Comparison of PICC lines vs. tunneled catheters (Hickman/Portacaths) in stem cell transplantation: A 4 year retrospective analysis of infection rates, complications, and cost-effectiveness

Abstract Background: Central venous catheters (CVCs) are essential for stem cell transplantation (SCT), with tunnelled catheters (Hickman/Portacaths) been traditionally always preferred over peripherally inserted central catheters (PICCs) due to perceived durability and lower infection risk. However, recent data suggest PICCs may offer better outcomes and cost advantages. We compared infection rates, complications, cost, and patient compliance between PICC lines and tunneled catheters in SCT recipients. Methods: We conducted a 4-year retrospective cohort study of 201 patients undergoing autologous/allogeneic SCT at Kokilaben Dhirubhai Ambani Hospitral between 2001 and June 2025, stratified by catheter type (PICC vs. Hickman/Portacath). Outcomes included: infection rates (CLABSI per 1000 catheter-days), mechanical complications (thrombosis, occlusion, dislodgement), cost analysis (placement, maintenance, complication management), and patient-reported compliance and tolerability Historical published data were incorporated for benchmarking. Results: Out of 201 stem cell transplants PICC lines were inserted in 186 patients with Portacaths inserted in 14 and Hickman inserted in 1 patient. The reason for very few tunnelled line insertions was because our unit has been practicing routing PICC line for all our transplant patients with Portacaths or Hickmans only being inserted either in very young patients below 1 year where PICC placement was either technically difficult or in cases where due to any reason where a PICC line insertion failed. PICCs line demonstrated comparable CLABSI rates in our cohort to Hickman/Portacath lines (2% vs. 1.5 to 4/1000 catheter-days (previously reported data), but lower early surgical-site infections (in first 30 days) of 0% vs. 1.5%. Mechanical complications (e.g., thrombosis) was seen only 3 cases (1.5%) which is comparable and less than published data of 3to 12%. Costs were significantly lower for PICCs (mean $500 vs. $2500), driven by reduced cost of PICC and placement fees. Patient compliance was superior with PICCs (fewer dressing complaints, easier outpatient management and in paediatric patient, no fear of a needle being inserted for a Partacath). Conclusion: PICCs are a viable alternative to tunneled catheters in SCT, with non-inferior infection rates, reduced costs, and better patient compliance. These findings challenge the traditional preference for Hickman/Portacaths and warrant prospective validation.