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Tunneled Peripherally Inserted Central Catheters and Bloodstream Infection: A Systematic Review and Meta-Analysis

Dong Jae Shim1,2, Eung Tae Kim3, Jae Hwan Lee4,5,6

  • 1Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Cardiovascular and Interventional Radiology
|December 2, 2025
PubMed
Abstract

Insights

Tunneled peripherally inserted central catheters (tPICCs) significantly reduce central line-associated bloodstream infections (CLABSI) compared to conventional PICCs. This finding supports subcutaneous tunneling as a strategy to improve patient safety in hospitals.

Area of Science:

  • Infection Control
  • Medical Devices
  • Clinical Epidemiology

Background:

  • Central line-associated bloodstream infections (CLABSI) are a significant concern in hospitalized patients.
  • Peripherally inserted central catheters (PICCs) are widely used, but carry infection risks.
  • Different insertion techniques, such as tunneled vs. conventional, may impact CLABSI rates.

Purpose of the Study:

  • To compare central line-associated bloodstream infection (CLABSI) rates between tunneled peripherally inserted central catheters (tPICCs) and conventionally inserted PICCs (cPICCs).

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials was conducted.
  • Searches were performed in PubMed, Embase, and Cochrane Library up to November 27, 2024.
  • Data were analyzed using a random-effects model to calculate risk ratios and assess heterogeneity.

Main Results:

  • The meta-analysis included four studies with 2,659 participants and 177,879 catheter days.
  • CLABSI rates were 0.31 per 1,000 catheter-days for tPICCs versus 0.68 per 1,000 catheter-days for cPICCs.
  • A 52% reduction in CLABSI was observed for tPICCs (Risk Ratio: 0.48; 95% CI, 0.28-0.81; p=0.02) with low heterogeneity.

Conclusions:

  • Subcutaneous tunneling for PICC placement is associated with a significant reduction in CLABSI rates.
  • This technique may enhance patient safety for hospitalized adults requiring central venous access.
  • Tunneled PICCs represent a potentially safer alternative to conventional PICCs for reducing bloodstream infections.
Keywords:
Bloodstream infectionsCatheterizationPeripheralSubcutaneous tissueVascular access device

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