The EDUCATOR needs education. First of all, just because a PICC starts in the peripheral vascular system, doesn't mean that it is a Peripheral Access Device. So a PICC is a Central Catheter. As so appropriately said in other posts, TPN should never go into the veins that terminate in the peripheral vascular system. TPN is a solution that ALWAYS needs to infuse via Central Catheter. That is, via a catheter whose tip resides in the distal 1/3rd of the Superior Vena Cava, or the Inferior Vena Cava if it's a femerol catheter.
It's shocking for me to also see that NICU patients are getting TPN running into their small veins in the arms... CAN WE SAY OWWWWWWW!. It doesn't matter what your population is.. TPN is TPN, IS TPN and MUST GO CENTRALLY! TPN rarely has a dextrose concentration of less or equal to 10%. Usually the dextrose concentration is 50-70%. If your concentration of dextrose is 10% or less, you may have PPN infusing.
While it is true that PPN may have an osmolarity of less than 600, the final admixture of the solution still needs to be assessed and if it is > 600, place a central catheter.
Also, there should not be a catheter which is denoted as a "Deep Tip PICC."
INS, as critter lover pointed out, states that one can have a true PICC which terminates in the SVC, or you may have a Midline catheter, but to have a PICC terminate in the midclavicular area (Subclavian vein, innominate vein) is a NO-NO. Thrombus rates skyrocket when a tip stops here, and therefore should not be done.
Midline IV catheters are 3-8 inches in length and are not central catheters as they stop or terminate before the axillary vein at the shoulder. Medications that need to go centrally, should not be infused via this catheter just like they should not be infused via short term peripheral access catheters (< 3 inches in length).
One on one, I'd kindly point out to your "educator" that you are aware of INS standards and they seem to differ from her views. Direct him or her to the INS web site www.ins1.org
to obtain a copy of their standards.