Journal Article

Real-world optimization of tunnel lengths in tunneled peripherally inserted central catheters for cancer patients: A multi-center retrospective cohort study

Wu, Yinyin, Feng, Bilong, Xiao, Meng, Deng, Qianhong, Tao, Fengqin, Ding, Wei, Chen, Chang, Chen, Hanbin, Liu, Yuying

2025

Overview

Standardized guidelines for optimal tunnel length in tunneled peripherally inserted central catheters (PICCs) are lacking. The objective of this study was to evaluate the real-world impact of tunnel length on clinical outcomes. This retrospective cohort study included 207 cancer patients who received tunneled PICCs, categorized into a control group (tunnel length > 4 cm, n = 134) and an observation group (tunnel length ≤ 4 cm, n = 73). Propensity score matching (PSM) was used to address baseline heterogeneity. Cox regression analyses were used to assess the risk of complication during a 120-day follow-up. Compared to the control group (tunnel length > 4 cm), the observation group (tunnel length ≤ 4 cm) had a significantly higher adjusted overall complication risk (HR = 2.92, 95% CI: 1.07-7.94, P = 0.036) and unplanned catheter removal rate (4.4% vs. 0.0%, P = 0.027), confirming the safety of longer tunnels despite comparable comfort levels between groups. After PSM, Cox regression analysis showed results consistent with those from the unmatched cohort. Subgroup analyses revealed a reduced risk of complications with longer tunnels in patients with BMI ≤ 25 kg/m² (HR = 0.29, 95% CI: 0.11-0.82), without hypertension (HR = 0.36, 95% CI: 0.13-1.00), without diabetes (HR = 0.38, 95% CI: 0.15-0.97), and with solid tumors (HR = 0.31, 95% CI: 0.11-0.85). The results show that tunnel lengths > 4 cm reduce overall complications and prolong catheter retention, supporting the implementation of standardized protocols while advocating for personalized adjustments based on BMI, comorbidities, and cancer type.

• Publisher: Public Library of Science,PLOS,Public Library of Science (PLoS)
• Subject: Adhesives / Adult / Aged / Analysis / Anticoagulants / Biology and Life Sciences / Cancer / Cancer patients / Cancer therapies / Care and treatment / Catheterization, Central Venous - adverse effects / Catheterization, Central Venous - methods / Catheterization, Peripheral - adverse effects / Catheterization, Peripheral - methods / Catheters / Central Venous Catheters - adverse effects / Chemotherapy / Clinical trials / Cohort analysis / Comorbidity / Diabetes mellitus / Electrocardiography / Engineering and Technology / Female / Heterogeneity / Humans / Hypertension / Infections / Innovations / Intubation / Local anesthesia / Male / Medical equipment / Medical instruments / Medical technology / Medicine and Health Sciences / Middle Aged / Neoplasms - drug therapy / Neoplasms - therapy / Optimization / Patients / Peripherally inserted central catheters / Phlebitis / Phlebotomy / Propensity Score / Radiology, Interventional / Regression analysis / Retrospective Studies / Risk assessment / Risk management / Solid tumors / Subgroups / Thrombosis / Tunnels / Ultrasonic imaging / Variables / Veins & arteries