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Report of Modification for Peripherally Inserted Central Catheter Placement

Subcutaneous Needle Tunnel for High Upper Arm Placement

Ostroff, Matthew D. MSN, RN, AGACNP, CRNI®, CPUI, VA-BC, CEN; Moureau, Nancy L. BSN, RN, CRNI®, CPUI, VA-BC

doi: 10.1097/NAN.0000000000000228

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.

Vascular 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.

Corresponding Author: Matthew D. Ostroff, MSN, RN, AGACNP, CRNI®, CPUI, VA-BC, CEN, 13 Pine St, Emerson, NJ 07630 (

Mr Ostroff is a speaker for BD and 3M. Through PICC Excellence, Ms Moureau has business relationships with Access Scientific, Angiodynamics, BD Carefusion, Chiesi, 3M, Nexus, Teleflex, and Linear Health Sciences, as well as research grants through Griffith University with 3M, Cook, and Entrotech.

© Copyright 2017 by Infusion Nurses Society