Table 1.

Definitions of complications and outcomes of PICC placement.

Outcomes	Definitions
Successful placement	Successful placement on first puncture attempt in the control group or successful placement by tunneling on first attempt in the experimental group.
Wound oozing	Oozing that lasted >24 hours after placement. Classified into three grades according to severity: Grade 1, (bleeding lasting for 2 to 3 days), Grade 2, (bleeding lasting for 4 to 5 days), and Grade 3 (bleeding lasting >6 days).
Bleeding from insertion site during placement	Measured by the difference in the weight of sterile gauze before and after insertion. During placement, all blood was absorbed by the sterile gauze.
Depth and diameter of puncture vein	Measured using the same B-ultrasound instrument used to assess the vessel.
Duration of cannulation	Measured from first puncture to complete fixation.
Catheter-related venous thrombosis	The presence of an intraluminal thrombus as confirmed by color Doppler ultrasound. Classified as symptomatic or asymptomatic (symptomatic thrombosis was diagnosed when symptoms occurred). Ultrasound evaluation was performed before catheter removal to check whether asymptomatic thrombosis had occurred.
Mechanical phlebitis	Symptoms of vein irritation including induration, warmth, pain, or tenderness existing around the insertion site. Classified into five grades according to the standards of the Infusion Nurses Society.
Medical adhesive-related skin injury	Skin itching, erythema, bulla, or tearing that persisted for ≥30 minutes after removal of adhesive dressing.18 Divided into three grades: slight, (slight skin itching and erythema (less than 5 × 5 cm)), moderate, (obvious skin itching, erythema, and papules (more than 5 × 5 cm)), and severe (unbearable itching accompanied by blisters, corrosion, or exudation (more than 10 × 10 cm) that affected sleep, daily life, and even therapy).
Catheter occlusion	Inability to infuse any fluid into the catheter or aspirate blood from the PICC.
Catheter-related infection	Defined according to the Centers for Disease Control and Prevention and classified as local infection or central line-associated bloodstream infection.
Catheter dislodgement	Exposed portion of PICC prolapsed by >2 cm.
Unplanned extubation	Removal of PICC because of complications or for reasons other than completion of the patient’s intended treatment.

PICC, peripherally inserted central catheter.