Different PICC insertion techniques reviewed
Abstract:
Background: Catheterization methods for peripherally inserted central catheters (PICC) mainly include the traditional method, one-needle subcutaneous tunnel catheterization, and two-needle subcutaneous tunnel catheterization, all of which are widely used in clinical practice. Researchers focus heavily on complications after these PICC catheterizations but ignore the effect of PICC catheterization process, such as one-time puncture success rate, patient experience, bleeding, and related issues.
Methods: This was a three-arm, parallel, randomized controlled trial. Patients were recruited from Zhongshan Hospital of Xiamen University in China between January and April 2025. Patients who met the inclusion criteria were randomly categorized into three groups. Primary indicators were the one-time puncture success rate, pain intensity, and total bleeding volume during catheterization. Secondary indicators included the blood oozing rate within 24 h after catheterization and catheterization operating time.
Results: In total, 681 patients were recruited. 226 in the traditional non-tunnel catheterization group, 232 in the one-needle subcutaneous tunnel catheterization group, and 223 in the two-needle subcutaneous tunnel catheterization group. The one-needle and two-needle subcutaneous tunnel catheterization groups demonstrated significantly better outcomes compared to the traditional non-tunnel catheterization group in terms of one-time puncture success rate (RD = 6.3 %, 95 % CI: 1.6 % to 11.1 %, P = 0.014; RD = 6.6 %, 95 % CI: 1.8 % to 11.3 %, P = 0.011) and blood oozing rate within 24 h after catheterization (RD = -7.8 %, 95 % CI: -13.5 % to -2.0 %, P = 0.012; RD = -8.3 %, 95 % CI: -14.1 % to -2.5 %, P = 0.007). Both the traditional non-tunnel catheterization group and the one-needle subcutaneous tunnel catheterization group demonstrated significantly lower values compared to the two-needle subcutaneous tunnel catheterization group in terms of total bleeding volume (MD = -0.2, 95 % CI: -0.3 to 0.0, P = 0.026; MD = -0.2, 95 % CI: -0.4 to -0.1, P = 0.002), pain intensity (MD = -0.2, 95 % CI: -0.3 to -0.1, P = 0.006; MD = -0.2, 95 % CI: -0.3 to -0.1, P = 0.003), catheterization operating time (MD = -0.9, 95 % CI: -1.6 to -0.2, P = 0.011; MD = -1.0, 95 % CI: -1.7 to -0.3, P = 0.006).
Conclusion: One-needle subcutaneous tunnel catheterization was superior to the other two methods and did not cause nerve or blood vessel damage. It is recommended for clinical use.
Registration: Registered in the Chinese Clinical Trial Registry (ChiCTR2400094988, www.chictr.org.cn). The first recruitment was conducted in January 2025. https://www.chictr.org.cn/bin/project/edit?pid=242304.
Reference:
Li L, Wu X, Lin L, Cai Z, Ye X, Lin Y, Wang Y, Yang L. Effects of three peripherally inserted central catheters insertion techniques on catheterization outcomes: A randomized controlled trial. Int J Nurs Stud. 2025 Sep 11;172:105209. doi: 10.1016/j.ijnurstu.2025.105209. Epub ahead of print. PMID: 41014904.