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



To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line–associated bloodstream infections (CLABSIs).


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.


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.


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.


Catheter-related infections Central venous catheter PICC placement Catheterizations Peripheral 



Central line–associated bloodstream infection


Conventional peripherally inserted central catheter


Peripherally inserted central catheter


Tunneled peripherally inserted central catheter



We thank Pyunghwa Kim for assisting with data collection.


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


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).




multicenter study


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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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