Cuffed PICC lines have a small fabric cuff under the skin that promotes tissue ingrowth and helps stabilize the catheter, while non-cuffed PICC lines lack this feature and thus are more prone to migration and dislodgement when not properly secured.
Key Differences
- Infection Risk: Evidence is mixed. Some studies suggest cuffed PICCs can lower rates of catheter infection, malposition, and thrombosis relative to uncuffed PICCs. However, recent research indicates that tunneled, non-cuffed PICCs may have similar or better rates of catheter-related bloodstream infections (CRBSIs) and longer dwell times compared to cuffed PICCs.
- Securement and Dislodgement: Cuffed PICCs are less likely to migrate or become dislodged because the cuff anchors the line once tissue grows into it. Uncuffed PICCs need extra securement measures to prevent displacement.
- Complication Rates in Pediatrics: Higher complication rates (infection, mechanical failure, thrombosis) are reported with non-cuffed PICCs, especially in neonates and small children, compared to cuffed PICCs.
- End of Therapy Success: Cuffed PICCs are more likely to remain in place for the full duration of therapy, requiring fewer replacements compared to uncuffed PICCs.
Clinical Considerations
- Cuffed PICCs are favored for long-term therapy, especially in populations at high risk of line migration or frequent manipulation (e.g., home care, pediatrics).
- Non-cuffed PICCs may still be appropriate in settings where ease of removal or shorter-term access is needed.
Practical Recommendations
- Non-cuffed PICCs require diligent securement methods and frequent site assessments to reduce risk of accidental line migration, especially in children.
- Type selection should be individualized based on patient size, therapy duration, and risk factors for infection/dislodgement.
Cuffed PICC lines provide enhanced stability and may reduce certain complications, particularly in pediatric populations, while non-cuffed PICCs require more securement and careful monitoring but may offer comparable infection rates in some studies.
A cuffed PICC is preferred over an uncuffed PICC in situations where long-term venous access is required, especially for patients who are at higher risk of catheter migration, accidental dislodgement, or complications due to frequent line handling. This is particularly true in pediatric populations, where studies have shown that cuffed PICCs are more likely to remain in place until the end of therapy and have lower rates of infection, malposition, and thrombosis compared to uncuffed lines.
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References:
Yong, T. et al., (2021, January 13) Comparing catheter related bloodstream infection rate between cuffed tunnelled and non-cuffed tunnelled peripherally inserted central catheter. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/33438482/
Bandari, M. et al., (2021, October 29) 65 Complication rate of cuffed versus uncuffed PICC lines placed by interventional radiology in pediatric patients. Oxford Academic. https://academic.oup.com/pch/article-abstract/26/Supplement_1/e46/6414164?redirectedFrom=fulltext&login=false
Luke, T. et al., (2013, May 3) Are cuffed peripherally inserted central catheters superior to uncuffed peripherally inserted central catheters? A retrospective review in a tertiary pediatric center. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/23648007/
USA Oncology Centers. Tunneled vs. Non-Tunneled Central Venous Catheters: The Differences. https://www.usaoncologycenters.com/tunneled-vs-non-tunneled-central-venous-catheters-the-differences/