Effectiveness of subcutaneous tunneling technique in reducing PICC dislodgement and malposition: a pilot multicenter randomized controlled trial
Article Category: Original article
Published Online: Mar 14, 2025
Page range: 145 - 153
Received: Mar 27, 2024
Accepted: Aug 04, 2024
DOI: https://doi.org/10.2478/fon-2025-0016
Keywords
© 2025 Yuan Sheng et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Figure 1.
Figure 2.
Demographic and clinical characteristics at baseline_
| Characteristics and categories | Experimental group ( |
Control group ( |
||
|---|---|---|---|---|
| 55.71 ± 13.46 | 56.03 ± 14.43 | –0.286 | 0.775 | |
| 24.19 ± 0.21 | 23.81 ± 3.86 | 1.248 | 0.212 | |
| Male | 55 (18.2%) | 48 (15.8%) | 0.602 | 0.438 |
| Female | 247 (81.8%) | 255 (84.2%) | ||
| Yes | 272 (90.1%) | 261 (86.1%) | 2.225 | 0.136 |
| No | 30 (9.9%) | 42 (13.9%) | ||
| Head disease | 14 (4.6%) | 12 (4.0%) | 2.202 | 0.9 |
| Breast disease | 57 (18.9%) | 69 (22.8%) | ||
| Respiratory disease | 17 (5.6%) | 16 (5.3%) | ||
| Gastrointestinal disease | 47 (15.6%) | 52 (17.2%) | ||
| Pelvic disease | 142 (47.0%) | 129 (42.6%) | ||
| Blood disease | 10 (3.3%) | 10 (3.3%) | ||
| Others | 15 (5.0%) | 15 (5.0%) | ||
| Hypertension | 41 (13.6%) | 52 (17.2%) | 1.495 | 0.221 |
| Diabetes | 19 (6.3%) | 24 (7.9%) | 0.608 | 0.435 |
| CHD | 6 (2.0%) | 13 (4.3%) | 2.639 | 0.104 |
| 11 (3.6%) | 12 (4.0%) | 0.042 | 0.838 | |
| 26 (8.6%) | 24 (7.9%) | 0.095 | 0.758 | |
| PLT | 247.77 ± 108.48 | 249.94 ± 94.27 | –0.263 | 0.793 |
| TT | 14.01 ± 1.69 | 13.78 ± 2.40 | 1.34 | 0.181 |
| APTT | 11.47± 1.61 | 11.54± 2.76 | –0.402 | 0.688 |
| PT | 30.52 ± 4.67 | 29.66 ± 5.96 | 1.962 | 0.051 |
| FIB | 3.47 ± 0.95 | 3.53 ± 1.26 | –0.687 | 0.492 |
| D–dimer | 1.13 ± 3.36 | 0.93 ± 1.72 | 0.897 | 0.37 |
| Left | 87 (28.8%) | 86 (28.4%) | 0.013 | 0.908 |
| Right | 215 (71.2%) | 217 (71.6%) | ||
| Basilic vein | 248 (82.1%) | 268 (88.4%) | 4.86 | 0.088 |
| Brachial vein | 47 (15.6%) | 30 (9.9%) | ||
| Cephalic vein | 7 (2.3%) | 5 (1.7%) | ||
| 0.28 (0.26, 0.31) | 0.34 (0.30, 0.43) | –11.224 | <0.001 | |
| 6.84 ± 0.65 | 6.85 ± 0.57 | –0.077 | 0.939 | |
| T5 | 9 (3.0%) | 16 (5.3%) | 2.64 | 0.451 |
| T6 | 92 (30.5%) | 82 (27.1%) | ||
| T7 | 159 (52.6%) | 160 (52.8%) | ||
| T8 | 42 (13.9%) | 45 (14.9%) |
Outcomes of the participants_
| Characteristics and category | Experimental group ( |
Control group ( |
χ2 | |
|---|---|---|---|---|
| 1.321 | 0.25 | |||
| 0–2 cm | 251 (83.1%) | 262 (86.5%) | ||
| ≥2 cm | 51 (16.9%) | 41 (13.5%) | ||
| 1.327 | 0.249 | |||
| 0–5 cm | 291 (96.4%) | 286 (94.4%) | ||
| ≥5 cm | 11 (3.6%) | 17 (5.6%) | ||
| Total | 13 (4.3%) | 30 (9.9%) | 7.175 | 0.007 |
| 0.5–2 cm | 8 (2.6%) | 19 (6.3%) | 7.185 | 0.028 |
| ≥2 cm | 5 (1.7%) | 11 (3.6%) | ||
| Total | 6 (2.0) | 16 (5.3) | 4.683 | 0.03 |
| Local infection | 4 (1.3) | 9 (3.0) | 0.101a | |
| CLABSI | 2 (0.7) | 7 (2.3) | ||
| Total | 11 (3.6) | 38 (12.5) | 16.092 | <0.001 |
| Symptomatic | 4 (1.3) | 12 (4.0) | 15.245 | <0.001 |
| Asymptomatic | 7 (2.3) | 25 (8.3) | ||
The key components of PICCs placement_
Follow the principle of the maximum sterile barrier during catheter placement and perform strict hand hygiene before surgery A modified Seldinger technique was used to insert PICCs under ultrasound guidance. The CVR ratio was calculated before catheter placement using the vein diameter at the venipuncture site without a tourniquet After inserting the catheter into the vein, a 12–15 cm tunneler with an end connecting the catheter and another end creates a subcutaneous tunnel from the vein puncture site to the tunnel exit site The tunnel length should be longer than 3 cm in the experimental group The exposure length in both groups is 5–7 cm The catheter exit sites were fixed with 2 cm × 2 cm gauze compression and then covered with a 10 cm × 10 cm sterile transparent dressing. A cross-section of sterile tape was used to affix the catheter and dressing, followed by tape used to secure the film’s lower edge All catheter tips were checked using posteroanterior chest X-ray radiography |