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Adoption support resource – insights from the NHS

2 Current practice

2 Current practice

There are a variety of reasons why someone may need a PICC for long- or short-term care. These include:

  • delivery of chemotherapy drugs, antibiotics or total parenteral nutrition

  • repeated administration of blood products

  • poor peripheral venous access

  • monitoring central venous pressure

  • power injection of contrast media for CT scans

  • infusion of vesicant, irritant or hyperosmolar solutions

  • people with needle phobia, to prevent repeated cannulation.

PICCs may be single, double or triple lumen in design (depending on the indication) and are available in a number of sizes. They may be open-ended or valved and made of silicone rubber or polyurethane. Device selection will be made following clinical assessment of the individual.

Using a PICC for central venous access, rather than a skin-tunnelled catheter or implanted port, presents a number of advantages: it can be inserted at the bedside or in a clinic setting, it does not require a surgical procedure for insertion or removal, and it does not leave a scar.

PICC insertion

In current NHS clinical practice, PICCs are inserted by clinicians including nurse specialists, intensive care consultants, anaesthetists, general physicians, radiologists and radiographers. The clinical settings where PICCs are inserted include operating theatres, emergency rooms, oncology departments, orthopaedic and other wards, radiology departments, intensive care, high dependency units and outpatient clinics.

Although there are no national guidelines for catheter insertion, a modified Seldinger micro‑introducer technique under local anaesthesia with ultrasound guidance is most commonly used for PICC insertion in the UK.

PICC tip placement

Opinions vary about the ideal catheter tip position (Tizard et al. 2012). However, the following positions are generally considered acceptable

  • mid-lower superior vena cava

  • atrio-caval junction

  • high right atrium.

NHS local practice guidelines and policies determine that a chest X‑ray, to confirm the PICC tip location, must be performed before the PICC can be used and that this must be documented in the patient's medical records.


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