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

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

By: Yuan Sheng,  Wei Gao and  Sheng-Yi Dongye  
Open Access
|Mar 2025

Figures & Tables

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 categoriesExperimental group (n = 302)Control group (n = 303)t2P
Age (years)55.71 ± 13.4656.03 ± 14.43–0.2860.775
BMI (kg/m2)24.19 ± 0.2123.81 ± 3.861.2480.212
Gender
  Male55 (18.2%)48 (15.8%)0.6020.438
  Female247 (81.8%)255 (84.2%)
Cancer
  Yes272 (90.1%)261 (86.1%)2.2250.136
  No30 (9.9%)42 (13.9%)
Diagnosis body
  Head disease14 (4.6%)12 (4.0%)2.2020.9
  Breast disease57 (18.9%)69 (22.8%)
  Respiratory disease17 (5.6%)16 (5.3%)
  Gastrointestinal disease47 (15.6%)52 (17.2%)
  Pelvic disease142 (47.0%)129 (42.6%)
  Blood disease10 (3.3%)10 (3.3%)
  Others15 (5.0%)15 (5.0%)
Comorbidity
  Hypertension41 (13.6%)52 (17.2%)1.4950.221
  Diabetes19 (6.3%)24 (7.9%)0.6080.435
  CHD6 (2.0%)13 (4.3%)2.6390.104
History of DVT11 (3.6%)12 (4.0%)0.0420.838
History of CVADs26 (8.6%)24 (7.9%)0.0950.758
Coagulation function
  PLT247.77 ± 108.48249.94 ± 94.27–0.2630.793
  TT14.01 ± 1.6913.78 ± 2.401.340.181
  APTT11.47± 1.6111.54± 2.76–0.4020.688
  PT30.52 ± 4.6729.66 ± 5.961.9620.051
  FIB3.47 ± 0.953.53 ± 1.26–0.6870.492
  D–dimer1.13 ± 3.360.93 ± 1.720.8970.37
Insertion arm
  Left87 (28.8%)86 (28.4%)0.0130.908
  Right215 (71.2%)217 (71.6%)
Insertion vein
  Basilic vein248 (82.1%)268 (88.4%)4.860.088
  Brachial vein47 (15.6%)30 (9.9%)
  Cephalic vein7 (2.3%)5 (1.7%)
CVR at the puncture site0.28 (0.26, 0.31)0.34 (0.30, 0.43)–11.224<0.001
Average length outside the skin6.84 ± 0.656.85 ± 0.57–0.0770.939
Tip position
  T59 (3.0%)16 (5.3%)2.640.451
  T692 (30.5%)82 (27.1%)
  T7159 (52.6%)160 (52.8%)
  T842 (13.9%)45 (14.9%)

Outcomes of the participants_

Characteristics and categoryExperimental group (n = 302)Control group (n = 303)χ2P
Distal movement
Criteria 1 1.3210.25
  0–2 cm251 (83.1%)262 (86.5%)
  ≥2 cm51 (16.9%)41 (13.5%)
Criteria 2 1.3270.249
  0–5 cm291 (96.4%)286 (94.4%)
  ≥5 cm11 (3.6%)17 (5.6%)
Proximal movement
  Total13 (4.3%)30 (9.9%)7.1750.007
  0.5–2 cm8 (2.6%)19 (6.3%)7.1850.028
  ≥2 cm5 (1.7%)11 (3.6%)
CRI
  Total6 (2.0)16 (5.3)4.6830.03
  Local infection4 (1.3)9 (3.0) 0.101a
  CLABSI2 (0.7)7 (2.3)
CRT
  Total11 (3.6)38 (12.5)16.092<0.001
  Symptomatic4 (1.3)12 (4.0)15.245<0.001
  Asymptomatic7 (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

DOI: https://doi.org/10.2478/fon-2025-0016 | Journal eISSN: 2544-8994 | Journal ISSN: 2097-5368
Language: English
Page range: 145 - 153
Submitted on: Mar 27, 2024
Accepted on: Aug 4, 2024
Published on: Mar 14, 2025
Published by: Shanxi Medical Periodical Press
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2025 Yuan Sheng, Wei Gao, Sheng-Yi Dongye, published by Shanxi Medical Periodical Press
This work is licensed under the Creative Commons Attribution 4.0 License.