Bundle nursing for patients with non-Hodgkin lymphoma (NHL) was found to reduce peripherally inserted central catheter-related upper extremity deep venous thrombosis (PICC-UEDVT) and improve patient satisfaction. These findings were published in the American Journal of Translational Research.

Patients receiving chemotherapy for NHL at the Cancer Hospital in Xinjiang Uygur Autonomous Region in China between 2018 and 2020 were recruited for this study. Participants were randomly assigned to receive routine nursing (185 patients) or bundle nursing (185 patients).

Bundle nursing is to provide a series of related effective interventions and nursing approaches intended to improve patient outcomes. The practice was proposed by the American Institute for Healthcare Improvement to ensure patients experience the best possible nursing services and outcomes.

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Patients in the intervention arm were instructed to be cleaned prior to intubation and hydrated daily, and were contacted by message or telephone to remind them to move their upper extremities often. Incidence of PICC-UEDVT were assessed.

Participants in the intervention and control groups were mean age 42.1±7.9 and 40.9±7.1 years and the male-to-female ratio was 100:85 and 97:88, respectively.

Fewer patients in the bundle-nursing cohort had a PICC-UEDVT (9.73% vs 18.92%; ÷2, 6.356; P =.012). More patients who received reminders to move their extremities were satisfied with their nursing care (84.32% vs 72.97%; ÷2, 12.413; P =.015).

Thrombosis events were associated with tumor stage (odds ratio [OR], 6.923; 95% CI, 1.221-8.231; P <.001), D-dimer levels (OR, 6.923; 95% CI, 1.221-8.231; P <.001), Eastern Cooperative Oncology Group scores (OR, 5.143; 95% CI, 1.416-21.932; P =.021), and hemoglobin levels (OR, 0.176; 95% CI, 0.081-0.689; P =.012).

Results of this study may not be generalizable outside of this hospital and requires confirmation in a larger, multicenter study.

These data indicated that a bundle nursing protocol decreased risk for PICC-UEDVT and increased satisfaction with nursing care among patients with NHL receiving chemotherapy.


Qian H, Liu J, Xu C, Zhu W, Chen L. Predisposing factors and effect of bundle nursing in PICC-related upper extremity deep venous thrombosis in patients with non-Hodgkin’s lymphoma undergoing chemotherapy. Am J Transl Res. 2021;13(8):9679-9686.