Peripherally inserted tunnelled catheters: a new option for venous access

We evaluated the feasibility and optimal technique for placing peripheral tunnelled central venous catheters. Fourteen peripherally inserted central catheters (PICC) were placed using a 2-3 cm subcutaneous tunnel created in the upper arm. An additional 29 PICC lines containing a cuff were placed, using a slight modification of the same technique. Indications for placement were the same as those for a conventional PICC line. All catheters were placed successfully. There were no procedural complications. The upper arm basilic vein was used in all cases. Catheters remained in place for 1-70 days. Catheters in place for only a short period of time were removed at the bedside, longer-term catheters required a minimal amount of blunt dissection for removal of the cuff portion. We conclude that tunnelled catheters can be safely placed in the upper arm with a reliable technique. The ease of placement and lack of procedural complications, suggests that follow-up studies are warranted, to determine if these catheters can be used for applications currently requiring tunnelled subclavian or internal jugular catheters.