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PICC lines

PICC Lines, also known as Peripherally Inserted Central Catheter Lines, are the most common and versatile central lines used to provide Vascular Access. This page describes PICC Line Placement, Insertion, Use, and Risks.


The PICC Line is generally inserted by PICC Nurses or PICC Teams, and these PICC Teams can be facility staffed or a contracted Vascular Access Team. Some hospitals augment internal PICC Teams and other hospitals completely outsource their PICC needs. Regardless of the reason, the hospital will outsource to a reputable company of PICC Nurses who are then credentialed for the hospital. Other facilities who have PICC Line needs will also outsource to PICC Nurses as outsourcing is the primary feasible and realistic option.

PICC Line Services

PICC Line Services is a term used often to describe vascular access services of standard lines including Ultrasound Guided PIVs, Midlines, and PICCs. PICC Line Services typically do not include advanced lines such as Small Bore Internal Jugular Lines, Femoral Lines, and Axillary Lines as well as Large Bore Lines including Vas Caths for Dialysis and Quad Lumen Lines. Further, depending on the nursing group, these services generally do not include other more comprehensive areas such as program management, education and training, and infection control consulting, and may not include pediatrics. As stated above, the purpose of this page is to focus on the PICC Line and not the more general, PICC Line Services.

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PICC Line Placement

PICC Line Placement or Procedure

PICC Line Placement generally starts in a vein just above the elbow and weaves around the shoulder to inside the Superior Vena Cava (SVC), a vein just above the heart. The SVC is a large vein that allows caustic medications to be received and diluted before being dispersed into the bloodstream by the heart. An experienced PICC Nurse will not place a PICC Line in the elbow area as such is more prone to bacteria and infection. This procedure holistically includes a review of the patient and the patient’s medical history and records, the actual line placement, and then careful clinical documentation. The PICC Line Procedure and Placement is not clinically appropriate in all cases and when there are contraindications, other central line devices must be considered including advanced lines as described below.

PICC Line Insertion

PICC Line Insertion and guidance of the needle is carefully performed using an ultrasound. The Modified Seldinger Technique (MST) is typically used for correct placement. Some PICC Nurses use needle guides and others, use needle visualization. Needle visualization is preferred and is usually indicative of a clinician with more training and experience and a clinician who is more likely to obtain vascular access in difficult cases. In any case, the line insertion must be confirmed as the PICC is inserted near the heart. PICC Line Insertion can be confirmed via Electrocardiogram (ECG) Tip Confirmation technology or X-Ray, and similar to clinicians who use needle visualization, clinicians who use ECG tend to be the ones with more training and experience. ECG is more convenient and efficient as, when clinically available, it often removes the need to wait for the Xray to be done and evaluated.

PICC Line Uses

PICC Line Use is clinically appropriate as follows:

• pH IV medications or fluids with extremes of pH
• TPN – Total Parenteral Nutrition, a method of getting nutrition into the body through the veins
• CVP – Central Venous Pressure Monitoring, the most accurate blood pressure reading available
• Extended access need > 5 days
• No current Central Venous Line Access (e.g., port, tunneled catheter)
• Current Central Venous Line Access not supportive of expected therapy(s)
*Infusion Nursing Standards of Practice. Journal of Intravenous Nursing, (15) January-February 2021.

In essence, while PICC Line Uses are many, they primarily include when the IV medications or fluids may irritate veins or when medications are to be given over a longer period of time. These medication or fluids include IV antibiotics, chemotherapy, and TPN (Total Parental Nutrition). Furthermore, PICC Lines can have more than 1 lumen (ie, tubing and cap) meaning that they can handle multiple medications with each medication being given in a separate lumen to avoid mixing.

PICC Line Risks

PICC Line Risks are present as PICC Line Placement is not a benign procedure. Rather, it is an invasive procedure and as such, prone to risks, some of which are more prevalent than others and all of which are mitigated by the experience of a trained PICC Nurse or clinician. Risks include:

• Central Line Associated Bloodstream Infection (CLABSI) – generally caused by bacteria accessing the body at the insertion site.
• Collapsed Lung (Pneumothorax) – generally caused by the needle piercing the lung, causing the lung to collapse.
• Arterial Puncture – generally caused by the needle puncturing the artery instead of the vein, potentially causing a hematoma due to blood collecting outside the artery.
• Nerve or Vein Injury – generally caused by the needle hitting the nerve or vein during insertion.
• Blood Clot or DVT – direct causes are not well documented, but one cause can be when the catheter takes up too much space in the vein.
• Air Embolism – generally caused by air entering the vein during catheter insertion.

Small Bore Lines

Small Bore Lines including Internal Jugular Lines, Femoral Lines, and Axillary Lines provide the next options for vascular access. Vascular Wellness places Axillary Lines; although, they are used much less frequently than Internal Jugular Lines and Femoral Lines.  Small Bore Lines are just some of the many ways Vascular Wellness provides the most comprehensive vascular access services.


As Vascular Access Specialists, Vascular Wellness nurse clinicians are Vascular Access Board Certified (VA-BC), insured, skill-verified, and salaried W2 employees.  Vascular Wellness requires semi-annual skill verification ensuring adherence to proprietary policies, procedures, competencies, and best practices.  We focus on holistic and comprehensive care and do not follow the pay per procedure model plus performance bonuses used by others that may create some adverse incentives for speed at the bedside versus holistic medical care helping to ensure the placement of the right line at the right time, the first time.  In fact, Vascular Wellness employs a Director of Research and Development who not only helps us stay up to date on best practices but helps us continue to innovate and improve upon Vascular Access Services.

Vascular access specialist services PICC lines

Vascular Access Specialists practice holistic medical care, meaning talking to the patient, addressing questions and fears, and performing a comprehensive medical review.  Prior to delivering any Vascular Access procedure, the Vascular Wellness clinician reviews the patient’s medical record, including history and lab reports, and independently verifies and confirms the doctor’s order.  If our clinician has questions or disagrees with the prescribing doctor, the clinician will consult with the doctor. Our Vascular Access Specialists have earned the trust of many doctors, and such doctors will defer to the clinician’s recommendation by ordering a “consult” as compared to a specific line.  Patient safety and vein preservation are critical – which is why a holistic, comprehensive evaluation and Advanced Lines are significant.  Other companies claiming to be Vascular Access Specialists may not follow this same approach frustrating medical doctors and nurses primarily because those 1099 Contractor PICC nurses do not place Advanced Lines (i.e, no options other than PIVs, Midlines, and PICCs) and get paid on a pay per procedure model.

In states where nurses are permitted, as Vascular Access Specialists, Vascular Wellness clinicians can provide immediate X-Ray Clearance of lines when tip confirmation is not available or appropriate and X-Ray confirmation must be used. This saves money, time, and coordination with a Radiologist or other doctor and enables the lines to be used immediately to avoid delaying treatment. Quicker therapy leads to better outcomes.

As Vascular Access Specialists, Vascular Wellness uses top rated and hospital preferred supplies from Becton Dickinson (BD), formerly Bard. Superior supplies and services help mitigate the potential for poor outcomes such as bad placement, clotting, infections, and other adverse events.  Other companies that are not Vascular Access Specialists may opt for inferior supplies and older equipment.

Let us be your Vascular Access Service

We offer timely, innovative, and advanced vascular access services at the bedside, with full administrative support, from skilled employees who care.

Want more than just a PICC Service or PICC Team?
Email us below or call 877-284-4435.
We are Vascular Access Specialists and here to help and answer your questions.

Let us be part of your trusted Healthcare Team.

Vascular Wellness provides comprehensive, quality, timely, and innovative vascular access services, including standard and advanced line placement, pediatrics, program management, education, training, and infection control and prevention to all healthcare settings such as Tertiary Hospitals, Community Hospitals, Long-Term Acute Care Hospitals, Hospital at Home Programs, Skilled Nursing Facilities, Surgical and Outpatient Centers, Hospice, and At-Home care. We support a 98+% Success Rate with 0% Insertion-Related Infection Rate across all lines, with an average response time of 3 hours. We help our clients improve patient outcomes, enable faster therapy, reduce costs, infections, and readmissions, decrease hospital length of stay, and reduce transportation expenses.

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