“Extended subcutaneous route” technique: a quick subcutaneous tunnelling technique for PICC insertion

Abstract

Extended subcutaneous route technique allows the creation of a subcutaneous tunnel <5 cm, without skin incision and additional manipulation. Extended subcutaneous route technique may be feasible and useful, particularly for patients with high risk of bleeding or infection.

Clinical Application Analysis of Tunneled-PICC

“…Tunneled PICCs with the extended subcutaneous route technique has been proved the safety and efficacy in European countries and performed an important alternative to normal standard placement for the benefits of reduced risk of thrombosis and infection, as well as extended retention [19][20][21][22][23][24][25][26][27]. Some researchers have explored the application in China and received satisfactory results.…”

“…In addition to the same indications as the PICC, the tunnel PICC is particularly suitable for patients with poor peripheral vascular conditions, prolonged bed rest, trauma, burns, localized skin damage, scarring, and low immunity. However, it also brings about an additional manipulation and the presence of a small surgical wound in the axillary area that, in some cases, may determine an incomplete closure, leaving uncovered a portion of the catheter in the subcutaneous level [21].…”

“…The extended subcutaneous route technique allows maintaining the PICC exit site in the green zone which has less body fluid secretion than the yellow area, less mechanical friction, and a strong sense of comfort. Moreover, the export position becomes highly selective, if there is trauma, burns, scars, etc., which cause skin damage, easy infection or difficult observation of the surrounding tissue of the puncture site can also use the tunneled technique [21]. A prospective evaluation was performed in a single facility for all PICC placements from September 2014 to June 2015.…”

“…The subcutaneous tunnel can fix the catheter better and reduce the displacement rate [19]. Tunneled catheters and totally implanted venous access devices are associated with low rates of infection and thrombosis since they are specifically protected from accidental removal [21]. In a recent study, tunneled PICC showed a significantly longer catheter-days compared to the non-tunneled PICC (mean 47 days versus 27 days) [24].…”

Short- and Intermediate-Term Use of Peripherally Inserted Central Catheters in Europe: A Systematic Literature Review

“…Across several studies, pain during catheter insertion was reported in 0% to 18% of patients using PICCs. [11][12][13][14][15] In the study by Konstantinou et al, 11 no significant difference was reported for pain during the procedure between PICCs and CICCs (7.7% vs. 12.2%, P = 0.502). In the study by Pedersen et al, 14 8.7% of patients with PICCs experienced pain during insertion, compared to 23.4% of patients with PIVC lines.…”