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...
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| Veröffentlicht in: | European radiology 2019-05, Vol.29 (5), p.2716-2723 |
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| creator | Kim, Il Jung Shim, Dong Jae Lee, Jae Hwan Kim, Eung Tae Byeon, Jong Hyun Lee, Hun Jae Cho, Soon Gu |
| description | 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. |
| doi_str_mv | 10.1007/s00330-018-5917-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2158239374</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2158239374</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-d464b346da00b181c7e07342128fc4b3918b5754dc4a4412e1de747327808e453</originalsourceid><addsrcrecordid>eNp1kctqHDEQRUWwyYydfEA2RuBNNp2UHt1SZ2cGJx4wZGOvhVpdE7fpl_UwM39vDe3EYMiqEPfUrSpdQr4w-MYA1PcAIAQUwHRR1kwV-w9kzaTgBQMtT8gaaqELVddyRc5CeASAmkn1kawElBWISqzJsB1m6yKddjSkxqVoR5xSoDGNI_aBTiOd0XfzA3rb9wfajQF9xJY6Gx8woqdzbx0OOMYf1NIh9bFz-ZEFj9FPYUYXu2ekIab28Imc7mwf8PNrPSf3P6_vNjfF7e9f283VbeGE4rFoZSUbIavWAjRMM6cQlJCccb1zWamZbkpVytZJKyXjyFpUUgmuNGiUpTgnXxff2U9PCUM0Qxcc9v1yneGs1FzUQsmMXr5DH6fkx7zdkVKVLuvqSLGFcvmk4HFnZt8N1h8MA3PMwixZmJyFOWZh9rnn4tU5NQO2_zr-fn4G-AKELI1_0L-N_r_rC5JflZY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2157685964</pqid></control><display><type>article</type><title>Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Kim, Il Jung ; Shim, Dong Jae ; Lee, Jae Hwan ; Kim, Eung Tae ; Byeon, Jong Hyun ; Lee, Hun Jae ; Cho, Soon Gu</creator><creatorcontrib>Kim, Il Jung ; Shim, Dong Jae ; Lee, Jae Hwan ; Kim, Eung Tae ; Byeon, Jong Hyun ; Lee, Hun Jae ; Cho, Soon Gu</creatorcontrib><description>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.</description><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-018-5917-x</identifier><identifier>PMID: 30560363</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Age ; Aged ; Catheter-Related Infections - epidemiology ; Catheter-Related Infections - etiology ; Catheterization, Peripheral - adverse effects ; Catheters ; Complications ; Confidence intervals ; Diagnostic Radiology ; Dislocations ; Female ; Humans ; Hypodermic needles ; Imaging ; Incidence ; Infections ; Internal Medicine ; Interventional ; Interventional Radiology ; Male ; Medical instruments ; Medicine ; Medicine & Public Health ; Needles ; Neuroradiology ; Occlusion ; Placement ; Radiology ; Regression analysis ; Regression models ; Republic of Korea - epidemiology ; Retrospective Studies ; Risk analysis ; Risk Factors ; Statistical analysis ; Thrombophlebitis ; Thrombophlebitis - epidemiology ; Thrombophlebitis - etiology ; Ultrasound</subject><ispartof>European radiology, 2019-05, Vol.29 (5), p.2716-2723</ispartof><rights>European Society of Radiology 2018</rights><rights>European Radiology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-d464b346da00b181c7e07342128fc4b3918b5754dc4a4412e1de747327808e453</citedby><cites>FETCH-LOGICAL-c372t-d464b346da00b181c7e07342128fc4b3918b5754dc4a4412e1de747327808e453</cites><orcidid>0000-0001-9596-0765</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-018-5917-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-018-5917-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30560363$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Il Jung</creatorcontrib><creatorcontrib>Shim, Dong Jae</creatorcontrib><creatorcontrib>Lee, Jae Hwan</creatorcontrib><creatorcontrib>Kim, Eung Tae</creatorcontrib><creatorcontrib>Byeon, Jong Hyun</creatorcontrib><creatorcontrib>Lee, Hun Jae</creatorcontrib><creatorcontrib>Cho, Soon Gu</creatorcontrib><title>Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>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.</description><subject>Age</subject><subject>Aged</subject><subject>Catheter-Related Infections - epidemiology</subject><subject>Catheter-Related Infections - etiology</subject><subject>Catheterization, Peripheral - adverse effects</subject><subject>Catheters</subject><subject>Complications</subject><subject>Confidence intervals</subject><subject>Diagnostic Radiology</subject><subject>Dislocations</subject><subject>Female</subject><subject>Humans</subject><subject>Hypodermic needles</subject><subject>Imaging</subject><subject>Incidence</subject><subject>Infections</subject><subject>Internal Medicine</subject><subject>Interventional</subject><subject>Interventional Radiology</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Needles</subject><subject>Neuroradiology</subject><subject>Occlusion</subject><subject>Placement</subject><subject>Radiology</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Republic of Korea - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Statistical analysis</subject><subject>Thrombophlebitis</subject><subject>Thrombophlebitis - epidemiology</subject><subject>Thrombophlebitis - etiology</subject><subject>Ultrasound</subject><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kctqHDEQRUWwyYydfEA2RuBNNp2UHt1SZ2cGJx4wZGOvhVpdE7fpl_UwM39vDe3EYMiqEPfUrSpdQr4w-MYA1PcAIAQUwHRR1kwV-w9kzaTgBQMtT8gaaqELVddyRc5CeASAmkn1kawElBWISqzJsB1m6yKddjSkxqVoR5xSoDGNI_aBTiOd0XfzA3rb9wfajQF9xJY6Gx8woqdzbx0OOMYf1NIh9bFz-ZEFj9FPYUYXu2ekIab28Imc7mwf8PNrPSf3P6_vNjfF7e9f283VbeGE4rFoZSUbIavWAjRMM6cQlJCccb1zWamZbkpVytZJKyXjyFpUUgmuNGiUpTgnXxff2U9PCUM0Qxcc9v1yneGs1FzUQsmMXr5DH6fkx7zdkVKVLuvqSLGFcvmk4HFnZt8N1h8MA3PMwixZmJyFOWZh9rnn4tU5NQO2_zr-fn4G-AKELI1_0L-N_r_rC5JflZY</recordid><startdate>20190501</startdate><enddate>20190501</enddate><creator>Kim, Il Jung</creator><creator>Shim, Dong Jae</creator><creator>Lee, Jae Hwan</creator><creator>Kim, Eung Tae</creator><creator>Byeon, Jong Hyun</creator><creator>Lee, Hun Jae</creator><creator>Cho, Soon Gu</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9596-0765</orcidid></search><sort><creationdate>20190501</creationdate><title>Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study</title><author>Kim, Il Jung ; Shim, Dong Jae ; Lee, Jae Hwan ; Kim, Eung Tae ; Byeon, Jong Hyun ; Lee, Hun Jae ; Cho, Soon Gu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-d464b346da00b181c7e07342128fc4b3918b5754dc4a4412e1de747327808e453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Aged</topic><topic>Catheter-Related Infections - epidemiology</topic><topic>Catheter-Related Infections - etiology</topic><topic>Catheterization, Peripheral - adverse effects</topic><topic>Catheters</topic><topic>Complications</topic><topic>Confidence intervals</topic><topic>Diagnostic Radiology</topic><topic>Dislocations</topic><topic>Female</topic><topic>Humans</topic><topic>Hypodermic needles</topic><topic>Imaging</topic><topic>Incidence</topic><topic>Infections</topic><topic>Internal Medicine</topic><topic>Interventional</topic><topic>Interventional Radiology</topic><topic>Male</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Needles</topic><topic>Neuroradiology</topic><topic>Occlusion</topic><topic>Placement</topic><topic>Radiology</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Republic of Korea - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Statistical analysis</topic><topic>Thrombophlebitis</topic><topic>Thrombophlebitis - epidemiology</topic><topic>Thrombophlebitis - etiology</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Il Jung</creatorcontrib><creatorcontrib>Shim, Dong Jae</creatorcontrib><creatorcontrib>Lee, Jae Hwan</creatorcontrib><creatorcontrib>Kim, Eung Tae</creatorcontrib><creatorcontrib>Byeon, Jong Hyun</creatorcontrib><creatorcontrib>Lee, Hun Jae</creatorcontrib><creatorcontrib>Cho, Soon Gu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Il Jung</au><au>Shim, Dong Jae</au><au>Lee, Jae Hwan</au><au>Kim, Eung Tae</au><au>Byeon, Jong Hyun</au><au>Lee, Hun Jae</au><au>Cho, Soon Gu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2019-05-01</date><risdate>2019</risdate><volume>29</volume><issue>5</issue><spage>2716</spage><epage>2723</epage><pages>2716-2723</pages><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30560363</pmid><doi>10.1007/s00330-018-5917-x</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9596-0765</orcidid></addata></record> |
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| identifier | ISSN: 0938-7994 |
| ispartof | European radiology, 2019-05, Vol.29 (5), p.2716-2723 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Age Aged Catheter-Related Infections - epidemiology Catheter-Related Infections - etiology Catheterization, Peripheral - adverse effects Catheters Complications Confidence intervals Diagnostic Radiology Dislocations Female Humans Hypodermic needles Imaging Incidence Infections Internal Medicine Interventional Interventional Radiology Male Medical instruments Medicine Medicine & Public Health Needles Neuroradiology Occlusion Placement Radiology Regression analysis Regression models Republic of Korea - epidemiology Retrospective Studies Risk analysis Risk Factors Statistical analysis Thrombophlebitis Thrombophlebitis - epidemiology Thrombophlebitis - etiology Ultrasound |
| title | Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study |
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