If a vein of adequate internal caliber (at least three times the external diameter of the catheter) is visualized by ultrasound in Dawson's green area, a non-tunneled PICC should be placed.
The insertion technique strictly involves the use of ultrasound guidance for venipuncture. Ultrasound is very accurate and cost-effective also for tip navigation and even for tip location; though, the international guidelines recommend to prefer tip location by intracavitary electrocardiograpy, since this method is simpler than ultrasound-based tip location and requires less training. Fluoroscopy should not be used for tip navigation or tip location: it is less safe, less accurate and less cost-effective if compared to both ultrasound and intracavitary ECG.
The principles of the proper insertion technique of PICCs are summarized in the SIP protocol (Safe Insertion of PICCs), developed by GAVeCeLT (see our website).
A non-tunneled PICC is usually considered an appropriate access for few months of duration; though, there are reports in the literature of non-tunneled PICCs left in place and functioning for longer periods (even two to three years).
PICCs should be power injectable, in polyurethane, open-ended, not valved. Evidence from the literature shows that silicone PICCs have no advantage over those in polyurethane, but - on the contrary - they have many disadvantages (low flow; high incidence of dislocation and rupture, because of their fragility). There is no evidence of any advantage in the use of valved PICCs, which are associated with an increased risk of malfunction and higher cost if compared to non-valved PICCs.