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European Radiology

, Volume 29, Issue 5, pp 2716–2723 | Cite as

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

  • Il Jung Kim
  • Dong Jae ShimEmail author
  • Jae Hwan Lee
  • Eung Tae Kim
  • Jong Hyun Byeon
  • Hun Jae Lee
  • Soon Gu Cho
Interventional
  • 184 Downloads

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.

Keywords

Catheter-related infections Central venous catheter PICC placement Catheterizations Peripheral 

Abbreviations

CLABSI

Central line–associated bloodstream infection

cPICC

Conventional peripherally inserted central catheter

PICC

Peripherally inserted central catheter

tPICC

Tunneled peripherally inserted central catheter

Notes

Acknowledgements

We thank Pyunghwa Kim for assisting with data collection.

Funding

This research was supported by a Grant of Translational R&D Project through Institute for Bio-Medical convergence, Incheon St. Mary’s Hospital, The Catholic University of Korea.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dong Jae Shim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Hun Jae Lee, College of Medicine, Inha University) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (IRB approval number: XC18REDI0032).

Methodology

retrospective

observational

multicenter study

References

  1. 1.
    Chopra V, O'Horo JC, Rogers MA, Maki DG, Safdar N (2013) The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 34:908–918CrossRefGoogle Scholar
  2. 2.
    Gunst M, Matsushima K, Vanek S, Gunst R, Shafi S, Frankel H (2011) Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect (Larchmt) 12:279–282CrossRefGoogle Scholar
  3. 3.
    Chopra V, Ratz D, Kuhn L, Lopus T, Chenoweth C, Krein S (2014) PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med 127:319–328CrossRefGoogle Scholar
  4. 4.
    Safdar N, Maki DG (2005) Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 128:489–495CrossRefGoogle Scholar
  5. 5.
    Bouzad C, Duron S, Bousquet A et al (2016) Peripherally inserted central catheter-related infections in a cohort of hospitalized adult patients. Cardiovasc Intervent Radiol 39:385–393CrossRefGoogle Scholar
  6. 6.
    Grau D, Clarivet B, Lotthé A, Bommart S, Parer S (2017) Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control 6:18CrossRefGoogle Scholar
  7. 7.
    McDiarmid S, Scrivens N, Carrier M et al (2017) Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study. CMAJ Open 5:E535–E539CrossRefGoogle Scholar
  8. 8.
    Walshe LJ, Malak SF, Eagan J, Sepkowitz KA (2002) Complication rates among cancer patients with peripherally inserted central catheters. J Clin Oncol 20:3276–3281CrossRefGoogle Scholar
  9. 9.
    Advani S, Reich NG, Sengupta A, Gosey L, Milstone AM (2011) Central line–associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis 52:1108–1115CrossRefGoogle Scholar
  10. 10.
    Randolph AG, Cook DJ, Gonzales CA, Brun-Buisson C (1998) Tunneling short-term central venous catheters to prevent catheter-related infection: a meta-analysis of randomized, controlled trials. Crit Care Med 26:1452–1457CrossRefGoogle Scholar
  11. 11.
    Timsit JF, Sebille V, Farkas JC et al (1996) Effect of subcutaneous tunneling on internal jugular catheter-related sepsis in critically III patients: a prospective randomized multicenter study. JAMA 276:1416–1420CrossRefGoogle Scholar
  12. 12.
    Timsit JF, Bruneel F, Cheval C et al (1999) Use of tunneled femoral catheters to prevent catheter-related infection: a randomized, controlled trial. Ann Intern Med 130:729–735CrossRefGoogle Scholar
  13. 13.
    (2001) Peripherally inserted tunnelled catheters: a new option for venous access. Springer, MilanoGoogle Scholar
  14. 14.
    Centers for Disease Control (CDC)/National healthcare Safety Network (NHSN) (2018) Protocol for definition of central-line associated bloodstream infection. Available at: http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed 10 July 2018
  15. 15.
    Sharp R, Cummings M, Fielder A, Mikocka-Walus A, Grech C, Esterman A (2015) The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud 52:677–685CrossRefGoogle Scholar
  16. 16.
    Sandrucci S, Mussa B (2014) Peripherally inserted central venous catheters. SpringerGoogle Scholar
  17. 17.
    Pittiruti M, Scoppettuolo G (2017) The GAVeCeLT manual of Picc and midline: indications, insertion, management. EdraGoogle Scholar
  18. 18.
    Ostroff MD, Moureau NL (2017) Report of modification for peripherally inserted central catheter placement: subcutaneous needle tunnel for high upper arm placement. J Infus Nurs 40:232–237CrossRefGoogle Scholar
  19. 19.
    O’Grady NP, Alexander M, Burns LA et al (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:e162–e193CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Bucheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Department of Radiology, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaBupyung-guRepublic of Korea
  3. 3.Center for Liver CancerNational Cancer CenterGoyang-siRepublic of Korea
  4. 4.Department of RadiologyHanyang University Guri HospitalGuri-siRepublic of Korea
  5. 5.Department of Radiology, College of MedicineKangwon National UniversityChuncheonSouth Korea
  6. 6.Department of Social and Preventive Medicine, College of MedicineInha UniversityMichuhol-GuRepublic of Korea
  7. 7.Department of Radiology, College of MedicineInha UniversityIncheonRepublic of Korea

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