PICC Maintenance Challenges Among Esophageal Cancer Patients: A Qualitative Study

ABSTRACT

Background

Esophageal cancer is a prevalent malignancy worldwide, often accompanied by dysphagia and malnutrition that necessitate long‐term intravenous nutritional support. Peripherally Inserted Central Catheters (PICCs) have become a standard nursing practice to facilitate chemotherapy and parenteral nutrition in these patients. However, maintaining PICCs poses significant challenges that can affect patient adherence and outcomes.

Objective

This study aims to explore the experiences and needs of esophageal cancer patients regarding PICC maintenance after hospital discharge, with the goal of providing evidence to optimize nursing care services.

Methods

A qualitative study was conducted involving semi‐structured interviews with 15 esophageal cancer patients receiving PICC care at a specialized oncology hospital in Beijing from October 2024 to January 2025. Descriptive phenomenological methods were used to analyze the data following Colaizzi's seven‐step approach.

Results

Patient experiences clustered into four main themes: (1) Survival under the combined pressures of nutritional needs and chemotherapy; (2) Maintenance challenges influenced by anatomical and treatment‐related factors; (3) Adherence difficulties due to symptoms and frequent hospital visits; (4) Emotional responses to dramatic physical changes and distressing symptoms.

Conclusion

Esophageal cancer patients face complex, multifaceted needs during PICC maintenance, encompassing practical care, informational support, and psychological assistance. To improve patient adaptation and quality of life, future nursing practices should focus on enhancing care techniques, developing accessible support tools, and strengthening health education strategies.

Qualitative interviews identified key factors influencing PICC maintenance in esophageal cancer patients: supportive care aids adherence, while discomfort, knowledge gaps, and logistical barriers hinder it; patients seek longer catheter use, tailored education, and better service access.

1. Introduction

Esophageal cancer is one of the most common malignant tumors worldwide, with an estimated 604,000 new cases reported in 2022 [1]. It ranks sixth among all cancers in terms of mortality. China is a high‐incidence region, where over 90% of cases are pathologically classified as squamous cell carcinoma [2]. Patients with esophageal cancer often experience dysphagia caused by the tumor itself, leading to impaired oral intake and subsequent malnutrition. Treatment modalities such as surgery and chemo/radiotherapy may further compromise swallowing function or induce side effects such as nausea and vomiting, increasing metabolic demands and significantly heightening the risk of malnutrition [3].

To meet essential nutritional needs, these patients often rely on long‐term parenteral nutrition (intravenous infusion of nutrients). At the same time, chemotherapy also requires intravenous drug delivery. Peripherally inserted central catheters (PICCs), widely used in patients with esophageal cancer, can reduce the pain of repeated venipuncture and minimize the risk of chemotherapy extravasation [4]. Preoperative PICC placement has been shown to reduce the risk of pneumothorax associated with central venous catheterization by more than 15%, while also accommodating postoperative thoracic negative pressure changes and long‐cycle chemotherapy requirements [5].

Currently, the PICC placement rate among esophageal cancer patients remains relatively low at 35%–50%, yet the average catheter retention time extends to 6.8 chemotherapy cycles—27% longer than in patients with other gastrointestinal malignancies [6]. Long‐term PICC maintenance involves specialized procedures such as dressing changes and catheter flushing, which impose a substantial physical, psychological, and daily life burden on patients [7]. However, maintaining a PICC line requires rigorous nursing care, as inadequate management can lead to complications such as infections, thrombosis, and catheter occlusion [8]. Therefore, optimizing PICC care strategies and improving patient adherence are critical areas of ongoing research [9].

In recent years, advancements in PICC care techniques—such as the development of improved catheter materials, ultrasound‐guided insertion, and smart monitoring systems—have significantly enhanced safety and success rates of catheterization. However, various challenges persist in clinical practice, particularly among patients with esophageal cancer [10]. These patients often suffer from dysphagia, malnutrition, and side effects of chemotherapy or radiotherapy, leading to prolonged treatment periods and heavy physical burdens [11]. As a result, long‐term PICC use has become common in this population due to their high dependence on intravenous access.

In this study, qualitative interviews with 15 esophageal cancer patients receiving PICC care revealed that adherence to PICC maintenance is influenced by factors such as daily routines, transportation access, ability to handle complications and emergencies, and support from family and community. Many patients reported difficulty attending follow‐up appointments due to physical weakness and logistical barriers, while most lacked the skills to manage issues such as catheter occlusion or dislodgement. The presence or absence of family caregiving and community health support directly impacted care effectiveness. Core patient needs included access to clear medical information, support from hospitals and communities, assistance from family members, and psychological care. Patients expressed a strong desire for better education and guidance to manage PICC care, as well as emotional support throughout treatment. Based on these findings, this study proposes personalized solutions to help patients adhere to proper PICC maintenance, ultimately improving care quality and treatment outcomes.

Despite growing interest in PICC management, few studies have focused specifically on the lived experiences and individualized needs of esophageal cancer patients undergoing long‐term PICC maintenance. Most existing research is quantitative, emphasizing complication rates and technical improvements, while qualitative insights into patient perspectives, daily challenges, and coping strategies remain scarce. Moreover, current evidence does not adequately address how anatomical, treatment‐related, and psychosocial factors intersect to influence adherence and quality of life in this unique patient group. This study addresses this gap by using a phenomenological approach to capture the real‐world experiences of esophageal cancer patients with PICCs, thereby providing a foundation for patient‐centered care innovations.

2. Methods

2.1. Design

This study adopted a qualitative research design in strict accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Semi‐structured interviews were conducted to generate meaningful themes and reveal the scientific significance underlying the observed phenomena. The research required investigators to accurately and precisely record patients' descriptions of their experiences without any modifications. Prior to conducting in‐depth interviews with patients, the researchers maintained complete neutrality without any preconceived hypotheses or biases regarding patients.

2.2. Participants

This study was conducted from October 2024 to January 2025 at a tertiary oncology hospital in Beijing, China. Participants were required to meet the following inclusion criteria: (a) Clinically diagnosed patients with esophageal cancer; (b) patients with a PICC, including both first‐time insertions and replacements, with an indwelling duration of at least 1 month; (c) aged 18 years or older; (d) cognitively intact, able to understand and respond to interview questions; (e) in a physical condition that allowed participation in the study; and (f) having provided written informed consent, either personally or through a legal guardian, agreeing to participate in the interview.

Using purposive sampling, 15 participants were selected from a pool of 205 based on factors such as age, gender, education level, economic status, and disease condition. The average age of the participants was 64.3 ± 8.3 years, with a mean PICC indwelling duration of 6.4 ± 2.3 weeks. Demographic and clinical characteristics of the participants are presented in Table 1. The participant inclusion and exclusion flow is presented in Figure 1.

TABLE 1.

Basic demographic and clinical information of study participants.

ID	Gender	Age	Occupation	Educational level	Received treatment	Months with PICC	Complication of PICC
P1	Female	65	Engineer	Bachelor's degree	Chemotherapy Surgery	5	Pruritus
P2	Female	52	Freelance worker	High school	Chemotherapy Surgery	4	Pruritus
P3	Female	83	Retiree	High school	Chemotherapy Surgery	6	Thrombosis
P4	Female	66	Freelance worker	Bachelor's degree	Chemotherapy Radiotherapy Surgery	8	Pruritus
P5	Male	59	Freelance worker	Middle school	Chemotherapy Surgery	6	Allergic
P6	Male	70	Retiree	Secondary vocational school	Chemotherapy Immunotherapy	5	Allergic
P7	Male	59	Farmer	Middle school	Chemotherapy Surgery	4	pruritus
P8	Male	66	Retiree	Middle school	Chemotherapy Surgery	9	Skin redness
P9	Male	61	Retiree	Bachelor's degree	Radiotherapy Chemotherapy Surgery	9	Pruritus
P10	Female	72	Retiree	Middle school	Chemotherapy Surgery	7	Arm Swelling
P11	Male	63	Farmer	Primary school	Chemotherapy Surgery	6	Catheter dislodgement
P12	Female	66	Freelance worker	Middle school	Radiotherapy Chemotherapy Immunotherapy	10	Thrombosis
P13	Male	65	Retiree	High school	Radiotherapy Chemotherapy Immunotherapy	4	None
P14	Male	70	Teacher	Junior college	Chemotherapy Surgery	3	Pruritus
P15	Male	48	Worker	Junior college	Chemotherapy Surgery	10	None

FIGURE 1.

Subject screening flowchart.

2.3. Procedure

The primary investigators had no conflicts of interest with the participants. An interview guide was developed based on a literature review and consultations with clinical experts. A pilot interview with one patient was conducted to refine question wording and sequencing. The final guide contained the following concise, open‐ended questions:

1. What do you know about PICC care?

2. How has PICC care affected your daily life?

3. Have you experienced any discomfort when using a PICC?

4. How do you ensure safety during PICC care?

5. Have you had any PICC‐related complications? How did you handle them?

6. Do your family members or caregivers understand PICC care?

7. What support do you need from healthcare providers?

8. What suggestions would you give to improve PICC care?

Interviews were conducted in the PICC room, a quiet and familiar setting, with only the researchers and participants present to ensure privacy. Each session began with an introduction, an explanation of the study's purpose, and assurances of confidentiality. Written informed consent was obtained from both patients and their family members. All interviews were audio‐recorded in full, and researchers also documented non‐verbal cues and emotional expressions in field notes.

Participants were encouraged to share freely until no new themes emerged. Data saturation was defined as the point at which two consecutive interviews yielded no new codes or themes, confirmed independently by two researchers. All 15 participants completed the interviews without dropouts. Each session lasted 30–50 min, and no repeated interviews were conducted. Interviews and transcripts were in Chinese; the final report was written in English.

3. Data Analysis

Within 24 h after each interview, the audio recordings were transcribed into text. The data were analyzed using the Colaizzi phenomenological analysis method, following these steps: (1) Each participant's interview was transcribed into an individual document that accurately reflected their perspectives. (2) All meaningful statements were extracted. (3) Recurring viewpoints were coded. (4) The coded statements were categorized and compiled. (5) A detailed and comprehensive description was written to ensure no information was omitted. (6) Similar viewpoints were identified and refined into overarching themes. (7) Findings were validated by returning to the participants for confirmation.

4. Data Quality Control

This study was designed and conducted in accordance with the COREQ checklist, ensuring rigor based on four key criteria: credibility, dependability, confirmability, and transferability. All interviews were conducted by the principal researchers, who possessed relevant knowledge of cancer and PICC catheterization. Before data collection, the research team underwent standardized training. Both team members and participants validated the recorded data and descriptions.

Interviews were conducted in a quiet environment, with experienced researchers guiding discussions while documenting the sessions. Data and the transcription process were carefully recorded and reflected upon to ensure accuracy in data collection and analysis. Additionally, researchers engaged in self‐reflection and shared findings with participants to enhance confirmability.

To establish trust, researchers familiarized themselves with the clinical setting before the interviews and built rapport with patients and their families by assisting them with catheter‐related procedures. Data were independently analyzed by two researchers to ensure objectivity and reliability.

4.1. Ethical Considerations

This study adheres to the ethical standards of the Hospital Research Committee and the Declaration of Helsinki. It has been approved by the Ethics Committee of Cancer Hospital, Chinese Academy of Medical Sciences, with the approval number: 24/164‐4444.

Informed consent was obtained from all participants before the interviews, and strict confidentiality measures were maintained. Participants were also given the freedom to withdraw from the study at any time.

5. Results

5.1. Facilitator

5.1.1. Reduce the Discomfort of Repeated Venipuncture and Simplify Treatment Procedures

The majority of participants highly acknowledged the convenience of PICC in treatment, recognizing its effectiveness in reducing the pain of repeated punctures and ensuring safe medication administration. Interviewees generally affirmed the important role of PICC in treatment and expressed willingness to actively cooperate with its maintenance. Therefore, healthcare providers should strengthen education on the advantages of PICC to help patients establish a correct understanding and improve treatment compliance.

P1: PICC care does have advantages. For chemotherapy patients like me, if we get infusion through hand veins, the whole blood vessel is exposed to chemotherapy drugs, which causes more damage. PICC causes less damage to blood vessels, and we don't have to worry about puncture risks.

P6: PICC is both safe and convenient. One catheter placement can last a year, which is really hassle‐free. If we had to get punctured in peripheral veins every time, it would be both time‐consuming and painful.

P12: The biggest benefit is not having to worry about chemotherapy drug extravasation. The red and white drugs I use are very irritating to blood vessels—leakage would be terrible. That's why I've persisted with PICC!

P13: Back then my hand was so swollen from infusions—swollen like a steamed bun—we couldn't even find veins anymore. If only I had known how good PICC was, I should have used it earlier.

5.1.2. Reduce the Risk of Complications

The findings demonstrate that PICC significantly reduces the risk of treatment‐related complications. By terminating the catheter tip in the central vein, PICC effectively minimizes common peripheral infusion complications such as extravasation and phlebitis. This safety advantage not only improves treatment outcomes but also alleviates patients' psychological distress. Clinicians should emphasize these protective features to facilitate informed decision‐making.

P8: I used to have frequent redness, swelling and pain in my arm with peripheral infusions—the nurses called it phlebitis. Since switching to PICC, these problems disappeared, and I don't have to constantly monitor the infusion site anymore.

P15: Chemotherapy leakage was my biggest fear—I heard stories about skin necrosis from extravasation. With PICC going straight to the big vein, the nurses said medications get diluted faster. It's much safer and let me sleep better at night.

5.2. Hindrance

5.2.1. The Dual Torment of Treatment Tolerance and Physical Exhaustion

Esophageal cancer patients rely on PICC lines to receive chemotherapy drugs and concentrated nutritional solutions to sustain their lives, but this process is fraught with contradictions. On one hand, these infusions help maintain essential bodily functions; on the other hand, they increase the burden on organs—causing liver dysfunction, electrolyte imbalances, and impaired intestinal motility. Patients find themselves caught between “staying alive” and “enduring treatment‐related harm,” feeling as though their bodies are being gradually worn down.

P10: What's being put in is life, but it's also a punishment.

P7: The nurse said the nutrition liquid is like food, but after it's infused, my belly feels like it's going to burst. I can't have a bowel movement for three days straight—it's really uncomfortable.

P8: The PICC is connected to the chemo pump, and sometimes it has to run for days nonstop. As soon as it's hooked up, I know I'm about to “suffer” again. I'm afraid to turn over because I might pull the tube. After the infusion, my whole body aches all over, but I have no choice—I have to endure it to get treated.

5.2.2. Anxiety Over Catheter Dislodgement Risk Impacts Quality of Life

Patients actively monitor their PICC lines through frequent physical sensations (e.g., palpating catheter pulsations), visual inspections, and by limiting arm movements to ensure catheter safety. However, due to a lack of clear home‐based criteria for identifying abnormalities, patients often misinterpret normal physiological phenomena—such as positional blood reflux—as signs of serious complications like thrombosis or infection. This leads to a feedback loop of self‐monitoring, over‐interpretation, and heightened anxiety, which ultimately increases psychological distress and complicates catheter care.

P3: I saw a short video saying that catheter blockage can cause a pulmonary embolism. Now whenever I cough, I worry it's a blood clot in my lung. I know it's not scientific, but I just can't stop overthinking.

P10: Right after my surgery, I was able to shower, but after the catheter was placed, I couldn't shower anymore. I'm afraid of water getting in and causing an infection, which makes me feel a bit irritated.

P12: The clot has dissolved, but I still have swelling. Because of chemotherapy, I still have to use this line. I don't want to have it removed; I hope it can last until my chemo is over. I'm very careful now and go to the hospital whenever something feels wrong.

P12: This catheter is very important. I hardly do any housework now and am very cautious not to put pressure on it. Every day, I check my arm to see if it's swollen or anything.

5.2.3. Anatomical Changes Increase the Difficulty of Catheter Care

Esophageal cancer patients face complex challenges in PICC maintenance due to anatomical changes and treatment toxicity. Gastric elevation into the thoracic cavity alters vascular anatomy, complicating catheter insertion and care. Triple‐incision surgeries limit body movement, forcing patients into painful “no‐win” situations during dressing changes. Chemotherapy‐induced vascular sclerosis and radiation‐damaged skin increase risks of pain, infection, and complications, severely affecting quality of life. Combined with overall physical debilitation and fatigue, these factors make catheter maintenance difficult, increasing psychological stress and caregiving burdens. Thus, PICC care in esophageal cancer patients demands both technical skill and attention to their physical and emotional resilience.

P3: Since they moved my stomach up into my chest, whenever I cough the catheter shakes. The nurse said my line tends to have a lot of blood return, so flushing it every day feels like torture. If I flush too hard, I get chest tightness; if I don't flush enough, I worry it'll get blocked.

P7: I've got incisions on my neck, chest, and abdomen—just breathing hurts. When I raise my arm for dressing changes, all three wounds hurt at once. The pain's so intense I black out.

P9: Chemo completely hardened the veins on the back of my hand—this PICC is the only one that still works. But when they pull off the dressing, it rips the skin that was already burned from radiation. It burns like hell.

P10: The doctor said they could place the catheter in my groin to avoid the surgical wounds, but walking made it rub and get inflamed. In the end, I went with my arm. It's uncomfortable during dressing changes, but better that than letting it get infected and rot.

P15: Even a little redness scares me to death. But last time it stayed red for two days and turned out to be nothing. I just don't know anymore—what does a real infection even look like?

5.2.4. The Paradox Between Survival Needs and Protective Behaviors

Postoperative esophageal cancer patients who undergo gastric transposition (gastric conduit reconstruction) frequently experience persistent gastroesophageal reflux and vomiting, with studies reporting a vomiting incidence as high as 78% in this population [8]. Current PICC catheter designs are based on the assumption of static body conditions and are not structurally equipped to accommodate the sudden increases in intra‐abdominal pressure that occur during vomiting, which may lead to catheter displacement. Moreover, there is a positional conflict between the supine position—considered optimal for PICC maintenance—and the semi‐recumbent 45° position recommended for aspiration prevention. This creates a “positional safety paradox,” where patients must choose between maintaining catheter integrity and preventing aspiration‐related complications.

P4: When I'm vomiting badly, I can't focus on the catheter. I just remember the nurse said not to tug it. So after I'm done, I always check to see if it's still okay—I'm mostly afraid it might get pulled out.

P9: I don't know how to hold the catheter properly so it stays in place but doesn't get in the way when I vomit.

P11: When I vomit, the whole world spins—I can't even think about the catheter. Now it's become a reflex: I grab my left collarbone with my right hand the moment I feel nausea.

P15: Whenever I cough or vomit, my heart jumps into my throat. When I'm throwing up, it's total chaos—I have to cover the stoma and protect the catheter at the same time. In the end, I just hunch over and press my knees against my stomach.

5.2.5. Physical Exhaustion During Chemotherapy Coupled With Frequent Hospital Visits

Patients undergoing postoperative chemotherapy often experience severe fatigue due to treatment side effects. However, they must still make frequent trips to the hospital for PICC maintenance. The time burden (e.g., waiting in line, prolonged appointments) and physical toll (e.g., prolonged sitting, travel exhaustion) further exacerbate their fatigue during chemotherapy.

P2: After my second chemo, I felt awful for over a week. The white blood cell booster shots made my whole body ache—I just wanted to lie still. But the thought of going back to the hospital for dressing changes made me so anxious.

P3: Oxaliplatin makes me so dizzy. It's already hard enough sitting through the hour‐long trip to the hospital, then another hour back. For elderly cancer patients like me, it's really tough.

5.2.6. Patients Struggle to Understand and Perform PICC Care Procedures

Under conditions of severe fatigue and chemotherapy‐induced brain fog, patients often find it difficult to retain or comprehend PICC care instructions—even when they see or hear them, the information feels like it “goes in one ear and out the other.” Neurological side effects such as peripheral neuropathy (e.g., numbness in the hands) further hinder their ability to carry out care tasks accurately, even if they understand the key steps—for example, they may struggle to detect abnormalities by touch. Patients express a strong desire for information to be delivered in simpler, more intuitive, and repetitive formats, and they need supportive tools such as mobile apps with step‐by‐step reminders to assist them in daily care.

P3: When the nurse taught me, it seemed like I understood all the precautions, but once I got home, my mind went blank. I only remember not to lift heavy things.

P6: My brain feels like mush, and my hands don't obey me. After chemo, my fingers feel like they're wearing gloves—I can't tell if the catheter has shifted by touch. Last time, it was my spouse who noticed the blood return.

P8: It would be great to have an alarm that reminds me when it's time to change the dressing. Right now, I rely entirely on my child to remember the schedule—when they tell me, I go.

P12: The maintenance manual's print is as small as ants, and after chemo I can't see it clearly at all. It would be better to have a video, like showing how to protect the catheter during bathing, something more intuitive.

5.2.7. The Burden of Coordinating Multiple Treatments and Catheter Maintenance

Esophageal cancer patients often suffer from moderate to severe malnutrition due to dysphagia. Under the dual impact of grade 3–4 fatigue and myelosuppression caused by platinum‐ or paclitaxel‐based chemotherapy, they are forced to endure a “treatment marathon” during weekly PICC maintenance. The rigid weekly catheter maintenance schedule forms a “time straitjacket” alongside radiotherapy administered daily and chemotherapy given every 21 days. Lack of transparent information or difficulty accessing it—such as uncoordinated schedules across departments and unclear community service details—prevents patients from effectively planning their visits, resulting in excessive travel burdens.

P1: Sometimes I stay at my own home, sometimes at my child's. I just want to know where the closest and most convenient place is to get maintenance done.

P5: Every time I have to make a separate trip just to change the catheter. If I could know in advance which days are for chemo and which for maintenance, I could coordinate better, but no one seems to know!

P14: “I feel worse the few days after chemo. Does the dressing really have to be changed every 7 days? It would be better if the timing were more flexible.”

P15: Patients like me have very little strength left. I also have a gastrostomy tube. The oncology department in my hometown provides home maintenance service, but I doubt other places understand my situation well enough to offer that.

5.2.8. Insufficient Community and Family Support

Esophageal cancer patients experience unique challenges due to thoracic wall deformation caused by radical surgery, prolonged externalization of the PICC catheter, and chemotherapy‐induced physical changes, forming a distinctive “patient‐catheter complex.” The inherent uncertainty of the disease, fear of treatment, and anxiety about the future render these patients particularly psychologically vulnerable. In this context, PICC maintenance transcends mere nursing procedures and becomes a critical opportunity for providing holistic humanistic care and psychological support.

P1: The nurse always says, ‘The disinfectant stings a bit; that's normal,’ or ‘Don't move during dressing changes.’ I want to ask why it hurts so much, or if there's another way, but they're either too busy to explain or just say, ‘It's like this for everyone; you have to endure it.’ It feels like my questions and feelings don't matter.

P4: The skin around the puncture site is always red and itchy, sometimes even broken. Every time the nurse wipes with alcohol swabs, it hurts so much I can't help flinching. They say thorough disinfection is necessary because infection would be terrible. I understand, but no one understands this pain.

P8: They only care if the catheter is patent, if it's positioned right, or if the dressing is secure. No one asks how I'm feeling physically or emotionally, whether I'm scared or if I can sleep at night. The truth is, I'm full of fear and frustration.

P9: In summer, with thin clothes, the catheter bulges on my arm, and the gauze over the insertion site is very obvious. When I take the bus, people glance at me secretly. I feel like a freak. I try not to go out, and if I do, I'm afraid someone will touch my arm.

5.3. Primary Needs

5.3.1. Enhancing Self‐Management Capabilities

Healthcare professionals' detailed explanations and patient guidance are pivotal in empowering patients. Many gradually master PICC self‐management skills, including: activity modification with the catheter, daily catheter monitoring, abnormal situation response, maintenance information access, compliance management. This transformation from initial uncertainty to becoming “semi‐experts” in PICC care not only boosts treatment confidence but significantly improves maintenance safety and effectiveness.

P4: I try my best to follow all the precautions the nurses explained. Every week without fail, I go to the specialized care center at our local hospital for maintenance—never miss an appointment.

P13: The nurse gave me a grip‐strengthening ball and showed me exercises to prevent blood clots. I do them religiously every day—works great so far (no problems at all).

5.3.2. Personalized Guidance

Patients report that generic maintenance instructions fail to address their individual needs, expressing a strong desire for tailored advice based on their specific treatment regimens and physical conditions.

P2: When issues come up, I always prefer asking medical staff directly. I avoid discussing with other patients—there's too much misinformation going around.

P4: I've got this special situation with sensitive skin that's prone to allergies. Really wish I could get some customized advice for my case.

5.3.3. Emergency Preparedness Guidance

Patients demonstrate limited ability to handle emergencies due to insufficient systematic education on complication management. There exists a critical need for clear, practical emergency protocols (e.g., for dislodgement, rashes, or swelling) during PICC maintenance to enable timely and effective responses to unexpected situations.

P4: When I suddenly saw redness and swelling around the insertion site, I completely freaked out—terrified something was wrong. Online searches showed conflicting advice—some said go to ER immediately, others suggested waiting. I desperately wished for professional guidance in that moment.

P11: After using the bathroom, I noticed part of the tube had come out. I was too scared to touch it—had no idea what to do. Just rushed to the hospital in a panic.

5.3.4. Psychosocial Support

The inherent uncertainties of disease progression, treatment‐related fears, and future anxieties render cancer patients particularly psychologically vulnerable. Within this context, PICC maintenance transcends being merely a clinical procedure—it represents a critical opportunity for delivering humanistic care. Patients frequently report experiencing significant anxiety and loneliness during maintenance sessions, making them acutely sensitive to healthcare providers' attitudes. There exists a profound longing for warmth and empathy within what is often perceived as a sterile medical environment. As one patient poignantly observed: “The most perfect technique can never replace a single comforting word.”

6. Discussion

This qualitative study provides an in‐depth exploration of the facilitators and barriers in PICC maintenance among esophageal cancer patients. The findings reveal that esophageal patients face multifaceted challenges during PICC care, encompassing both objective clinical difficulties and subjective cognitive and psychological barriers. These interconnected factors collectively influence patients' adherence to maintenance protocols and their overall quality of life.

Patients with esophageal cancer face multifaceted challenges in managing PICC care. Objectively, PICC maintenance imposes significant limitations on daily activities such as bathing, dressing, and sleeping. Transportation burdens associated with hospital‐based maintenance visits further compound these difficulties, particularly for patients in remote or mobility‐limited settings. Additionally, the procedures themselves often cause physical discomfort, while many patients feel unprepared to manage complications such as catheter dislodgement or local inflammation.

These visible difficulties reflect deeper cognitive and behavioral issues. Many patients underestimate the importance of PICC maintenance, prioritize treatment over care, or deliberately neglect maintenance due to practical constraints. Cognitive side effects of chemotherapy, such as “chemo‐brain” from platinum‐based drugs, impair memory and lead to high knowledge attrition rates [12]. Optimistic bias and poor risk perception are common, resulting in low adherence and increased complication rates.

Critically, current educational systems are overly focused on procedural knowledge, neglecting the integration of medical care into daily routines [13]. This disconnect leaves patients to navigate care through trial and error, often with unsafe results—for instance, using plastic wrap for waterproofing, which can cause skin maceration. To bridge this gap, an empowerment‐based educational model should be implemented [14], incorporating scenario‐based simulations, caregiver training, community support, and digital tools like “PICC Life Adaptation Navigators” to demonstrate catheter protection in real‐life situations.

From a systems perspective, the burden of PICC care stems from a mismatch between the technical design of maintenance protocols and the physiological vulnerabilities of esophageal cancer patients [15]. Weekly hospital visits during chemotherapy conflict with patients' limited physical capacity, increasing fatigue and infection risk. A tiered care model should be developed, integrating hospital–community–home collaboration. This includes training community nurses, leveraging smart dressings for remote infection monitoring, embedding PICC reminders into chemotherapy schedules via mobile apps, and incorporating home‐based maintenance services into insurance reimbursement systems.

Esophageal cancer‐specific anatomical and treatment‐related factors further complicate PICC care [16]. Skin toxicity from chemotherapy, neuropathy, altered body positioning post‐surgery, and sensitivity to standard adhesives and disinfectants necessitate technical modifications [17]. Recommendations include silicone‐based low‐irritation dressings, dissolvable adhesives, catheter sleeve devices, side‐lying dressing supports, and pressure‐adjustable flushing devices to accommodate thoracic negative pressure fluctuations.

A stratified health information strategy is essential to address disparities in literacy, disease stage, and complication risk [18]. An “assess‐stratify‐reinforce” model should be adopted: assess health literacy using tools like REALM‐SF; deliver tiered educational content (e.g., animations vs. decision trees); and reinforce learning via digital care logs and personalized reminders. Risk stratification based on lab indicators and local catheter conditions can guide individualized monitoring plans, especially for high‐risk patients with hypoalbuminemia or immunosuppression.

Finally, there is a pressing need to reconcile standardized medical procedures with patients' psychological and emotional needs [19]. Esophageal cancer patients often report a sense of objectification during care—stemming from impersonal language, lack of privacy, or inadequate communication during complications [20]. A dignity‐conserving care model should be implemented, focusing on respectful language (“your catheter” vs. “this catheter”), personalized testing for skin sensitivity, and visible concealment strategies to support body image. Narrative medicine offers a powerful tool to restore empathy in care. Embedding a “3‐minute narrative contact” protocol—eliciting patients' experiences before, during, and after procedures—can foster trust and patient‐centeredness. Narrative response rates and empathetic communication frequency should be incorporated into nursing quality metrics.

In conclusion, PICC care for esophageal cancer patients involves not only technical and clinical dimensions but also cognitive, emotional, and systemic components. Addressing these interrelated challenges requires a comprehensive, patient‐centered approach that integrates lifestyle empowerment, technological innovation, stratified information delivery, and dignity‐driven humanistic care. Only through such multidimensional strategies can we ensure both clinical safety and quality of life across the entire treatment continuum.

Beyond the practical implications, this study makes several important theoretical contributions. By employing a descriptive phenomenological approach, it advances understanding of how esophageal cancer patients experience and navigate the complexities of long‐term PICC maintenance. The findings enrich existing nursing and self‐management theories by highlighting the interplay between patients' cognitive, emotional, and behavioral responses within a clinical context. Furthermore, the study proposes a patient‐centered stratified health information delivery model and dignity‐conserving care framework, offering new conceptual tools to guide future research and practice in catheter‐related nursing care. These theoretical insights lay a foundation for developing more holistic, empathetic, and tailored interventions that can improve adherence and quality of life for this vulnerable population.

This study builds on our previous work on PICC care in cancer patients by providing deeper qualitative insights specifically into esophageal cancer patients' experiences. It highlights key challenges and patient needs that were not fully captured before. The findings emphasize the importance of patient‐centered, multidisciplinary approaches to improve PICC maintenance adherence and quality of life.

7. Conclusion

This qualitative study highlights both the benefits and challenges of PICC care from the patient perspective. While the catheter serves as a vital conduit for treatment and nutrition, patients—affected by dysphagia, malnutrition, post‐surgical anatomical changes, and chemotherapy‐induced toxicities such as skin and nerve damage—struggle between therapeutic dependence and the burdens of maintenance. Four central conflicts emerge: the survival paradox, technical mismatch, implementation gap, and dignity disruption. Despite receiving instruction focused on technical procedures, many patients fail to translate knowledge into effective daily practice and often experience a loss of privacy and emotional detachment during care. The study also identifies an urgent need for practical self‐management guidance, emergency preparedness education, and psychosocial support. Addressing these issues requires a dual approach: technological innovation to optimize materials, streamline procedures, and incorporate smart devices, thereby minimizing the physical burden of care; and humanistic reform, integrating narrative medicine and dignity‐conserving practices to elevate routine care into personalized, empathetic engagement. Only through this integrated strategy can truly patient‐centered PICC care be realized, enabling esophageal cancer patients to regain a sense of control amid illness and improving both their treatment experience and quality of life.

8. Limitations

This study has several limitations. First, as a qualitative study conducted in a single tertiary oncology hospital, the findings may have limited generalizability to other settings or populations. Second, purposive sampling may introduce selection bias, potentially affecting the diversity of patient experiences captured. Third, interviews relied on self‐reported data, which may be influenced by recall bias or social desirability. Future multi‐center studies with larger sample sizes and mixed methods are warranted to validate and expand upon these findings.

Author Contributions

Wei Zhang designed the study, Huanfei Guo and Caiyun Li conducted the interviews and drafted the manuscript. Xin Wang and Yang Liu recorded and transcribed the interviews. Jiwen Zhang revised and finalized the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Supporting Information.

Huanfei G., Caiyun L., Xin W., Jiwen Z., Yang L., and Wei Z., “ PICC Maintenance Challenges Among Esophageal Cancer Patients: A Qualitative Study,” Thoracic Cancer 16, no. 18 (2025): e70164, 10.1111/1759-7714.70164.

Data Availability Statement

The datasets generated and/or analyzed during the current study are not publicly available due to the need to protect participant confidentiality, in accordance with the ethics approval granted by Ethics Committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, but de‐identified excerpts relevant to the study are available from the corresponding author on reasonable request.