Comparison of Three PICC Insertion Techniques on Efficiency, Complications, and Patient Experience Among Oncology Patients: A Prospective Observational Study

Background Peripherally inserted central catheters (PICCs) provide essential long-term intravenous access for oncology patients, but different insertion techniques may impact patient outcomes. We aimed to compare the efficiency, safety, and patient experience of three PICC insertion techniques—conventional ultrasound-guided non-tunneled, single-puncture subcutaneous tunneling, and double-puncture subcutaneous tunneling—in oncology patients. Methods A prospective observational study was conducted at a single tertiary oncology center in China from June 2022 to December 2023. A total of 418 cancer patients requiring PICC placement were consecutively allocated to the conventional group (n = 131), single-puncture tunneling group (n = 178), or double-puncture tunneling group (n = 109). Insertion efficiency (first-attempt success and procedure time), catheter-related complications, and patient-reported outcomes (pain and satisfaction scores) were assessed over a 16-week follow-up. Group outcomes were compared using one-way ANOVA and chi-square tests, with P < 0.05 considered statistically significant. Results Baseline characteristics were comparable across groups ( P  > 0.05). The first-attempt success rate was significantly higher in the conventional group (98.5%) compared with the double-needle group (90.8%, P  < 0.05), with no difference between conventional and single-needle groups. Operation time differed significantly ( P  < 0.001), being shortest in the conventional group (26.44 ± 4.73 min), followed by single-needle (31.69 ± 3.92 min) and double-needle (36.39 ± 2.48 min). The incidence of catheter-related thrombosis was lowest in the single-needle group (3.4%), significantly lower than conventional (8.4%) and double-needle (11.0%) approaches ( P  = 0.034). Total complication rates were also lowest in the single-needle group (12.9%, P  < 0.001). Pain scores were significantly lower in conventional (1.44 ± 0.57) and single-needle (1.71 ± 0.66) groups compared to double-needle (3.45 ± 0.99) ( P  < 0.001), while satisfaction was highest in the single-needle group (8.78 ± 1.20, P  < 0.001). Conclusions For oncology patients, the single-puncture subcutaneous tunneling technique achieved the best overall balance of safety, efficiency, and patient experience. It can be recommended as the preferred PICC insertion method in oncology nursing practice. The double-puncture technique offers greater catheter stability and may be reserved for patients at high risk of catheter migration, while the conventional non-tunneled approach remains the fastest option for urgent access but carries a higher complication risk.