Construction and evaluation of a predictive model for catheter dysfunction in cancer patients with implanted vascular access ports: A cross-sectional study

Construction and evaluation of a predictive model for catheter dysfunction in cancer patients with implanted vascular access ports: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Construction and evaluation of a predictive model for catheter dysfunction in cancer patients with implanted vascular access ports: A cross-sectional study Jiahui Wu, Jia Li, Xuefang Huang, Xiling Lin, Huiying Qin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7427340/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Catheter dysfunction in implanted vascular access ports (ports) is a prevalent complication disrupting cancer treatment, yet existing evidence lacks risk prediction models specifically for cancer populations and standardized dysfunction assessment. Methods: A cross-sectional study enrolled 413 cancer patients from a Chinese Tertiary A hospital (Jan–Jun 2024). Catheter function was assessed using the Catheter Injection and Aspiration Scheme (CINAS). Univariate/multivariate logistic regression identified predictors, and a nomogram was constructed. Model validation included Hosmer-Lemeshow test, AUC, Cox & Snell R 2 , Nagelkerke R 2 , and 1,000-bootstrap resampling. Results: Dysfunction incidence was 16.7% (69/413), with 88.4% resolved post-intervention. Three independent predictors emerged: port retention time >12 months (OR=5.105, P<0.001), history of catheter dysfunction (OR=30.672, P<0.001), and lower CPT-SMS self-management score (OR=0.936 per point, P<0.001). The nomogram assigned CPT-SMS the highest weight (53.5%). The model showed excellent discrimination (AUC=0.910, 95% CI:0.879–0.941), calibration (P=0.577), and minimal overfitting (0.002). Conclusions: A predictive model was developed based on retention time, history of catheter dysfunction, and CPT-SMS score to estimate the risk of catheter dysfunction in cancer patients. The validated model exhibited good discrimination and accuracy. Its implementation could support effective patient assessment, enabling early identification and professional nursing interventions to prevent and resolve most catheter dysfunctions. Implanted Vascular Access Port Catheter dysfunction Risk Prediction Model Central Venous Access Device cancer Figures Figure 1 Figure 2 Figure 3 1 Introduction There were an estimated 20 million new cancer cases and 9.7 million deaths worldwide in 2022( 1 ). Intravenous chemotherapy is the most important form of cancer treatment, and the Central Venous Access Device (CVAD) is the most pivotal tool for administering it, significantly enhancing patient venous safety( 2 , 3 ). The implanted vascular access port (port) is a type of CVAD( 4 ). Numerous studies have demonstrated the reliability of ports, especially in facilitating anti-cancer and supportive therapies for cancer populations( 5 – 7 ). As the utilization of ports has surged over the past decades, so has the substantial risk of associated complications( 8 – 10 ). Catheter dysfunction, proposed by Goossens et al.( 11 ), is defined as an injection and/or an aspiration ability that is difficult or impossible. The newest version(2024) of Infusion Therapy Standards of Practice( 12 ) also points out that CVAD should be assessed for patency by injecting and aspirating for a blood return. With an incidence of 0.6% ~ 15.8%( 13 – 18 ), catheter dysfunction is one of the most common complications associated with ports, which can lead to treatment delays, reduced efficacy, extended hospital stays, heightened hospitalization rates, escalated overall treatment costs, and ultimately compromised survival rates due to disruptions in treatment schedules( 19 – 21 ). However, in the existing research, catheter dysfunction is usually vaguely described as catheter occlusion, which is defined as an injection ability that is difficult or impossible, while neglecting the catheter’s aspiration ability( 9 , 14 – 17 ). Some studies have introduced the concept of partial occlusion of catheters, taking into account the aspiration ability of the catheter, but have not further classified it( 22 ). Developed by Goossens et al.( 11 ), the catheter injection and aspiration scheme (CINAS) has classified catheter functions into 16 grades. Through the clear classification of CINAS, early detection of catheter dysfunction in clinical settings can be facilitated, allowing for earlier intervention and prevention of further deterioration of early-stage catheter dysfunction. In addition, in the existing research, the research populations are mostly pediatric patients( 3 , 23 ) or hemodialysis patients( 24 ), and there was little research specifically addressing catheter dysfunction in ports used for cancer patients. Understanding the risk factors of catheter dysfunction in cancer patients and developing a risk prediction model is important to reduce the occurrence of similar situations. In this study, the catheter functional status of patients was assessed using CINAS, we first determined the incidence of catheter dysfunction and identified four independent risk factors in cancer patients. Then, we constructed a risk prediction model, providing a simple and individualized assessment tool for assessing the risk of catheter dysfunction in cancer patients with port. 2 Method 2.1 Study design and patient selection This study was a cross-sectional study conducted at a Tertiary A cancer hospital from January to June 2024, and the subjects were ambulatory cancer patients. The convenience sampling method was used to evaluate the catheter function of ports and investigate patients, who met the sample inclusion and exclusion criteria, the demographic characteristics, disease-related characteristics, CVAD-related information, and cancer patients' self-management level with port. This study was approved by the ethics committee of the Sun Yat-sen University Cancer Center (approval number: B2024-230-01), and informed consent was obtained from all patients. The inclusion criteria were as follows: ( 1 ) Pathological diagnosis is cancer; ( 2 ) Patients who implanted port at the suggestion of clinicians for disease treatment; ( 3 ) Age > 18 years old; ( 4 ) No intellectual or mental disorders, have a certain reading ability, can fill in the questionnaire independently or with the assistance of researchers; ( 5 ) Know about this study and sign informed consent. The exclusion criteria were as follows: ( 1 ) There are serious heart, liver, lung, kidney, and other organ diseases unrelated to the original cancer; ( 2 ) Patients who implanted ports of lower limbs; ( 3 ) Patients who died or lost follow-up after implantation of port;(4) Patients with other serious complications such as catheter shedding, embolism, hematoma, and require extubation after implantation of ports. 2.2 Assessment of Catheter Function 2.2.1 General Information Questionnaire The questionnaire was self-designed by the researcher (supplementary file), including three aspects: demographic characteristics, disease-related characteristics, and CVAD-related information. Demographic characteristics included name, gender, age, education level, etc. Disease-related characteristics included the disease diagnosis, chemotherapy regimen, underlying disease, infectious diseases, etc. CVAD-related information included patients’ CVAD implanting history, date of implantation, implanting position, implanting vein, location of port tip, etc. The patients themselves provided their demographic characteristics, while the researchers filled in the patients’ disease information and CVAD-related information based on their medical records. 2.2.2 The Catheter Injection and Aspiration Scheme (CINAS) The CINAS, created by Goossens( 11 ), is a catheter function classification tool that uniformly evaluates both injection and aspiration capabilities. It comprises 16 unique combinations of four codes, each reflecting the injection (IN) ability of at least 1 ml fluid and the aspiration (AS) ability of at least 3 ml blood. These abilities are scored on a scale of one to three: one for easy (non-hindered), two for difficult (problematic handling), and three for impossible (inability to perform). An additional option, 'x', is used when the injection and/or aspiration ability is unknown. An IN1AS1 score indicates good catheter function, while other combinations suggest dysfunction, necessitating nursing interventions. The CINAS has an assessment accuracy of 98.7%. 2.2.3 Cancer patients TIVAPs self-management scale (CPT-SMS) Designed and verified by Wu Xiaohong( 25 ), the scale was designed for cancer patients implanted port for intravenous infusion. With Cronbach's α coefficient was 0.931 and retest reliability was 0.90, it had good structural validity, aggregation validity, and differential validity. The content of the scale includes 29 items in 7 dimensions, including observation of complications with ports, treatment of abnormal situations, maintenance compliance of port, access to port-relevant information, protection in sports and life with the port, protection during the use of port and confidence in self-management with port. Likert five-level scoring method was used to score as 1 to 5. Higher scores indicate better self-management behavior. A score less than 87 is classified as a low level, between 87 and 116 is a medium level, and more than 116 is a good level. 2.3 Statistical analysis Continuous variables are presented as the means(M) and standard deviations(SD), and categorical variables are presented as absolute values and percentages. SPSS23.0 was used for statistical analysis, with the influencing factors of the occurrence of catheter dysfunction as independent variables and the occurrence of catheter dysfunction as dependent variables, and univariate analysis was conducted for each factor by using the T-test and Chi-square test. Multivariate Logistic regression analysis was performed for the variables with statistically significant differences in the univariate analysis results. The odds ratio (OR) and 95% confidence interval (CI)were presented as effect estimates. Conduct collinearity diagnostics on the predictor variables with significant differences to eliminate the effects of multicollinearity and screen the variables. Use Tolerance and Variance Inflation Factor (VIF) as the criteria for assessment. Screen the variables (P < 0.05) from the results of multivariate logistic regression as the influencing factors for port catheter dysfunction in cancer patients. Use the rms package of R4.1.2 to draw a nomogram model. Evaluate the goodness-of-fit of the model through the HL test and by plotting calibration curves. Assess the performance of the constructed risk prediction model by examining the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC Curve (AUC). 3 Results 3.1 Characteristics of Participants A total of 413 cancer patients with implanted ports were selected in this study, and 413 effective questionnaires were finally collected, with an effective rate of 100%. The demographic characteristics, disease-related characteristics, and CVAD-related information of cancer patients with ports are shown in Table 1 . Table 1 Patients’ characteristics and univariate analysis of catheter function (n = 413,n 1 = 69,n 2 = 344) Variables Catheter function n(%) t/ \(\:{\mathcal{X}}^{2}\) P Catheter dysfunction n 1 (%) Good condition n 2 (%) Demographic characteristics Gender Male 24(34.8) 141(41.0) 0.923 0.337 Female 45(65.2) 203(59.0) Age(year) 53.48 \(\:\pm\:\) 11.17 51.24 \(\:\pm\:\) 12.93 -1.481 0.142 BMI \(\:\) 23.9 28(40.6) 118(34.3) Place of residence Town 50(72.5) 239(69.5) 0.244 0.621 Village 19(27.5) 105(30.5) Degree of education Primary school or below 16(23.2) 50(14.5) 8.766 0.067 Junior high school 24(34.8) 84(24.4) Senior high school 14(20.3) 95(27.6) Junior college 6(8.7) 50(14.5) Bachelor or above 9(13.0) 65(18.9) Occupation Retirement 17(24.6) 88(25.6) 0.747 0.980 On-post staff 23(33.3) 110(32.0) Freelancer 9(13.0) 35(10.2) Farmer 7(10.1) 40(11.6) Unemployed 5(7.2) 25(7.3) Else 8(11.6) 46(13.4) Marital status Unmarried 5(7.2) 30(8.7) 0.306 0.858 Married 62(89.9) 301(87.5) Lose marriage 2(2.9) 13(3.8) Medical insurance type Medical insurance for workers 36(52.2) 187(54.3) 0.163 0.922 Medical insurance for residents 31(44.9) 149(43.3) No medical insurance 2(2.9) 8(2.3) Disease-related characteristics Diagnose Breast Cancer 17(24.6) 99(28.8) 2.107 0.716 Colorectal Cancer 16(23.2) 73(21.2) Nasopharynx Cancer 17(24.6) 66(19.2) Lymphoma 2(2.9) 19(5.5) Else 19(27.5) 87(25.3) Completed chemotherapy Yes 20(29.0) 99(28.8) 0.001 0.972 No 49(71.0) 245(71.2) The chemotherapy regimen included a home-chemotherapy-pump Yes 6(8.7) 64(18.6) 4.009 0.045 No 63(91.3) 280(81.4) Other underlying diseases Yes 20(29.0) 98(28.5) 0.007 0.934 No 49(71.0) 246(71.5) Infectious disease Yes 7(10.1) 30(8.7) 0.143 0.705 No 62(89.9) 314(91.3) Smoke or not Yes 4(5.8) 23(6.7) 0.000 * 0.995 No 65(94.2) 321(93.3) CVAD-related information Time with port(month) 26.59 \(\:\pm\:\) 30.21 9.47 \(\:\pm\:\) 15.87 -4.584 0.000 Implanting position Chest port 65(94.2) 336(97.7) 1.379 * 0.240 Upper arm port 4(5.8) 8(2.3) Implanting limb Right 57(82.6) 267(77.6) 0.847 0.357 Left 12(17.4) 77(22.4) Location of port tip Upper or mid of superior vena cava 25(36.2) 91(26.5) 35.430 0.000 Lower of superior vena cava or right atrium 36(52.2) 251(73.0) Not in superior vena cava 8(11.6) 2(0.6) Maintain port schedule Yes 64(92.8) 332(96.5) 1.215 * 0.270 No 5(7.2) 12(3.5) Implanted CVAD before Yes 5(7.2) 30(8.7) 0.161 0.688 No 64(92.8) 314(91.3) Occurred catheter dysfunction before Yes 34(49.3) 10(2.9) 129.814 0.000 No 35(50.7) 334(97.1) The score of CPT-SMS 97.14 \(\:\pm\:\) 8.10 108.96 \(\:\pm\:\) 15.43 9.218 0.000 * Continuous calibration chi-square test 3.2 Incidence of catheter dysfunction in cancer patients with ports Among 413 cancer patients with implanted ports investigated in this study, 344 cases (83.3%) had good catheter function and 69 cases (16.7%) had catheter dysfunction. The CINAS evaluation results are shown in Table 2 . Table 2 CINAS Classification(n = 413) CINAS Classification Injection Ability(IN) EASY \(\:\ge\:\) 1ml IN1 DIFFICULT \(\:\ge\:\) 1ml IN2 IMPOSSIBLE \(\:<\) 1ml IN3 UNKNOWN INx Aspiration Ability (AS) EASY \(\:\ge\:\) 1ml AS1 IN1AS1 IN2AS1 IN3AS1 INxAS1 344(83.3%) 3 (0.7%) 1 (0.2%) 0 DIFFICULT \(\:\ge\:\) 1ml AS2 IN1AS2 IN2AS2 IN3AS2 INxAS2 30 (7.3%) 6 (1.5%) 2 (0.5%) 0 IMPOSSIBLE \(\:<\) 1ml AS3 IN1AS3 IN2AS3 IN3AS3 INxAS3 24 (5.8%) 2 (0.5%) 1 (0.2%) 0 UNKNOWN ASx IN1ASx IN2ASx IN3ASx INxASx 0 0 0 0 Management measures for patients with catheter dysfunction include:( 1 )Pulse maneuver flushing again;( 2 )Instruct patient to adjust the body position or move arms;( 3 )Retain urokinase for 30 minutes. After management measures of 69 patients with catheter dysfunction, 61(88.4%) patients recovered from their catheter dysfunction, and 8(11.6%) patients remained with catheter dysfunction. Among the 61 patients whose catheters returned to good condition, 23(37.7%) patients’ catheter function returned good condition by pulsing maneuver flushing again, 19(31.1%) patients’ catheter function returned good condition by instructing patients to adjust their body position or move arms, 19(31.1%) patients’ catheter function return good condition by retaining urokinase for 30 minutes. Among the 8 patients whose catheters were still not restored, 5 patients had no blood return for a long time with ports. All 8 patients were instructed to undergo an X-ray examination, and the port-implantation physicians were consulted to assess the position of the catheter tip and the catheter status. It was determined that the ports of 5 patients could still be used normally. For the other 3 patients, as they had completed their chemotherapy, the port-implantation physicians recommended early removal of the ports, with no further interventions planned. 3.3 Cancer patients' self-management behavior with port In this study, the score of CPT-SMS ranged from 62 ~ 139, the total mean score was (106.98 \(\:\pm\:\) 15.11). As the number of items in each dimension is different, the total score of each dimension cannot be directly compared, so the score ratio is used to compare the score of each dimension, the score ratio = (total mean score/highest score) \(\:\times\:\) 100%, the dimension of the highest score ratio are skin protection at the base and protection during infusion, and the dimension of the lowest score ratio is port-maintenance information acquisition. 5.3% of patients had a total score of \(\:\le\:\) 87, which indicates that the patient's self-management level is low. 65.4% of patients had a total score of 87~ 116, which means medium level. 29.3% of patients had a total score of \(\:>\) 116, which represents a high level of self-management. The seven dimension scores are shown in Table 3 . Table 3 The score of CPT-SMS(n = 413) Dimensions Items M SD Score ratio(%) A.Observation of anomalies 6 19.2 5.7 60.0 B. Exception handling and port-maintenance compliance 6 21.7 4.4 70.0 C. Protection of the skin at the base 4 20.0 1.7 100.0 D. Self-management confidence with port 4 12.3 2.4 60.0 E. Protection of ports during infusion 3 14.9 0.8 100.0 F. Protection of sports and life with port 3 12.8 2.1 86.7 G. Port-Maintenance information acquisition 3 6.7 2.1 46.2 Total 29 107.0 15.1 77.0 3.4 Univariate analysis of influencing factors of catheter dysfunction in cancer patients with ports 3.4.1 Influence of demographic characteristics on catheter dysfunction in cancer patients The T-test and Chi-square test results of gender, age, BMI, place of residence, degree of education, occupation, marital status, and type of medical insurance found that there was no difference in demographic characteristics between the two groups with catheter function, as shown in Table 1 . 3.4.2 Influence of disease-related characteristics on Catheter Dysfunction in cancer patients The Chi-square test results of diagnosis, whether chemotherapy was completed, whether the chemotherapy regimen included a home-chemotherapy-pump, whether there are other underlying diseases, whether there is any infectious disease, whether smoke or not found that there was a statistically significant difference between the group whether the chemotherapy regimen included a home-chemotherapy-pump(P = 0.045), as shown in Table 1 . 3.4.3 Influence of CVAD-related information on catheter dysfunction in cancer patients The T-test and Chi-square test results of time with port, implanting position, implanting limb, location of port tip, whether port maintenance was scheduled, whether implanted CVAD before, and whether catheter dysfunction occurred before, found that there was a statistically significant difference in time with port(P = 0.000), location of port tip(P = 0.000), whether catheter dysfunction occurred before(P = 0.000) between the groups with good catheter function and those with catheter dysfunction, as shown in Table 1 . 3.4.4 Influence of cancer patients' self-management behavior with port on catheter dysfunction The study results found that there was a statistically significant difference(P = 0.000) in the score of CPT-SMS between the groups with good catheter function and those with catheter dysfunction, as shown in Table 1 . 3.4.5 Univariate analysis of meaningful covariance diagnosis among independent variables According to the research findings, no complex multicollinearity phenomena were observed among the 5 independent variables, as shown in Table 4 . Table 4 Univariate analysis of meaningful covariance diagnosis among independent variables Variables Tolerance VIF The chemotherapy regimen included a home-chemotherapy-pump 0.971 1.029 Location of port tip 0.990 1.010 Occurred catheter dysfunction before 0.927 1.079 Time with port(month) 0.921 1.086 The score of CPT-SMS 0.933 1.072 3.5 Multivariate analysis of influencing factors of catheter dysfunction in cancer patients with ports Five factors with statistical significance in the univariate analysis were taken as independent variables (whether the chemotherapy regimen included a home chemotherapy pump, time with port, location of the port tip, whether catheter dysfunction occurred before, the score of CPT-SMS), whether the catheter dysfunction occurred at the infusion port was included in the regression model as the dependent variable, and the variable assignment was shown in Table 5 . Table 5 Variables and variable assignment in binary Logistic regression Variables Variable assignment Catheter function 0 = good condition, 1 = catheter dysfunction The chemotherapy regimen included a home-chemotherapy-pump 0 = No, 1 = Yes Location of port tip 0 = lower of superior vena cava or right atrium, 1 = upper or mid of superior vena cava, 2 = Not in superior vena cava Occurred catheter dysfunction before 0 = No, 1 = Yes Time with port(month) entry of original continuous numerical values The score of CPT-SMS entry of original continuous numerical values Logistic regression results showed that time with port > 6 months, abnormal location of the port tip, and history of catheter dysfunction were independent risk factors for catheter dysfunction in cancer patients with ports, and high-level of self-management behavior of cancer patients with ports were independent protective factors for catheter dysfunction at infusion port of cancer patients. Table 6 Multivariate analysis of influencing factors of catheter dysfunction in cancer patients with ports (n = 413). Variables B SE Wald P OR 95%CI Time with port(month) 0.027 0.008 11.552 0.001 1.027 1.011–1.043 The location of the port tip is not in superior vena cava 2.860 1.058 7.302 0.007 17.466 2.194-139.047 Occurred catheter dysfunction before 3.362 0.449 55.961 0.000 28.843 11.954–69.595 The score of CPT-SMS -0.055 0.015 13.774 0.000 0.919 0.919–0.974 3.6 Construction and evaluation of risk prediction model for catheter dysfunction in cancer patients with ports 3.6.1 Construction of risk prediction model for catheter dysfunction in cancer patients with ports This study has derived a risk prediction model for catheter dysfunction in cancer patients with ports: $$\:\text{L}\text{o}\text{g}\text{i}\text{t}\left(\text{P}\right)={{\beta\:}}_{0}+{{\beta\:}}_{1}{\text{X}}_{1}+{{\beta\:}}_{2}{\text{X}}_{2}+\dots\:+{{\beta\:}}_{\text{i}}{\text{X}}_{\text{i}}=2.851+0.027\ast\:\text{T}\text{i}\text{m}\text{e}\:\text{w}\text{i}\text{t}\text{h}\:\text{p}\text{o}\text{r}\text{t}\left(\text{m}\text{o}\text{n}\text{t}\text{h}\right)+2.860\ast\:\text{L}\text{o}\text{c}\text{a}\text{t}\text{i}\text{o}\text{n}\:\text{o}\text{f}\:\text{p}\text{o}\text{r}\text{t}\:\text{i}\text{s}\:\text{n}\text{o}\text{t}\:\text{i}\text{n}\:\text{s}\text{u}\text{p}\text{e}\text{r}\text{i}\text{o}\text{r}\:\text{v}\text{e}\text{n}\text{a}\:\text{c}\text{a}\text{v}\text{a}+3.362\ast\:\text{O}\text{c}\text{c}\text{u}\text{r}\text{r}\text{e}\text{d}\:\text{c}\text{a}\text{t}\text{h}\text{e}\text{t}\text{e}\text{r}\:\text{m}\text{a}\text{l}\text{f}\text{u}\text{n}\text{c}\text{t}\text{i}\text{o}\text{n}\:\text{b}\text{e}\text{f}\text{o}\text{r}\text{e}-0.055\ast\:\text{T}\text{h}\text{e}\:\text{s}\text{c}\text{o}\text{r}\text{e}\:\text{o}\text{f}\:\text{C}\text{P}\text{T}-\text{S}\text{M}\text{S}$$ Using a nomogram to present the risk prediction model, as shown in Fig. 1 . Each segment of the nomogram corresponds to a variable, and the patient's relevant information is marked on the corresponding scale. These are converted based on partial regression coefficients, with each predictor variable having a value range of 0 to 100 points. The higher the weight of a variable, the higher the score corresponding to that factor. Finally, the scores corresponding to the four indicators are summed up to obtain a total score, which is then used to derive the probability of catheter dysfunction in infusion ports for tumor patients. 3.6.2 Evaluation of risk prediction model for catheter dysfunction in cancer patients with ports Using the HL test to assess the accuracy of the model, the result shows that, \(\:{\chi\:}^{2}\) =8.472(P=0.389>0.05). Using the ROC curve to validate the risk prediction model, as shown in Fig. 2 . The result shows AUC is 0.892(95%CI:0.854–0.931), P<0,001. The Calibration curve was used to assess whether the predicted probabilities of the model align with the actual probabilities, as shown in Fig. 3 . In Fig. 3 , the horizontal axis represents the predicted probabilities, and the vertical axis represents the actual observed probabilities. The ideal line is a diagonal line passing through the origin with x = y. The actual curve describes the relationship between predicted probabilities and actual observed probabilities. The curve in the graph is evenly distributed around the ideal line. The above indicates that the risk prediction model for catheter dysfunction in cancer patients with ports developed in this study has certain predictive value, it possesses relatively accurate predictive abilities and is authentic and reliable. 4 Discussion 4.1Incidence of catheter dysfunction in ports is high In this study, we found that the incidence rate of port catheter dysfunction is 16.7%(69/413), which is consistent with the results of previous studies( 13 – 18 ). Tsuruta et al.( 14 ), Capozzi et al.( 15 ), and Yu et al.( 16 ) found that the incidence of catheter occlusion is respectively 0.6%, 0.6%, and 2.8%. One reason for the low incidence in these studies can be attributable to the first two studies did not specifically target cancer patients. Due to the weaker constitution of cancer patients and the longer treatment cycles, side effects such as nausea, vomiting, and decreased appetite during chemotherapy lead to reduced physical activity among patients. Additionally, the long-term retention of ports and other characteristics increase the incidence of catheter dysfunction( 23 ). Yu et al.( 16 ) also further validated that breast cancer, lung cancer, and gastric cancer were risk factors for the late complications associated with ports. Another reason can be attributable to the vague definition of catheter dysfunction and catheter occlusion. Catheter occlusion is the clinical sign of catheter dysfunction. These studies only documented cases of catheter occlusion, which presents as difficult or impossible in injection but did not assess the catheter’s aspiration ability, which means the reference value of the aforementioned studies still needs further discussion. Goossens et al.( 11 ) developed the CINAS classification for assessing the function of the port, it can evaluate the catheter’s injection and aspiration ability simultaneously, and classify them accordingly. In our study utilizing the CINAS, patients with catheter dysfunction mainly (n = 54,78.3%) manifest as injection ability easy while aspiration ability difficult or impossible, which is the early stage of catheter dysfunction and further development may lead to the complete loss of both injection and aspiration functions of the catheter, resulting in complete occlusion of the catheter. Such catheter dysfunction can be identified through assessment by professionals and targeted interventions can be carried out to prevent its further development. However, in clinical practice, such dysfunction may be overlooked frequently. Therefore, professionals must conduct reasonable assessments and implement targeted nursing interventions. 4.2 Catheter dysfunction in ports is affected by various factors In this study, we found that time with ports, location of the port tip, history of catheter dysfunction of port, and the score of CPT-SMS are risk factors for catheter dysfunction in port. 4.2.1 Time with port Our research revealed that the longer the indwelling port is retained, the more likely it is to experience catheter dysfunction. Yang et al.( 26 ) pointed out that as the indwelling time of ports increases, the port tip is subjected to blood flow impact, leading to the formation of a fibrin sheath on the tip due to the fibrinogen in the blood. This can cause injection and aspiration difficulties. The longer the port is used, the more likely it is for drugs or blood to deposit on the inner wall of the catheter, ultimately resulting in catheter dysfunction. Therefore, for patients with long-term indwelling ports, it is essential to provide health education and guide them on regular maintenance. When patients return to the hospital for maintenance, their injection and aspiration ability should be assessed, and timely interventions should be made in case of any issues. Additionally, patients should be told how to observe their condition and the precautions for daily activities, with instructions to revisit the hospital promptly if any problems arise. 4.2.2 Location of port tip Our research found that the abnormal location of the port tip is an independent risk factor for catheter dysfunction, which is consistent with Nickel et al.( 12 ) and Jia et al.( 13 ). Akhtar et al.( 27 ) found that one of the most common reasons for catheter premature removal was malposition, with a rate of 11% in port. The newest version (2024) of Infusion Therapy Standards of Practice( 12 ) points out that positioning the tip of the catheter at the lower one-third of the superior vena cava or the junction of the superior vena cava and the right atrium can reduce the incidence of catheter dysfunction. Therefore, it is recommended to use assistive catheter tip localization techniques such as intracardiac electrocardiography (IC-ECG), Sherlock intracavity 3CG positioning, and transthoracic echocardiography (TTE) to compensate for the inability of X-ray localization to directly observe the catheter position within the superior vena cava during the procedure, thereby improving the ideal rate of tip localization. 4.2.3 History of catheter dysfunction of port Our study proposed that the occurrence of catheter dysfunction in port significantly impacts the likelihood of subsequent catheter dysfunction. Catheter dysfunction often indicates the presence of some degree of drug deposits or mechanical obstacles within the catheter, which may reinitiate catheter dysfunction during subsequent infusion processes. Besides, a history of catheter dysfunction may also impact the flow rate and infusion efficiency of ports. To reduce the risk of catheter dysfunction in ports this time, close attention should be paid to the usage of patients’ ports, and regular inspections of the port’s condition should be conducted to promptly identify and address any potential issues. Furthermore, for patients with a history of catheter dysfunction, a file should be established to document their condition. Every time the patient returns to the hospital for infusion or catheter maintenance, their port status should be recorded. Regular follow-ups should also be conducted as necessary. 4.2.4 Cancer Patients' self-management behavior with port The results of this study indicated that the self-management behavior of cancer patients with port has an impact on the occurrence of catheter dysfunction. Since the port base is implanted under the skin, it has minimal impact on patient's daily lives and work. During the interval period of treatment, patients may easily overlook their ports, neglecting the observation and protection of ports. This leads them to engage in many unsuitable or even dangerous activities, resulting in the occurrence of complications. Current research on patients' awareness of the maintenance of ports consistently points out that patients have poor compliance with the maintenance of ports and insufficient understanding of relevant maintenance knowledge( 25 , 28 , 29 ). Therefore, assessing patients' self-management behavior related to their ports and promptly understanding whether they possess knowledge about port maintenance is crucial. This allows healthcare professionals to identify issues promptly and conduct effective port-related health education, thereby enhancing patients' self-management behavior concerning their ports. In addition, healthcare professionals should take measures to improve patients' engagement and acceptance of knowledge related to port. This can be achieved through various forms of health education for patients, such as distributing health education manuals, providing face-to-face guidance, and conducting online follow-ups. The aim is to enhance and strengthen patients' self-management abilities concerning their ports, thereby reducing the incidence of catheter dysfunction and ensuring the smooth progress of treatment plans. 4.3 The risk prediction model for catheter dysfunction of ports is an effective screening tool A nomogram is a graphical representation of a complex multi-factor regression model, visualizing the model in a way that intuitively reflects the impact of various factors on the outcome( 30 ). Based on multiple influencing factors, this study has developed a risk prediction model using a nomogram, which can predict the risk of catheter dysfunction for port in cancer patients. Compared to complex model formulas, this nomogram offers better readability and simplicity. The use of the nomogram facilitates the practical application of the model in clinical practice, enabling healthcare providers to easily assess patients and maintain the proper functioning of their ports. Various model evaluation indicators indicate that this risk prediction model exhibits good fit and discriminant ability. In summary, the risk prediction model developed in this study aids clinical healthcare providers in predicting the risk of catheter dysfunction for port, thereby enabling them to formulate personalized nursing plans, intervene promptly, and prevent the occurrence of catheter dysfunction. 5 Limitations This study has several limitations. Primarily limitation of this study is that was conducted in a single cancer center. Furthermore, this study is a cross-sectional study. Due to the above limitations, and the constraints of time and resources, the study was only able to include a convenience sample of participants, which may not be fully representative of the broader population. And there was no follow-up tracking of the patient’s condition. Despite this, the sample size in this study is large, allowing it to represent the patient population fairly well. Additionally, single-center studies have a homogeneous sample source, which facilitates easy control of variables and allows for concentrated utilization of resources, ensuring the depth and breadth of the research. Longitudinal studies are overly time-consuming and require significant human and material resources. Therefore, this study believes that a single-center cross-sectional study is sufficient to accurately reflect the patient’s situation. More importantly, this research is one of the few studies focusing on port catheter dysfunction. 6 Conclusion In conclusion, we developed a predictive model based on time with port, location of port tip, history of catheter dysfunction before, and the score of CPT-SMS to predict the risk of catheter dysfunction among cancer patients. The model demonstrates good discrimination and accuracy. By applying this model effective assessments can be conducted on patients, and most catheter dysfunctions can be prevented through early identification and be resolved through the professional intervention of nurses. By applying this model effective assessments can be conducted on patients, and most catheter dysfunctions can be prevented through early identification and be resolved through the professional intervention of nurses. Abbreviations CINAS: Catheter Injection and Aspiration Scheme; CPT-SMS: Cancer patients TIVAPs self-management scale; CVAD: Central Venous Access Device; INS: Infusion Therapy Standards of Practice; port: implanted vascular access port; ROC: Receiver Operating Characteristic; non-SVC: non-superior vena cava. Declarations Ethics approval Our study was approved by the ethics committee of the Sun Yat-sen University Cancer Center (approval number: B2024-230-01), and informed consent was obtained from all participants included in the study. This study involving human participants was conducted in strict compliance with the principles of the Declaration of Helsinki (https://www.wma.net/policies-post/wma-declaration-of-helsinki/). Data availablity The data generated and analyzed in the study are available from the corresponding author upon reasonable request. Conflict of interest The authors declare no conflicts of interest. Funding This study was supported by the Guangdong Province Nurses Association of China(Grant numbers: gdshsxh2023ms44). Author contributions All authors contributed to the study conception and design. JHW, XFH and XLL collected the data, analyzed the data, and drafted the manuscript. QHY and JL guided the group members in completing the publication, provided intellectual input, and edited the paper. All authors read and approved the final version of the manuscript. Acknowledgments We thank every one of the patients who took part in the clinical study. Author details 1 Outpatient Department, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China 2 Nursing Department, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China References World Health Organization. Global cancer burden growing, amidst mounting need for services. Saudi Med J. 2024 Mar;45(3):326–7. Kehagias E, Galanakis N, Tsetis D. Central venous catheters: Which, when and how. Br J Radiol. 2023 Nov;96(1151):20220894. Nunn JL, Takashima MD, Wray-Jones EM, Soosay Raj TA, Hanna DMT, Ullman AJ. Central venous access device adverse events in pediatric patients with cancer: a systematic review and meta-analysis. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer. 2024 Sep 16;32(10):662. Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion Therapy Standards of Practice, 8th Edition. Journal of Infusion Nursing: The Official Publication of the Infusion Nurses Society. 2021 Feb 1;44(1S Suppl 1):S1–224. Liu S, Xiang Y, Gu Y, Chen N, Fu P, Wei Y, et al. Patient preferences and willingness to pay for central venous access devices in breast cancer: A multicenter discrete choice experiment. Int J Nurs Stud. 2024 Apr;152:104695. Cesaro S, Caddeo G. Vascular Access. In: Sureda A, Corbacioglu S, Greco R, Kröger N, Carreras E, editors. The EBMT Handbook: Hematopoietic Cell Transplantation and Cellular Therapies. 8th ed. Cham (CH): Springer; 2024. Lu A, Hu M, Qi X, Zhao Y, Huang Y. A retrospective cohort study of implantable venous access port-related and peripherally inserted central catheter-related complications in patients with hematological malignancies in China. SAGE open medicine. 2024;12:20503121241257190. Ullman AJ, Gibson V, Takashima MD, Kleidon TM, Schults J, Saiyed M, et al. Pediatric central venous access devices: practice, performance, and costs. Pediatr Res. 2022 Nov;92(5):1381–90. D’Souza PC, Kumar S, Kakaria A, Al-Sukaiti R, Al-Baimani K, Hamid RS, et al. Complications and Management of Totally Implantable Central Venous Access Ports in Cancer Patients at a University Hospital in Oman. Sultan Qaboos Univ Med J. 2021 Feb;21(1):e103–9. Beck O, Muensterer O, Hofmann S, Rossmann H, Poplawski A, Faber J, et al. Central Venous Access Devices (CVAD) in Pediatric Oncology Patients-A Single-Center Retrospective Study Over More Than 9 Years. Front Pediatr. 2019;7:260. Goossens GA, De Waele Y, Jerome M, Fieuws S, Janssens C, Stas M, et al. Diagnostic accuracy of the Catheter Injection and Aspiration (CINAS) classification for assessing the function of totally implantable venous access devices. SUPPORTIVE CARE IN CANCER. 2016 Feb;24(2):755–61. Nickel B, Gorski L, Kleidon T, Kyes A, DeVries M, Keogh S, et al. Infusion Therapy Standards of Practice, 9th Edition. Journal of Infusion Nursing. 2024 Jan;47(1S):S1–285. Jia Xiufen, Liu Yuping, Long Shuhong, Wang Xing. Study on risk factors of catheter dysfunction of idle totally implantable access port in patients with cancer. Chinese Nursing Research. 2024;38(11):2009–13. Tsuruta S. Late complications associated with totally implantable venous access port implantation via the internal jugular vein. Support Care Cancer. 2019 Nov 14; Capozzi VA, Monfardini L, Sozzi G, Armano G, Butera D, Scarpelli E, et al. Peripherally Inserted Central Venous Catheters (PICC) versus totally implantable venous access device (PORT) for chemotherapy administration: a meta-analysis on gynecological cancer patients. Acta Biomed. 2021 Nov 3;92(5):e2021257. Yu XY, Xu JL, Li D, Jiang ZF. Late complications of totally implantable venous access ports in patients with cancer: Risk factors and related nursing strategies. Medicine (baltimore). 2018 Sep;97(38):e12427. Zhang S, Xiao Z, Yang F. Analysis of related complications of totally implantable venous access ports in children’s chemotherapy: Single center experience. Medicine (baltimore). 2022 Jul 8;101(27):e29899. Wang Liying, Xue Mei, Tao Yong, Jiang Gaosong, Wu Linyan, Zhu Min. Analysis and management of catheter dysfunction of central venous port access system in 1047 patients. J Intervent Radiol. 2021;30(2):191–5. Gündogdu F, Semerci R, Bay F. Totally Implantable Venous Access Device Care Practices and Experiences of Pediatric and Adult Oncology Nurses. Journal of Infusion Nursing: The Official Publication of the Infusion Nurses Society. 2024 Jun 1;47(3):182–9. Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC cancer. 2024 Apr 19;24(1):498. Scanlon MC, Venkitachalam R, Catchpole K. When is a central venous access device not a central venous access device? When it is a hazard. Pediatr Res. 2024 Aug 1; Egnatios D, Gloria C. Implanted Port Patency: Comparing Heparin and Normal Saline. Clin J Oncol Nurs. 2021 Apr 1;25(2):169–73. Hyun A, Condon P, Kleidon T, Xu G, Edwards R, Gibson V, et al. Problem-solving processes for central venous catheter occlusion within pediatric cancer care: A qualitative study. European Journal of Oncology Nursing: The Official Journal of European Oncology Nursing Society. 2024 Apr;69:102520. van Oevelen M, Heggen BD, Abrahams AC, Rotmans JI, Snoeijs MG, Vernooij RW, et al. Central venous catheter-related complications in older haemodialysis patients: A multicentre observational cohort study. J Vasc Access. 2023 Nov;24(6):1322–31. Wu, Xiaohong. Study on Current Statis and Analysis of Influencing Factors about Self-Management Behavior of TIVAP among Cancer Patients [Internet] [Master]. Shantou University; 2022. Yang Tingting, Zhang Chunhua, Su Aijiang, Zhou Jing. Causes and protective countermeasures of catheter blockage in patients with tumor chemotherapy treated by venous port access. Nursing Practice and Research. 2020;17(10):137–8. Akhtar N, Lee L. Utilization and Complications of Central Venous Access Devices in Oncology Patients. Current Oncology (Toronto, Ont). 2021 Jan 10;28(1):367–77. Bu Li, Yang Lihua, Han Xue, Han Xiao, Li Zhengjun, Liu Yunhui, et al. Application study of preventive nursing project of unplanned extubation at implantable venous access ports for cancer patients. Journal of Nursing Administration. 2024;24(3):196–200. Zhang Yuanhong, Zhang Jie, Cao Susheng, Wang Wei, Li Xinxian. The survey analysis on outpatients’ nursing status of implanted venous port. Nursing Practice and Research. 2014;11(12):96–8. Park SY. Nomogram: An analogue tool to deliver digital knowledge. J Thorac Cardiovasc Surg. 2018 Apr;155(4):1793. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":102320,"visible":true,"origin":"","legend":"\u003cp\u003eRisk prediction model Nomogram diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7427340/v1/9b51933fe6eea4fb13905bf1.png"},{"id":92445066,"identity":"a3161eeb-c68d-4a1e-a446-6c0deef8c067","added_by":"auto","created_at":"2025-09-29 19:58:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":57218,"visible":true,"origin":"","legend":"\u003cp\u003eRisk prediction model ROC curve\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7427340/v1/0f669032b4a2da678c807c99.png"},{"id":92446131,"identity":"ff225846-1564-40eb-8c9a-0a85443415fe","added_by":"auto","created_at":"2025-09-29 20:14:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":68119,"visible":true,"origin":"","legend":"\u003cp\u003eRisk prediction model Calibration curve\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7427340/v1/99607381a3666ded6ccd18bc.png"},{"id":107518218,"identity":"54ec4264-ef21-4579-a87f-e33a1e0b0e01","added_by":"auto","created_at":"2026-04-22 08:43:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1098278,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7427340/v1/ce7d829b-c8d1-4937-855b-e6de49d42d37.pdf"},{"id":92445648,"identity":"803b8136-fad5-41b5-921c-f514eabf7924","added_by":"auto","created_at":"2025-09-29 20:06:34","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16832,"visible":true,"origin":"","legend":"","description":"","filename":"supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-7427340/v1/fa3257c548a8d9bcb0fd38bc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Construction and evaluation of a predictive model for catheter dysfunction in cancer patients with implanted vascular access ports: A cross-sectional study","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eThere were an estimated 20\u0026nbsp;million new cancer cases and 9.7\u0026nbsp;million deaths worldwide in 2022(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Intravenous chemotherapy is the most important form of cancer treatment, and the Central Venous Access Device (CVAD) is the most pivotal tool for administering it, significantly enhancing patient venous safety(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The implanted vascular access port (port) is a type of CVAD(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Numerous studies have demonstrated the reliability of ports, especially in facilitating anti-cancer and supportive therapies for cancer populations(\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). As the utilization of ports has surged over the past decades, so has the substantial risk of associated complications(\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCatheter dysfunction, proposed by Goossens et al.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), is defined as an injection and/or an aspiration ability that is difficult or impossible. The newest version(2024) of Infusion Therapy Standards of Practice(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) also points out that CVAD should be assessed for patency by injecting and aspirating for a blood return. With an incidence of 0.6% ~ 15.8%(\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), catheter dysfunction is one of the most common complications associated with ports, which can lead to treatment delays, reduced efficacy, extended hospital stays, heightened hospitalization rates, escalated overall treatment costs, and ultimately compromised survival rates due to disruptions in treatment schedules(\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, in the existing research, catheter dysfunction is usually vaguely described as catheter occlusion, which is defined as an injection ability that is difficult or impossible, while neglecting the catheter\u0026rsquo;s aspiration ability(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Some studies have introduced the concept of partial occlusion of catheters, taking into account the aspiration ability of the catheter, but have not further classified it(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Developed by Goossens et al.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), the catheter injection and aspiration scheme (CINAS) has classified catheter functions into 16 grades. Through the clear classification of CINAS, early detection of catheter dysfunction in clinical settings can be facilitated, allowing for earlier intervention and prevention of further deterioration of early-stage catheter dysfunction. In addition, in the existing research, the research populations are mostly pediatric patients(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) or hemodialysis patients(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and there was little research specifically addressing catheter dysfunction in ports used for cancer patients. Understanding the risk factors of catheter dysfunction in cancer patients and developing a risk prediction model is important to reduce the occurrence of similar situations.\u003c/p\u003e\u003cp\u003eIn this study, the catheter functional status of patients was assessed using CINAS, we first determined the incidence of catheter dysfunction and identified four independent risk factors in cancer patients. Then, we constructed a risk prediction model, providing a simple and individualized assessment tool for assessing the risk of catheter dysfunction in cancer patients with port.\u003c/p\u003e"},{"header":"2 Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Study design and patient selection\u003c/h2\u003e\n \u003cp\u003eThis study was a cross-sectional study conducted at a Tertiary A cancer hospital from January to June 2024, and the subjects were ambulatory cancer patients. The convenience sampling method was used to evaluate the catheter function of ports and investigate patients, who met the sample inclusion and exclusion criteria, the demographic characteristics, disease-related characteristics, CVAD-related information, and cancer patients\u0026apos; self-management level with port. This study was approved by the ethics committee of the Sun Yat-sen University Cancer Center (approval number: B2024-230-01), and informed consent was obtained from all patients.\u003c/p\u003e\n \u003cp\u003eThe inclusion criteria were as follows: (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) Pathological diagnosis is cancer; (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) Patients who implanted port at the suggestion of clinicians for disease treatment; (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) Age\u0026thinsp;\u0026gt;\u0026thinsp;18 years old; (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e) No intellectual or mental disorders, have a certain reading ability, can fill in the questionnaire independently or with the assistance of researchers; (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e) Know about this study and sign informed consent. The exclusion criteria were as follows: (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) There are serious heart, liver, lung, kidney, and other organ diseases unrelated to the original cancer; (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) Patients who implanted ports of lower limbs; (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) Patients who died or lost follow-up after implantation of port;(4) Patients with other serious complications such as catheter shedding, embolism, hematoma, and require extubation after implantation of ports.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Assessment of Catheter Function\u003c/h2\u003e\n \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.1 \u003cem\u003eGeneral Information Questionnaire\u003c/em\u003e\u003c/h2\u003e\n \u003cp\u003eThe questionnaire was self-designed by the researcher (supplementary file), including three aspects: demographic characteristics, disease-related characteristics, and CVAD-related information. Demographic characteristics included name, gender, age, education level, etc. Disease-related characteristics included the disease diagnosis, chemotherapy regimen, underlying disease, infectious diseases, etc. CVAD-related information included patients\u0026rsquo; CVAD implanting history, date of implantation, implanting position, implanting vein, location of port tip, etc. The patients themselves provided their demographic characteristics, while the researchers filled in the patients\u0026rsquo; disease information and CVAD-related information based on their medical records.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.2 \u003cem\u003eThe Catheter Injection and Aspiration Scheme (CINAS)\u003c/em\u003e\u003c/h2\u003e\n \u003cp\u003eThe CINAS, created by Goossens(\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e), is a catheter function classification tool that uniformly evaluates both injection and aspiration capabilities. It comprises 16 unique combinations of four codes, each reflecting the injection (IN) ability of at least 1 ml fluid and the aspiration (AS) ability of at least 3 ml blood. These abilities are scored on a scale of one to three: one for easy (non-hindered), two for difficult (problematic handling), and three for impossible (inability to perform). An additional option, \u0026apos;x\u0026apos;, is used when the injection and/or aspiration ability is unknown. An IN1AS1 score indicates good catheter function, while other combinations suggest dysfunction, necessitating nursing interventions. The CINAS has an assessment accuracy of 98.7%.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.3 \u003cem\u003eCancer patients TIVAPs self-management scale (CPT-SMS)\u003c/em\u003e\u003c/h2\u003e\n \u003cp\u003eDesigned and verified by Wu Xiaohong(\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e), the scale was designed for cancer patients implanted port for intravenous infusion. With Cronbach\u0026apos;s \u0026alpha; coefficient was 0.931 and retest reliability was 0.90, it had good structural validity, aggregation validity, and differential validity. The content of the scale includes 29 items in 7 dimensions, including observation of complications with ports, treatment of abnormal situations, maintenance compliance of port, access to port-relevant information, protection in sports and life with the port, protection during the use of port and confidence in self-management with port. Likert five-level scoring method was used to score as 1 to 5. Higher scores indicate better self-management behavior. A score less than 87 is classified as a low level, between 87 and 116 is a medium level, and more than 116 is a good level.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e\n \u003cp\u003eContinuous variables are presented as the means(M) and standard deviations(SD), and categorical variables are presented as absolute values and percentages. SPSS23.0 was used for statistical analysis, with the influencing factors of the occurrence of catheter dysfunction as independent variables and the occurrence of catheter dysfunction as dependent variables, and univariate analysis was conducted for each factor by using the T-test and Chi-square test. Multivariate Logistic regression analysis was performed for the variables with statistically significant differences in the univariate analysis results. The odds ratio (OR) and 95% confidence interval (CI)were presented as effect estimates. Conduct collinearity diagnostics on the predictor variables with significant differences to eliminate the effects of multicollinearity and screen the variables. Use Tolerance and Variance Inflation Factor (VIF) as the criteria for assessment. Screen the variables (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) from the results of multivariate logistic regression as the influencing factors for port catheter dysfunction in cancer patients. Use the rms package of R4.1.2 to draw a nomogram model. Evaluate the goodness-of-fit of the model through the HL test and by plotting calibration curves. Assess the performance of the constructed risk prediction model by examining the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC Curve (AUC).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Characteristics of Participants\u003c/h2\u003e\u003cp\u003eA total of 413 cancer patients with implanted ports were selected in this study, and 413 effective questionnaires were finally collected, with an effective rate of 100%. The demographic characteristics, disease-related characteristics, and CVAD-related information of cancer patients with ports are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatients\u0026rsquo; characteristics and univariate analysis of catheter function (n\u0026thinsp;=\u0026thinsp;413,n\u003csub\u003e1\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;69,n\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;344)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCatheter function\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et/\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\mathcal{X}}^{2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCatheter dysfunction\u003c/p\u003e\u003cp\u003en\u003csub\u003e1\u003c/sub\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003cp\u003econdition\u003c/p\u003e\u003cp\u003en\u003csub\u003e2\u003c/sub\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDemographic characteristics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24(34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e141(41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.337\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45(65.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e203(59.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge(year)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53.48\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e11.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.24\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e12.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.481\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.142\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\u0026lt;\\)\u003c/span\u003e\u003c/span\u003e18.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26(7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.922\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.141\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.5ཞ23.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40(58.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e200(58.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\u0026gt;\\)\u003c/span\u003e\u003c/span\u003e23.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28(40.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50(72.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e239(69.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.621\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVillage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19(27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e105(30.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDegree of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school or below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16(23.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50(14.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.766\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24(34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84(24.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95(27.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50(14.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9(13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65(18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetirement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(24.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88(25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.747\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.980\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOn-post staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110(32.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFreelancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9(13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35(10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7(10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40(11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25(7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8(11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46(13.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.858\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62(89.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e301(87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLose marriage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13(3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedical insurance type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical insurance for workers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36(52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e187(54.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.922\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical insurance for residents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31(44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e149(43.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo medical insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8(2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDisease-related characteristics\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiagnose\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreast Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(24.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99(28.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.716\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColorectal Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16(23.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73(21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNasopharynx Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(24.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66(19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19(5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19(27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87(25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompleted chemotherapy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20(29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99(28.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.972\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49(71.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e245(71.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThe chemotherapy regimen included a home-chemotherapy-pump\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64(18.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63(91.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e280(81.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther underlying diseases\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20(29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98(28.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.934\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49(71.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e246(71.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInfectious disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7(10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.705\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62(89.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e314(91.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoke or not\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23(6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.995\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65(94.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e321(93.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCVAD-related information\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime with port(month)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26.59\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e30.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.47\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e15.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-4.584\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eImplanting position\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChest port\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65(94.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e336(97.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.379\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.240\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUpper arm port\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8(2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eImplanting limb\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57(82.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e267(77.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.847\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.357\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12(17.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77(22.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocation of port tip\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUpper or mid of\u003c/p\u003e\u003cp\u003esuperior vena cava\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25(36.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91(26.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35.430\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower of superior\u003c/p\u003e\u003cp\u003evena cava or right atrium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36(52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e251(73.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot in superior vena cava\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8(11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(0.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaintain port schedule\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64(92.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e332(96.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.215\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.270\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12(3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eImplanted CVAD before\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.688\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64(92.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e314(91.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccurred catheter dysfunction before\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34(49.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e129.814\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35(50.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e334(97.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThe score of CPT-SMS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e97.14\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e8.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108.96\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e15.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*\u003c/sup\u003eContinuous calibration chi-square test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Incidence of catheter dysfunction in cancer patients with ports\u003c/h2\u003e\u003cp\u003eAmong 413 cancer patients with implanted ports investigated in this study, 344 cases (83.3%) had good catheter function and 69 cases (16.7%) had catheter dysfunction. The CINAS evaluation results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCINAS Classification(n\u0026thinsp;=\u0026thinsp;413)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eCINAS\u003c/p\u003e\u003cp\u003eClassification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003eInjection Ability(IN)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEASY\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e1ml\u003c/p\u003e\u003cp\u003eIN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDIFFICULT\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e1ml\u003c/p\u003e\u003cp\u003eIN2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIMPOSSIBLE\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\u0026lt;\\)\u003c/span\u003e\u003c/span\u003e1ml\u003c/p\u003e\u003cp\u003eIN3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUNKNOWN\u003c/p\u003e\u003cp\u003eINx\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eAspiration\u003c/p\u003e\u003cp\u003eAbility\u003c/p\u003e\u003cp\u003e(AS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEASY\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e1ml\u003c/p\u003e\u003cp\u003eAS1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIN1AS1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIN2AS1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIN3AS1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eINxAS1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e344(83.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(0.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDIFFICULT\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e1ml\u003c/p\u003e\u003cp\u003eAS2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIN1AS2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIN2AS2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIN3AS2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eINxAS2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003cp\u003e(7.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(1.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(0.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIMPOSSIBLE\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\u0026lt;\\)\u003c/span\u003e\u003c/span\u003e1ml\u003c/p\u003e\u003cp\u003eAS3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIN1AS3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIN2AS3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIN3AS3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eINxAS3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e(5.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(0.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(0.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eUNKNOWN\u003c/p\u003e\u003cp\u003eASx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIN1ASx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIN2ASx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIN3ASx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eINxASx\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eManagement measures for patients with catheter dysfunction include:(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)Pulse maneuver flushing again;(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)Instruct patient to adjust the body position or move arms;(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)Retain urokinase for 30 minutes. After management measures of 69 patients with catheter dysfunction, 61(88.4%) patients recovered from their catheter dysfunction, and 8(11.6%) patients remained with catheter dysfunction.\u003c/p\u003e\u003cp\u003eAmong the 61 patients whose catheters returned to good condition, 23(37.7%) patients\u0026rsquo; catheter function returned good condition by pulsing maneuver flushing again, 19(31.1%) patients\u0026rsquo; catheter function returned good condition by instructing patients to adjust their body position or move arms, 19(31.1%) patients\u0026rsquo; catheter function return good condition by retaining urokinase for 30 minutes. Among the 8 patients whose catheters were still not restored, 5 patients had no blood return for a long time with ports. All 8 patients were instructed to undergo an X-ray examination, and the port-implantation physicians were consulted to assess the position of the catheter tip and the catheter status. It was determined that the ports of 5 patients could still be used normally. For the other 3 patients, as they had completed their chemotherapy, the port-implantation physicians recommended early removal of the ports, with no further interventions planned.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Cancer patients' self-management behavior with port\u003c/h2\u003e\u003cp\u003eIn this study, the score of CPT-SMS ranged from 62\u0026thinsp;~\u0026thinsp;139, the total mean score was (106.98\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e15.11). As the number of items in each dimension is different, the total score of each dimension cannot be directly compared, so the score ratio is used to compare the score of each dimension, the score ratio = (total mean score/highest score) \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\times\\:\\)\u003c/span\u003e\u003c/span\u003e100%, the dimension of the highest score ratio are skin protection at the base and protection during infusion, and the dimension of the lowest score ratio is port-maintenance information acquisition. 5.3% of patients had a total score of \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\le\\:\\)\u003c/span\u003e\u003c/span\u003e87, which indicates that the patient's self-management level is low. 65.4% of patients had a total score of 87~ 116, which means medium level. 29.3% of patients had a total score of \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\u0026gt;\\)\u003c/span\u003e\u003c/span\u003e116, which represents a high level of self-management. The seven dimension scores are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe score of CPT-SMS(n\u0026thinsp;=\u0026thinsp;413)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimensions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eScore ratio(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA.Observation of anomalies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB. Exception handling and port-maintenance compliance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e70.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC. Protection of the skin at the base\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD. Self-management confidence with port\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE. Protection of ports during infusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF. Protection of sports and life with port\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e86.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG. Port-Maintenance information acquisition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e46.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e107.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e77.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Univariate analysis of influencing factors of catheter dysfunction in cancer patients with ports\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e3.4.1 Influence of demographic characteristics on catheter dysfunction in cancer patients\u003c/h2\u003e\u003cp\u003eThe T-test and Chi-square test results of gender, age, BMI, place of residence, degree of education, occupation, marital status, and type of medical insurance found that there was no difference in demographic characteristics between the two groups with catheter function, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.4.2 Influence of disease-related characteristics on Catheter Dysfunction in cancer patients\u003c/h2\u003e\u003cp\u003eThe Chi-square test results of diagnosis, whether chemotherapy was completed, whether the chemotherapy regimen included a home-chemotherapy-pump, whether there are other underlying diseases, whether there is any infectious disease, whether smoke or not found that there was a statistically significant difference between the group whether the chemotherapy regimen included a home-chemotherapy-pump(P\u0026thinsp;=\u0026thinsp;0.045), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.4.3 Influence of CVAD-related information on catheter dysfunction in cancer patients\u003c/h2\u003e\u003cp\u003eThe T-test and Chi-square test results of time with port, implanting position, implanting limb, location of port tip, whether port maintenance was scheduled, whether implanted CVAD before, and whether catheter dysfunction occurred before, found that there was a statistically significant difference in time with port(P\u0026thinsp;=\u0026thinsp;0.000), location of port tip(P\u0026thinsp;=\u0026thinsp;0.000), whether catheter dysfunction occurred before(P\u0026thinsp;=\u0026thinsp;0.000) between the groups with good catheter function and those with catheter dysfunction, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.4.4 Influence of cancer patients' self-management behavior with port on catheter dysfunction\u003c/h2\u003e\u003cp\u003eThe study results found that there was a statistically significant difference(P\u0026thinsp;=\u0026thinsp;0.000) in the score of CPT-SMS between the groups with good catheter function and those with catheter dysfunction, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e3.4.5 Univariate analysis of meaningful covariance diagnosis among independent variables\u003c/h2\u003e\u003cp\u003eAccording to the research findings, no complex multicollinearity phenomena were observed among the 5 independent variables, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate analysis of meaningful covariance diagnosis among independent variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTolerance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVIF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe chemotherapy regimen included a home-chemotherapy-pump\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.971\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation of port tip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccurred catheter dysfunction before\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.927\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.079\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime with port(month)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.921\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.086\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe score of CPT-SMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.933\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Multivariate analysis of influencing factors of catheter dysfunction in cancer patients with ports\u003c/h2\u003e\u003cp\u003eFive factors with statistical significance in the univariate analysis were taken as independent variables (whether the chemotherapy regimen included a home chemotherapy pump, time with port, location of the port tip, whether catheter dysfunction occurred before, the score of CPT-SMS), whether the catheter dysfunction occurred at the infusion port was included in the regression model as the dependent variable, and the variable assignment was shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVariables and variable assignment in binary Logistic regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable assignment\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCatheter function\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026thinsp;=\u0026thinsp;good condition, 1\u0026thinsp;=\u0026thinsp;catheter dysfunction\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe chemotherapy regimen included a home-chemotherapy-pump\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026thinsp;=\u0026thinsp;No, 1\u0026thinsp;=\u0026thinsp;Yes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation of port tip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026thinsp;=\u0026thinsp;lower of superior vena cava or right atrium, 1\u0026thinsp;=\u0026thinsp;upper or mid of superior vena cava, 2\u0026thinsp;=\u0026thinsp;Not in superior vena cava\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccurred catheter dysfunction before\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026thinsp;=\u0026thinsp;No, 1\u0026thinsp;=\u0026thinsp;Yes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime with port(month)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eentry of original continuous numerical values\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe score of CPT-SMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eentry of original continuous numerical values\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLogistic regression results showed that time with port\u0026thinsp;\u0026gt;\u0026thinsp;6 months, abnormal location of the port tip, and history of catheter dysfunction were independent risk factors for catheter dysfunction in cancer patients with ports, and high-level of self-management behavior of cancer patients with ports were independent protective factors for catheter dysfunction at infusion port of cancer patients.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate analysis of influencing factors of catheter dysfunction in cancer patients with ports (n\u0026thinsp;=\u0026thinsp;413).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWald\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime with port(month)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.552\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.011\u0026ndash;1.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThe location of the port tip is not in superior vena cava\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.860\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e17.466\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.194-139.047\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccurred catheter dysfunction before\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.449\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.961\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e28.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11.954\u0026ndash;69.595\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThe score of CPT-SMS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.774\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.919\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.919\u0026ndash;0.974\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Construction and evaluation of risk prediction model for catheter dysfunction in cancer patients with ports\u003c/h2\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e3.6.1 Construction of risk prediction model for catheter dysfunction in cancer patients with ports\u003c/h2\u003e\u003cp\u003eThis study has derived a risk prediction model for catheter dysfunction in cancer patients with ports:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\text{L}\\text{o}\\text{g}\\text{i}\\text{t}\\left(\\text{P}\\right)={{\\beta\\:}}_{0}+{{\\beta\\:}}_{1}{\\text{X}}_{1}+{{\\beta\\:}}_{2}{\\text{X}}_{2}+\\dots\\:+{{\\beta\\:}}_{\\text{i}}{\\text{X}}_{\\text{i}}=2.851+0.027\\ast\\:\\text{T}\\text{i}\\text{m}\\text{e}\\:\\text{w}\\text{i}\\text{t}\\text{h}\\:\\text{p}\\text{o}\\text{r}\\text{t}\\left(\\text{m}\\text{o}\\text{n}\\text{t}\\text{h}\\right)+2.860\\ast\\:\\text{L}\\text{o}\\text{c}\\text{a}\\text{t}\\text{i}\\text{o}\\text{n}\\:\\text{o}\\text{f}\\:\\text{p}\\text{o}\\text{r}\\text{t}\\:\\text{i}\\text{s}\\:\\text{n}\\text{o}\\text{t}\\:\\text{i}\\text{n}\\:\\text{s}\\text{u}\\text{p}\\text{e}\\text{r}\\text{i}\\text{o}\\text{r}\\:\\text{v}\\text{e}\\text{n}\\text{a}\\:\\text{c}\\text{a}\\text{v}\\text{a}+3.362\\ast\\:\\text{O}\\text{c}\\text{c}\\text{u}\\text{r}\\text{r}\\text{e}\\text{d}\\:\\text{c}\\text{a}\\text{t}\\text{h}\\text{e}\\text{t}\\text{e}\\text{r}\\:\\text{m}\\text{a}\\text{l}\\text{f}\\text{u}\\text{n}\\text{c}\\text{t}\\text{i}\\text{o}\\text{n}\\:\\text{b}\\text{e}\\text{f}\\text{o}\\text{r}\\text{e}-0.055\\ast\\:\\text{T}\\text{h}\\text{e}\\:\\text{s}\\text{c}\\text{o}\\text{r}\\text{e}\\:\\text{o}\\text{f}\\:\\text{C}\\text{P}\\text{T}-\\text{S}\\text{M}\\text{S}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eUsing a nomogram to present the risk prediction model, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Each segment of the nomogram corresponds to a variable, and the patient's relevant information is marked on the corresponding scale. These are converted based on partial regression coefficients, with each predictor variable having a value range of 0 to 100 points. The higher the weight of a variable, the higher the score corresponding to that factor. Finally, the scores corresponding to the four indicators are summed up to obtain a total score, which is then used to derive the probability of catheter dysfunction in infusion ports for tumor patients.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e3.6.2 Evaluation of risk prediction model for catheter dysfunction in cancer patients with ports\u003c/h2\u003e\u003cp\u003eUsing the HL test to assess the accuracy of the model, the result shows that, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\chi\\:}^{2}\\)\u003c/span\u003e\u003c/span\u003e=8.472(P=0.389\u0026gt;0.05). Using the ROC curve to validate the risk prediction model, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The result shows AUC is 0.892(95%CI:0.854\u0026ndash;0.931), P\u0026lt;0,001.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe Calibration curve was used to assess whether the predicted probabilities of the model align with the actual probabilities, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the horizontal axis represents the predicted probabilities, and the vertical axis represents the actual observed probabilities. The ideal line is a diagonal line passing through the origin with x\u0026thinsp;=\u0026thinsp;y. The actual curve describes the relationship between predicted probabilities and actual observed probabilities. The curve in the graph is evenly distributed around the ideal line.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe above indicates that the risk prediction model for catheter dysfunction in cancer patients with ports developed in this study has certain predictive value, it possesses relatively accurate predictive abilities and is authentic and reliable.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e4.1Incidence of catheter dysfunction in ports is high\u003c/h2\u003e\u003cp\u003eIn this study, we found that the incidence rate of port catheter dysfunction is 16.7%(69/413), which is consistent with the results of previous studies(\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Tsuruta et al.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), Capozzi et al.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and Yu et al.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) found that the incidence of catheter occlusion is respectively 0.6%, 0.6%, and 2.8%. One reason for the low incidence in these studies can be attributable to the first two studies did not specifically target cancer patients. Due to the weaker constitution of cancer patients and the longer treatment cycles, side effects such as nausea, vomiting, and decreased appetite during chemotherapy lead to reduced physical activity among patients. Additionally, the long-term retention of ports and other characteristics increase the incidence of catheter dysfunction(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Yu et al.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) also further validated that breast cancer, lung cancer, and gastric cancer were risk factors for the late complications associated with ports. Another reason can be attributable to the vague definition of catheter dysfunction and catheter occlusion. Catheter occlusion is the clinical sign of catheter dysfunction. These studies only documented cases of catheter occlusion, which presents as difficult or impossible in injection but did not assess the catheter\u0026rsquo;s aspiration ability, which means the reference value of the aforementioned studies still needs further discussion.\u003c/p\u003e\u003cp\u003eGoossens et al.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) developed the CINAS classification for assessing the function of the port, it can evaluate the catheter\u0026rsquo;s injection and aspiration ability simultaneously, and classify them accordingly. In our study utilizing the CINAS, patients with catheter dysfunction mainly (n\u0026thinsp;=\u0026thinsp;54,78.3%) manifest as injection ability easy while aspiration ability difficult or impossible, which is the early stage of catheter dysfunction and further development may lead to the complete loss of both injection and aspiration functions of the catheter, resulting in complete occlusion of the catheter. Such catheter dysfunction can be identified through assessment by professionals and targeted interventions can be carried out to prevent its further development. However, in clinical practice, such dysfunction may be overlooked frequently. Therefore, professionals must conduct reasonable assessments and implement targeted nursing interventions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Catheter dysfunction in ports is affected by various factors\u003c/h2\u003e\u003cp\u003eIn this study, we found that time with ports, location of the port tip, history of catheter dysfunction of port, and the score of CPT-SMS are risk factors for catheter dysfunction in port.\u003c/p\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003e4.2.1 Time with port\u003c/h2\u003e\u003cp\u003eOur research revealed that the longer the indwelling port is retained, the more likely it is to experience catheter dysfunction. Yang et al.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) pointed out that as the indwelling time of ports increases, the port tip is subjected to blood flow impact, leading to the formation of a fibrin sheath on the tip due to the fibrinogen in the blood. This can cause injection and aspiration difficulties. The longer the port is used, the more likely it is for drugs or blood to deposit on the inner wall of the catheter, ultimately resulting in catheter dysfunction. Therefore, for patients with long-term indwelling ports, it is essential to provide health education and guide them on regular maintenance. When patients return to the hospital for maintenance, their injection and aspiration ability should be assessed, and timely interventions should be made in case of any issues. Additionally, patients should be told how to observe their condition and the precautions for daily activities, with instructions to revisit the hospital promptly if any problems arise.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003e4.2.2 Location of port tip\u003c/h2\u003e\u003cp\u003eOur research found that the abnormal location of the port tip is an independent risk factor for catheter dysfunction, which is consistent with Nickel et al.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and Jia et al.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Akhtar et al.(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) found that one of the most common reasons for catheter premature removal was malposition, with a rate of 11% in port. The newest version (2024) of Infusion Therapy Standards of Practice(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) points out that positioning the tip of the catheter at the lower one-third of the superior vena cava or the junction of the superior vena cava and the right atrium can reduce the incidence of catheter dysfunction. Therefore, it is recommended to use assistive catheter tip localization techniques such as intracardiac electrocardiography (IC-ECG), Sherlock intracavity 3CG positioning, and transthoracic echocardiography (TTE) to compensate for the inability of X-ray localization to directly observe the catheter position within the superior vena cava during the procedure, thereby improving the ideal rate of tip localization.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section3\"\u003e\u003ch2\u003e4.2.3 History of catheter dysfunction of port\u003c/h2\u003e\u003cp\u003eOur study proposed that the occurrence of catheter dysfunction in port significantly impacts the likelihood of subsequent catheter dysfunction. Catheter dysfunction often indicates the presence of some degree of drug deposits or mechanical obstacles within the catheter, which may reinitiate catheter dysfunction during subsequent infusion processes. Besides, a history of catheter dysfunction may also impact the flow rate and infusion efficiency of ports. To reduce the risk of catheter dysfunction in ports this time, close attention should be paid to the usage of patients\u0026rsquo; ports, and regular inspections of the port\u0026rsquo;s condition should be conducted to promptly identify and address any potential issues. Furthermore, for patients with a history of catheter dysfunction, a file should be established to document their condition. Every time the patient returns to the hospital for infusion or catheter maintenance, their port status should be recorded. Regular follow-ups should also be conducted as necessary.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section3\"\u003e\u003ch2\u003e4.2.4 Cancer Patients' self-management behavior with port\u003c/h2\u003e\u003cp\u003eThe results of this study indicated that the self-management behavior of cancer patients with port has an impact on the occurrence of catheter dysfunction. Since the port base is implanted under the skin, it has minimal impact on patient's daily lives and work. During the interval period of treatment, patients may easily overlook their ports, neglecting the observation and protection of ports. This leads them to engage in many unsuitable or even dangerous activities, resulting in the occurrence of complications. Current research on patients' awareness of the maintenance of ports consistently points out that patients have poor compliance with the maintenance of ports and insufficient understanding of relevant maintenance knowledge(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Therefore, assessing patients' self-management behavior related to their ports and promptly understanding whether they possess knowledge about port maintenance is crucial. This allows healthcare professionals to identify issues promptly and conduct effective port-related health education, thereby enhancing patients' self-management behavior concerning their ports. In addition, healthcare professionals should take measures to improve patients' engagement and acceptance of knowledge related to port. This can be achieved through various forms of health education for patients, such as distributing health education manuals, providing face-to-face guidance, and conducting online follow-ups. The aim is to enhance and strengthen patients' self-management abilities concerning their ports, thereby reducing the incidence of catheter dysfunction and ensuring the smooth progress of treatment plans.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e\u003ch2\u003e4.3 The risk prediction model for catheter dysfunction of ports is an effective screening tool\u003c/h2\u003e\u003cp\u003eA nomogram is a graphical representation of a complex multi-factor regression model, visualizing the model in a way that intuitively reflects the impact of various factors on the outcome(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Based on multiple influencing factors, this study has developed a risk prediction model using a nomogram, which can predict the risk of catheter dysfunction for port in cancer patients. Compared to complex model formulas, this nomogram offers better readability and simplicity. The use of the nomogram facilitates the practical application of the model in clinical practice, enabling healthcare providers to easily assess patients and maintain the proper functioning of their ports. Various model evaluation indicators indicate that this risk prediction model exhibits good fit and discriminant ability. In summary, the risk prediction model developed in this study aids clinical healthcare providers in predicting the risk of catheter dysfunction for port, thereby enabling them to formulate personalized nursing plans, intervene promptly, and prevent the occurrence of catheter dysfunction.\u003c/p\u003e\u003c/div\u003e"},{"header":"5 Limitations","content":"\u003cp\u003eThis study has several limitations. Primarily limitation of this study is that was conducted in a single cancer center. Furthermore, this study is a cross-sectional study. Due to the above limitations, and the constraints of time and resources, the study was only able to include a convenience sample of participants, which may not be fully representative of the broader population. And there was no follow-up tracking of the patient\u0026rsquo;s condition. Despite this, the sample size in this study is large, allowing it to represent the patient population fairly well. Additionally, single-center studies have a homogeneous sample source, which facilitates easy control of variables and allows for concentrated utilization of resources, ensuring the depth and breadth of the research. Longitudinal studies are overly time-consuming and require significant human and material resources. Therefore, this study believes that a single-center cross-sectional study is sufficient to accurately reflect the patient\u0026rsquo;s situation. More importantly, this research is one of the few studies focusing on port catheter dysfunction.\u003c/p\u003e"},{"header":"6 Conclusion","content":"\u003cp\u003eIn conclusion, we developed a predictive model based on time with port, location of port tip, history of catheter dysfunction before, and the score of CPT-SMS to predict the risk of catheter dysfunction among cancer patients. The model demonstrates good discrimination and accuracy. By applying this model effective assessments can be conducted on patients, and most catheter dysfunctions can be prevented through early identification and be resolved through the professional intervention of nurses. By applying this model effective assessments can be conducted on patients, and most catheter dysfunctions can be prevented through early identification and be resolved through the professional intervention of nurses.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCINAS: Catheter Injection and Aspiration Scheme; CPT-SMS: Cancer patients TIVAPs self-management scale; CVAD: Central Venous Access Device; INS: Infusion Therapy Standards of Practice; port: implanted vascular access port; ROC: Receiver Operating Characteristic; non-SVC: non-superior vena cava.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study was approved by the ethics committee of the Sun Yat-sen University Cancer Center (approval number: B2024-230-01), and informed consent was obtained from all participants included in the study. This study involving human participants was conducted in strict compliance with the principles of the Declaration of Helsinki (https://www.wma.net/policies-post/wma-declaration-of-helsinki/).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availablity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data generated and analyzed in the study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Guangdong Province Nurses Association of China(Grant numbers: gdshsxh2023ms44).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJHW, XFH and XLL collected the data, analyzed the data, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eQHY and JL guided the group members in completing the publication, provided intellectual input, and edited the paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank every one of the patients who took part in the clinical study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Outpatient Department, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Nursing Department, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. 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SUPPORTIVE CARE IN CANCER. 2016 Feb;24(2):755\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eNickel B, Gorski L, Kleidon T, Kyes A, DeVries M, Keogh S, et al. Infusion Therapy Standards of Practice, 9th Edition. Journal of Infusion Nursing. 2024 Jan;47(1S):S1\u0026ndash;285. \u003c/li\u003e\n\u003cli\u003eJia Xiufen, Liu Yuping, Long Shuhong, Wang Xing. Study on risk factors of catheter dysfunction of idle totally implantable access port in patients with cancer. Chinese Nursing Research. 2024;38(11):2009\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eTsuruta S. Late complications associated with totally implantable venous access port implantation via the internal jugular vein. Support Care Cancer. 2019 Nov 14; \u003c/li\u003e\n\u003cli\u003eCapozzi VA, Monfardini L, Sozzi G, Armano G, Butera D, Scarpelli E, et al. 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Clin J Oncol Nurs. 2021 Apr 1;25(2):169\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eHyun A, Condon P, Kleidon T, Xu G, Edwards R, Gibson V, et al. Problem-solving processes for central venous catheter occlusion within pediatric cancer care: A qualitative study. European Journal of Oncology Nursing: The Official Journal of European Oncology Nursing Society. 2024 Apr;69:102520. \u003c/li\u003e\n\u003cli\u003evan Oevelen M, Heggen BD, Abrahams AC, Rotmans JI, Snoeijs MG, Vernooij RW, et al. Central venous catheter-related complications in older haemodialysis patients: A multicentre observational cohort study. J Vasc Access. 2023 Nov;24(6):1322\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eWu, Xiaohong. Study on Current Statis and Analysis of Influencing Factors about Self-Management Behavior of TIVAP among Cancer Patients [Internet] [Master]. Shantou University; 2022.\u003c/li\u003e\n\u003cli\u003eYang Tingting, Zhang Chunhua, Su Aijiang, Zhou Jing. Causes and protective countermeasures of catheter blockage in patients with tumor chemotherapy treated by venous port access. Nursing Practice and Research. 2020;17(10):137\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAkhtar N, Lee L. Utilization and Complications of Central Venous Access Devices in Oncology Patients. Current Oncology (Toronto, Ont). 2021 Jan 10;28(1):367\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eBu Li, Yang Lihua, Han Xue, Han Xiao, Li Zhengjun, Liu Yunhui, et al. Application study of preventive nursing project of unplanned extubation at implantable venous access ports for cancer patients. Journal of Nursing Administration. 2024;24(3):196\u0026ndash;200. \u003c/li\u003e\n\u003cli\u003eZhang Yuanhong, Zhang Jie, Cao Susheng, Wang Wei, Li Xinxian. The survey analysis on outpatients\u0026rsquo; nursing status of implanted venous port. Nursing Practice and Research. 2014;11(12):96\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003ePark SY. Nomogram: An analogue tool to deliver digital knowledge. J Thorac Cardiovasc Surg. 2018 Apr;155(4):1793. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Implanted Vascular Access Port, Catheter dysfunction, Risk Prediction Model, Central Venous Access Device, cancer","lastPublishedDoi":"10.21203/rs.3.rs-7427340/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7427340/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCatheter dysfunction in implanted vascular access ports (ports) is a prevalent complication disrupting cancer treatment, yet existing evidence lacks risk prediction models specifically for cancer populations and standardized dysfunction assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study enrolled 413 cancer patients from a Chinese Tertiary A hospital (Jan–Jun 2024). Catheter function was assessed using the Catheter Injection and Aspiration Scheme (CINAS). Univariate/multivariate logistic regression identified predictors, and a nomogram was constructed. Model validation included Hosmer-Lemeshow test, AUC, Cox \u0026amp; Snell R\u003csup\u003e2\u003c/sup\u003e, Nagelkerke R\u003csup\u003e2\u003c/sup\u003e, and 1,000-bootstrap resampling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Dysfunction incidence was 16.7% (69/413), with 88.4% resolved post-intervention. Three independent predictors emerged: port retention time \u0026gt;12 months (OR=5.105, P\u0026lt;0.001), history of catheter dysfunction (OR=30.672, P\u0026lt;0.001), and lower CPT-SMS self-management score (OR=0.936 per point, P\u0026lt;0.001). The nomogram assigned CPT-SMS the highest weight (53.5%). The model showed excellent discrimination (AUC=0.910, 95% CI:0.879–0.941), calibration (P=0.577), and minimal overfitting (0.002).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eA predictive model was developed based on retention time, history of catheter dysfunction, and CPT-SMS score to estimate the risk of catheter dysfunction in cancer patients. The validated model exhibited good discrimination and accuracy. Its implementation could support effective patient assessment, enabling early identification and professional nursing interventions to prevent and resolve most catheter dysfunctions.\u003c/p\u003e","manuscriptTitle":"Construction and evaluation of a predictive model for catheter dysfunction in cancer patients with implanted vascular access ports: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-29 19:58:29","doi":"10.21203/rs.3.rs-7427340/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"53ff5a90-3c62-45de-8bef-14a2d7d766d7","owner":[],"postedDate":"September 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T08:42:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-29 19:58:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7427340","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7427340","identity":"rs-7427340","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}