Peripherally Inserted Central Catheter Insertion (PICC)

What is a Peripherally Inserted Central Catheter (PICC)?

A peripherally inserted central catheter (PICC) is a long, thin tube that goes into your body through a vein in your upper arm. The end of this catheter goes into a large vein above your heart called the Superior Vena Cava (SVC). 

  • The PICC is used to carry nutrients and medicines into your body.  It is also used to draw blood when you need to have blood tests.  
  • A PICC is used when you need intravenous (IV) treatment over a long period of time or if blood draws done via venipuncture have become difficult.  
  • A PICC can also be used for Chemotherapy drugs.

Our staff has the ability to perform these types of lines in the Home, Clinic, and Hospitals. We use Ultrasound and 3CG Technology helping clinicians have the highest success rates in the industry.

  • The most efficient & safe method is use of 3CG. This verifies the placement of the PICC by using the patient’s heart rhythm. This method allows for immediate use of the line.
  • Another way to confirm placement is with a Chest X-Ray  This method must be used in patients with atrial fibrillation and atrial pacemakers.
  • Indicated for use as an alternative method to chest X-ray and fluoroscopy for PICC tip placement confirmation in adult patients.
  • Immediate confirmation of PICC tip position at the bedside and immediate use of the PICC line.
  • Increases placement efficiency and reduces catheter malpositions as compared to “blind” catheter placements.
  • Eliminates costs associated with confirmatory chest X-ray and time previously spent waiting for X-ray confirmation readings.
  • Eliminates confirmatory chest X-ray exposure to the patient and clinician.

Central Venous Catheter (CVC)

A Central venous catheter (CVC) is a type of IV access used for acutely ill patients typically in an ICU or E.R setting.  These lines are placed into the Internal Jugular (IJ), Subclavian or the Femoral veins.  These lines are meant for shorter term use, typically less than 14 days but can be longer if needed.  This line is preferred over a PICC line in patients with Kidney Disease, known blood clots or extensive scar tissue in the veins of the upper arms. 

Tunneled CVC’s are placed under the skin and are meant to be used for a longer duration of time versus non-tunneled, which are designed to be temporary.

How can we help you?

Our vascular specialists are highly skilled at placing CVCs for any procedure in the inpatient/outpatient setting as well as the ongoing care and management of the CVC.  At VATCO, we work every day to deliver far more than our patients expect. We bring our full range of medical capabilities and service excellence to every patient.

Midline Catheter Line Insertion (ML)

  • The midline catheter (i.e. long peripheral catheter) is an IV catheter placed into a peripheral vein, which varies in length from 8 to 20cm in length, are inserted via the same veins used for PICC placement in the middle third of the upper arm; however, the midline catheter is advanced and placed so that the catheter tip is level or near the level of the axilla and distal to the shoulder
  • Midline catheters are contraindicated when there is a history of venous thrombosis, restricted blood flow to the extremities, and end-stage renal disease requiring peripheral vein preservation
When are midline catheters used?

Consider these factors when debating whether to use a midline catheter:

  • Type of I.V. drug: Vesicants, including chemotherapy drugs, and highly irritating drugs such as vancomycin are best administered via a central line. You can safely use a midline catheter for hydrating solutions and drugs that aren’t vesicants, have a pH level near blood plasma (5 to 9), or have low osmolarity (below 500 mOsm).  Examples of such drugs include Heparin and Cephalosporins.


  • Length of I.V. therapy:  Midline catheters are appropriate for patients who need I.V. therapy for more than 5 but fewer than 28 days, so the typical medical/surgical patient hospitalized for less than 5 days probably isn’t a good candidate for midline placement.
  • Patient age: Midline catheters are good for older adults, who may have limited venous access or medical conditions that contribute to increased length of stay.

Extended-Dwell Catheter Insertion (EDC)

What is an extended-dwell catheter insertion?

The extended dwell peripheral intravenous (EPIV) catheter is a 6-cm and 10-cm silicone catheter for peripheral vein insertion, which is a newer vascular access device than peripherally inserted central catheters (PICCs) and peripheral intravenous (PIV) catheter.

  • 96% First Attempt Success Rate
  • Minimized Blood Exposure:
    • Closed catheter system designed to enhance clinician safety and decrease infection risk
  • Minimized Kinking:
    • Variable stiffness guidewire
  • Extended Dwell / Short Term use

Ultrasound-Guided Peripheral Access (USGPIV)

Ultrasound IV Insertion has propelled itself into the hospital, mostly in the Emergency department setting, becoming a favorable procedure among patients and clinicians.  Proper Ultrasound assessment of the arm vasculature is one of the most important aspects to be proficient in IV insertions.  This is a very important skill to help increase success rates while decreasing potential negative outcomes.  Our team is highly skilled with Ultrasound Insertions and uses it for all of the procedures that we perform. 

Ultrasound-Guided Peripheral IV (USGPIV) has also become popular among inpatients who are requesting USGPIV over regular IV insertions. Why? Because USGPIV has proven to be more successful, requiring fewer attempts, and is less painful with decreased infection rates and increased patient satisfaction.

USGPIV Indicators: 
  • Patients that are known or suspected of difficult IV access
  • End-Stage Renal Disease (ESRD) patients when vein preservation is of the highest importance
  • Edematous or Hypovolemic patients whose veins are not visible or close to the surface of the skin
  • Vein-debilitating conditions, such as sickle cell disease or Cancer
  • Those who have had multiple venipunctures
  • Obese patients
  • Extremities with burns
  • Extremities with AV Fistulas
  • Extremities that have known Deep Vein Thrombosis (DVT)
  • Extremity with an associated history of a mastectomy and lymph node removal

Port Access

How to Access the port?

A port-a-cath also referred to as a port, is an implanted device that allows easy access to a patient’s veins. A port-a-cath is surgically-inserted completely beneath the skin and consists of two parts – the portal and the catheter.

The portal is typically made from a silicone bubble and appears as a small bump under the skin. The portal, made of special self-sealing silicone, can be punctured by a needle repeatedly before the strength of the material is compromised. Its design contributes to a very low risk of infection. The slender, plastic catheter attached to the portal is threaded into a central vein (usually the jugular vein or subclavian vein and terminates in the superior vena cava).

What is the indication for a port-a-cath?

Ports are indicated for patients requiring frequent and long-term intravenous therapy, such as the oncology population. Having a port allows healthcare professionals easy access to a major vein with a low risk of infection.

This benefit is extremely important for the immunocompromised population of oncology patients. Additionally, it reduces the pain that would otherwise be experienced with countless needle pokes for IVs since the skin over a port hub becomes thicker and desensitized.

Another consideration is that oncology patients may receive chemotherapy often, which can be toxic and erosive to tissues in the body. By infusing chemotherapy through a strong vein via the port, the medication has a lower chance of leaking into tissues and causing extravasation or irritation. 

Once a port is cleared for use, a patient may receive intravenous therapy through it for the course of his/her treatment. An adult portal chamber can take about 2,000 punctures on average, which may last a patient several years.

What are the overall benefits for a patient with a port?
  • Easy and quick access with less pain than typical needle sticks
  • The longevity of device use
  • Reduction of infection risk
  • Low maintenance care at home 
  • Body image (not noticeable under the skin)

Assessment of Vascular Access Devices (VAD)


Safe and reliable venous access is paramount when administering medications in critically ill and ICU patients. “Central venous access devices (CVADs) are commonly used in ICUs and pose a significant infectious and thrombotic risk to patients,” explains VATCO CEO Ryan Walker, RN, CRNI, VA-BC. Underlying disease, immobility, sedation, and the number, type, and duration of catheters used are just some of the risk factors associated with catheter-related complications in ICU patients. Studies show that the risk for complications associated with central venous catheters (CVCs) is higher in ICUs when compared with other hospital departments.

“It’s important to balance the clinical needs of patients with risks associated with any vascular device,” says Mr. Walker. “This requires having processes in place for selecting devices, inserting the devices aseptically, and caring for, managing, and removing devices when they’re no longer necessary.” The association between thrombosis, infections and devices highlights why use of devices, such as peripherally inserted central catheters (PICCs), should be considered carefully. Despite this knowledge, some PICCs may not be placed for clinically valid reasons. “Defining appropriate indications for PICC use is an important patient safety issue,” Mr. Walker says.

Vascular Access Device (VAD): 

Any device utilized for venous access regardless of location. These include peripheral intravenous catheter (PIV), peripherally inserted central catheter (PICC), Midline catheter, Hemodialysis catheter, central venous catheter (CVC) and implanted venous port. 

Assessment and Device Selection 

  • All clients requiring vascular access, regardless of the duration of therapy, require the use of a structured approach such as an algorithm to facilitate a comprehensive client assessment and the development of a vascular access care plan prior to the initiation of therapy. 
  • To determine the most appropriate type of vascular access device, the nurse needs to consider the following factors: 
    • Prescribed therapy
    • Duration of therapy
    • Physical assessment
    • Client health history
    • Support system/resources
    • Device availability
    • Client preference
Client Education

Nurses will discuss the options for vascular access devices with the client and family caregivers. Device selection is a collaborative process between the nurse, client, physician, and other members of the health care team, however, the nurse has a role to educate and advocate for clients in relation to the selection of appropriate devices.

In order to support continuity of client care within and between organizations, all clients with a vascular access device and/or their caregivers need to have available comprehensive information about the device, which should include, as a minimum:  

  • Details of therapy
  • Type of vascular access device, including number of lumens
  • Date of insertion
  • Tip location, for all central vascular access devices
  • Delivery system in use
  • Client education plan
  • Client-specific instructions
  • Details of any complications experienced
  • Appropriate resources, as required.

Vascular Access Device Removal

We provide nursing guidance for the safe removal of all vascular access devices. Our promise is to ensure patient safety by reducing the risk of potential complications during the removal process.

Central Venous Catheter (CVC) – [also known as a central line or a Central Venous Access Device (CVAD)] is an indwelling device that is inserted into a vein of the central vasculature. CVCs are being used increasingly in inpatient, outpatient, and community settings to provide long-term venous access. 

Indications for Venous Access Removal
  • If patient is stable and no potent IV Drugs are required
  • No indication for CVP measurement
  • Catheter related Infection
  • Catheter exceeded recommend dwell time
  • Persistent catheter occlusion
  • Damaged catheter Aims of Protocol
Indications for Use
  • Administer intravenous fluids and blood products
  • Administer hypertonic solutions (Total Parental Nutrition [TPN]), vesicants (e.g. chemotherapy),
  • irritants (e.g. cloxacillin), and solutions with extreme pH values (e.g. vancomycin).
  • Obtain venous blood samples
  • Provide long term intravenous therapy
  • Administer large volumes of intravenous fluid quickly
  • Administer vasopressor or vasodilator therapy (e.g. dopamine)
  • Monitor central venous pressure (CVP)
  • Access venous circulation when a patient has difficult or impossible peripheral access



Phlebotomy is a process of making a puncture in a vein usually in the arm, with a cannula, for the purpose of drawing blood. The procedure itself is known as venipuncture. A person who performs phlebotomy is called a phlebotomist, although most doctors, nurses, and other technicians can also carry out phlebotomy.

For nurses, particularly our staff who care for critically ill patients, obtaining a blood specimen via venous stick is a crucial nursing skill that we specialize in. In the hospital, the phlebotomy team may not be available, especially during the nighttime hours or when a stat result is needed. That’s where we come in!

Therapeutic phlebotomy is used to treat people with:

  • Hemochromatosis
  • Polycythemia vera
  • Porphyria cutanea tarda
  • Sickle cell disease
  • Nonalcoholic fatty liver disease

In order to find the best and most reliable treatment, please reach out to one of our staff members directly at to get instant answers.

Arterial Catheter Insertion

What is an Arterial line (A-line)?

An Arterial line is a short, thin catheter inserted into an artery, typically at the wrist or above the elbow. It is connected to pressure-rated tubing in a closed system.

  • Arterial lines are used to continuously monitor blood pressure in critically ill patients.
  • They also allow for frequent lab draws and blood samples, reducing the need for repeated needle sticks.
  • Arterial lines facilitate the monitoring of arterial blood gases (ABGs), minimizing the need for needle sticks by providing effortless blood samples.

Our hospital staff is skilled in placing Arterial lines, utilizing ultrasound for efficient and successful insertion.

arterial catheter insertion