PICCs are available as single, double and triple lumen; may be non‐valved or valved (the latter may reduce occlusions) (Bartock [18], Johnston et al. [234]); and may be made of silicine, polyurethane or newer polymers of polyurethane (de Lutio [109], Dougherty [123]). A stylet within a silicone catheter adds firmness, which makes advancement easier. Stylets are not usually required with a polyurethane catheter because of catheter stiffness (Perucca [369]). Newer polyurethane polymers have improved material stiffness and biocompatibility while mechanical strength is preserved (de Lutio [109]). These newer catheters are available as power‐injectable devices that can tolerate up to 300 psi (de Lutio [109], Wilkes [472]). Catheters usually measure 55 cm long, with a diameter of 2–7 Fr (Figure 17.30). PICCs can be cut to the required length, if required, unless valved at the tip (Dougherty [123]). Valved catheters may have valves either proximally or distally; these open and close depending on the pressure. If a PICC is damaged or disconnected, or at the end of an infusion, the low pressure closes the valve, thereby preventing backflow and occlusion. This safety feature and ease of use make valved PICCs preferred for home‐care and outpatient settings (Mussa [341]).

The catheter is inserted using a modified Seldinger technique, in which venous access is established via a needle or cannula; a guidewire is threaded through the needle, which is then removed; a dilator, introducer or peel‐away sheath is threaded over the guidewire (frequently a scalpel is used to enlarge the skin puncture site and facilitate the advancement of the introducer); the guidewire and dilator are then removed; and the catheter is advanced into the venous system through the introducer or peel‐away sheath (Dougherty [123], Gabriel [161], Hadaway [194], Sansivero [398], Weinstein and Hagle [465]). The benefit of this technique is that it reduces the trauma to the vein and lowers the risk of arterial or nerve damage (Bullock‐Corkhill [56]). It can also be used to facilitate placement in smaller difficult veins, as well as ultrasound‐guided upper arm placement (Bullock‐Corkhill [56], Moureau [329], Sansivero [398]). The use of an ECG navigating system is recommended to ascertain tip position at the time of insertion and minimize the need to reposition catheters (NICE [352]).

The use of local anaesthetic by injection reduces the pain associated with the initial venepuncture and ensures that the area where the incision is made (or deeper tissues) are anaesthetized to reduce pain and discomfort (Dwyer and Rutkowski [135], Hartley‐Jones [201]). Injectable local anaesthetic, such as 1% lidocaine, is commonly used, and it has been found that intradermal lidocaine is superior to EMLA (eutectic mixture of local anaesthetics: lidocaine and prilocaine) prior to insertion of PICCs (Fry and Aholt [158]).