Hybrid anterograde tunnelling for PICC insertion without a dedicated blunt tunneller: A case report

Tunnelling of peripherally inserted central catheters (PICCs) may be useful when the optimal venous entry site does not coincide with a manageable exit site. This case report describes a 39-year-old man with C5-C6 spondylodiscitis requiring prolonged intravenous antimicrobial therapy and cervical spine surgery, in the setting of poor peripheral venous access. Ultrasound assessment identified the right proximal basilic-axillary region as the most suitable venous target, although direct puncture would have resulted in an unfavourable axillary exit site. A hybrid approach combining pseudo-tunnelling with an additional anterograde subcutaneous tract allowed placement of a double-lumen 5-Fr PICC with the exit site relocated to the mid-upper arm. The catheter remained fully functional during a 10-day dwell, with no mechanical, thrombotic, or infectious complications. This case supports the technical feasibility of hybrid tunnelling in carefully selected patients when conventional exit-site placement is unsuitable and dedicated blunt tunnelling equipment is unavailable.