Key result
Subcutaneous tunneling significantly reduced proximal catheter movement compared to standard non-tunneled placement (4.3% vs. 9.9%, P=0.007), though it did not significantly reduce distal movement.
Why the study?
Does subcutaneous tunneling reduce catheter dislodgement, malposition, and catheter-related complications in patients requiring PICC placement?
RCT (n=630)
Single-blind
Block randomization stratified by center with variable block size
Yes
Does subcutaneous tunneling reduce catheter dislodgement, malposition, and catheter-related complications in patients requiring PICC placement?
Absolute Event Rate: 4.3% vs 9.9%
p-value: p=0.007
The subcutaneous tunneling technique for PICC placement significantly reduces proximal catheter movement, catheter-related infections, and catheter-related thrombosis compared to standard non-tunneled placement.
Objective To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheters (PICCs) dislodgement and malposition. Dislodged or malpositioned PICCs can lead to improper treatment. The subcutaneous tunneling strategy may be effective, but there is insufficient evidence, and proximal movement has not been explored. Methods We randomized 630 patients who needed PICCs placement to either the tunneled PICCs (experimental group) or the nontunneled PICCs (control group). Dislodgement and malposition of the catheter were the primary outcomes, and catheter-related infection (CRI) and catheter-related thrombosis (CRT) were the secondary outcomes. Results Subcutaneous tunneling does not significantly reduce distal catheter movement, but it significantly reduces proximal catheter movement (4.3% vs. 9.9%, P = 0.007), which may explain the lower incidence of CRI (2.0% vs. 5.3%, P = 0.030) and CRT (3.6% vs. 12.5%, P < 0.001). Conclusions Although subcutaneous tunneling does not significantly improve catheter prolapse, it should still be used clinically because proximal catheter movement can be a more serious problem associated with CRI and CRT.
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Sheng et al. (2025) conducted an RCT in Patients requiring peripherally inserted central catheters (PICCs) (n=630). Subcutaneous tunneling technique for PICCs vs. Non-tunneled PICCs was evaluated on Proximal catheter movement (p=0.007). Subcutaneous tunneling significantly reduced proximal catheter movement compared to standard non-tunneled placement (4.3% vs. 9.9%, P=0.007), though it did not significantly reduce distal movement.
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