Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study

Objective To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line–associated bloodstream infections (CLABSIs). Methods Our dual-facility central institutional review board approved this retrospective study. We compared 302 of 327 consecutive recipients (mean age [± SD], 68.0 ± 15.9 years; men, 134; women, 168) of tunneled PICCs (October 2017 to May 2018) with 309 of 328 consecutive recipients (mean age, 68.7 ± 14.6 years; men, 142; women, 167) of conventional PICCs (April 2016 to September 2017). Tunnels were made near puncture sites (~ 1 in. away) using hemostats or puncture needles. In each group, procedure times and rates of complications, including CLABSI, entry-site infection, dislocation, thrombophlebitis, and occlusion, were examined. Risk factors for CLABSI were analyzed via logistic and Cox regression models. Results Subcutaneous tunnels were achieved in all patients, enabling successful peripheral vein cannulations. Group procedure times were similar ( p = 0.414). CLABSI proved to be significantly less frequent after tunneling (8/6972 catheter-days) than after conventional (28/7574 catheter-days) PICC placement (adjusted hazard ratio = 0.328; 95% confidence interval, 0.149–0.721). Other risk factors (i.e., age, gender, comorbidity, PICC duration, veins, hospital stay, and intensive care unit stay) showed no significant correlations with CLABSI. Conclusions Compared with conventional means, a subcutaneous tunneling approach for PICC placement significantly reduces the rate of CLABSI. Key Points • Subcutaneous tunnels created to place peripherally inserted central catheters significantly reduced catheter-associated bloodstream infections. • Subcutaneous tunnel creation did not significantly prolong procedural time. • There were no subcutaneous tunnel-related complications.