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.