patients. A prospective cohort study. The study was conducted at a 4500-bed university-affiliated medical center in China. One hundred seventy-three cancer patients with peripherally inserted central catheters were included. Peripherally inserted central catheter–related thrombosis was assessed using ultrasound at a series of timepoints, once every two days post–insertion. Data on age, body mass index, blood hypercoagulation, insertion attempts, catheter-to-vein ratio, and blood flow velocity were collected as risk factors. Descriptive statistics and structural equation modeling were used to describe the study samples and analyze the effects of systemic and local risk factors. Among the 173 cancer patients included, 126 (72.8%) patients were diagnosed with peripherally inserted central catheter–related thrombosis. Most thromboses (n = 118, 93.7%) were detected within five days, and 100% were detected within nine days post–insertion. Structural equation modeling analysis showed that local risk factors [catheter-to-vein ratio (standardized path coefficient = 0.32, p < 0.05) and blood flow velocity (standardized path coefficient = −0.35, p < 0.05)] had a greater effect than systemic factors [age (standardized path coefficient = 0.13, p < 0.05) and blood hypercoagulation (standardized path coefficient = 0.17, p < 0.05)] on triggering peripherally inserted central catheter–related thrombosis. Peripherally inserted central catheter–related thrombosis is quite common and can occur very early post–insertion in cancer patients. Among the common risk factors, local risk factors reflecting peripherally inserted central catheter technology itself had a greater effect than systemic risk factors reflecting predisposition to thrombosis. Clinical Registration: Clinical Trials ChiCTR1900024890. [ABSTRACT FROM AUTHOR]