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Effectiveness of subcutaneous tunneling technique in reducing PICC dislodgement and malposition: a pilot multicenter randomized controlled trial

Yuan Sheng

Yuan Sheng

School of Nursing and Rehabilitation, Shandong UniversityJinan, China
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Sheng, Yuan
, 
Wei Gao

Wei Gao

Department of PICCs Clinic, Qilu Hospital of Shandong UniversityJinan, China
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Gao, Wei
 e 
Sheng-Yi Dongye

Sheng-Yi Dongye

Department of Pathology, The Second Affiliated Hospital of Shandong First Medical UniversityTaian, China
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Dongye, Sheng-Yi
  
14 mar 2025
Effectiveness of subcutaneous tunneling technique in reducing PICC dislodgement and malposition: a pilot multicenter randomized controlled trial's Cover Image
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Categoria dell'articolo: Original article
Pubblicato online: 14 mar 2025
Pagine: 145 - 153
Ricevuto: 27 mar 2024
Accettato: 04 ago 2024
DOI: https://doi.org/10.2478/fon-2025-0016
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© 2025 Yuan Sheng et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

CONSORT flowchart of study participants. Abbreviations: CONSORT, consolidated standards of reporting trials; PICCs, peripherally inserted central catheters.
CONSORT flowchart of study participants. Abbreviations: CONSORT, consolidated standards of reporting trials; PICCs, peripherally inserted central catheters.

Figure 2.

Average movement length of exposed PICCs in both groups. Note: The latest follow-up data were used to fill in missing values caused by extubation. Abbreviation: PICCs, peripherally inserted central catheters.
Average movement length of exposed PICCs in both groups. Note: The latest follow-up data were used to fill in missing values caused by extubation. Abbreviation: PICCs, peripherally inserted central catheters.

Demographic and clinical characteristics at baseline_

Characteristics and categories Experimental group (n = 302) Control group (n = 303) t/χ2 P
Age (years) 55.71 ± 13.46 56.03 ± 14.43 –0.286 0.775
BMI (kg/m2) 24.19 ± 0.21 23.81 ± 3.86 1.248 0.212
Gender
  Male 55 (18.2%) 48 (15.8%) 0.602 0.438
  Female 247 (81.8%) 255 (84.2%)
Cancer
  Yes 272 (90.1%) 261 (86.1%) 2.225 0.136
  No 30 (9.9%) 42 (13.9%)
Diagnosis body
  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%)
Comorbidity
  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
History of DVT 11 (3.6%) 12 (4.0%) 0.042 0.838
History of CVADs 26 (8.6%) 24 (7.9%) 0.095 0.758
Coagulation function
  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
Insertion arm
  Left 87 (28.8%) 86 (28.4%) 0.013 0.908
  Right 215 (71.2%) 217 (71.6%)
Insertion vein
  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%)
CVR at the puncture site 0.28 (0.26, 0.31) 0.34 (0.30, 0.43) –11.224 <0.001
Average length outside the skin 6.84 ± 0.65 6.85 ± 0.57 –0.077 0.939
Tip position
  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 (n = 302) Control group (n = 303) χ2 P
Distal movement
Criteria 1 1.321 0.25
  0–2 cm 251 (83.1%) 262 (86.5%)
  ≥2 cm 51 (16.9%) 41 (13.5%)
Criteria 2 1.327 0.249
  0–5 cm 291 (96.4%) 286 (94.4%)
  ≥5 cm 11 (3.6%) 17 (5.6%)
Proximal movement
  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%)
CRI
  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)
CRT
  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
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