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Report of Modification for Peripherally Inserted Central Catheter Placement: Subcutaneous Needle Tunnel for High
Matthew D Ostroff1, Nancy L Moureau
1Vascular Access Department, St Joseph's Regional Medical Center, Paterson, New Jersey (Mr Ostroff); PICC Excellence, Inc, Hartwell, Georgia (Ms Moureau); Greenville Memorial University Medical Center, Greenville, South Carolina (Ms Moureau); Griffith University, School of Nursing and Midwifery, Brisbane, Australia (Ms Moureau); and Alliance for Vascular Access Teaching and Research, Brisbane, Australia (Ms Moureau). Matthew D. Ostroff, MSN, RN, AGACNP, CRNI®, CPUI, VA-BC, CEN, recently completed an acute care adult and geriatric nurse practitioner certification and a master's degree from Drexel University. He is currently an advanced practice nurse at St. Joseph's Regional Medical Center, Paterson, New Jersey, where he performs ultrasound-guided peripheral and central vascular access device placement. Nancy L. Moureau, BSN, RN, CRNI®, CPUI, VA-BC, is a researcher in conjunction with Griffith University, where she is pursuing a doctorate in nursing research. She is also a vascular access staff nurse with Greenville Memorial University Medical Center, where she places ultrasound-guided peripheral and peripherally inserted central catheters. The owner of PICC Excellence, Inc, Ms Moureau also is an educator, consultant, and legal expert on vascular access.
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.
