Subcutaneous tunnel for high upper arm PICC placement

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Subcutaneous tunneling, when applied to bedside PICC insertions, provides a safe, effective, and cost-efficient option for a select, more challenging patient population” Ostroff and Moureau (2017).

Abstract:

The majority of peripherally inserted central catheters (PICCs) are currently inserted with the aid of ultrasound guidance in the middle third of the upper arm. A growing patient population is presenting with challenging vessel access requiring placement of the PICC in the high upper third of the arm.

To avoid this suboptimal exit site, a subcutaneous tunneling of the PICC is established away from the axilla to a more appropriate skin exit site. A prospective evaluation was performed in a single facility for all PICC placements from September 2014 to June 2015. Of the results of 685 PICC requests received during the study, 50 (7.2%) were placed with the modified Seldinger tunneling technique with 96% success. There were no reports of increased pain, insertion complications, or therapy failures. Subcutaneous tunneling, when applied to bedside PICC insertions, provides a safe, effective, and cost-efficient option for a select, more challenging patient population.

Reference:

Ostroff, M.D. and Moureau, N.L. (2017) Report of Modification for Peripherally Inserted Central Catheter Placement: Subcutaneous Needle Tunnel for High Upper Arm Placement. Journal of Infusion Nursing. 40(4), p.232-237.

doi: 10.1097/NAN.0000000000000228.

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