The IR docs in my department have been placing PICCs in our pediatric centre. We are now looking into an RN/MRT PICC insertion program--using fluoro on cuffed PICC lines. Just wondering if anybody out there does PICC inserts using access--wire into IVC--lidocaine--dermatotomy--dilatation/sheath--PICC--fluoro with contrast administration--cuff insertion--suturing of line etc. Seems like a lot, I know, but our hospital uses cuffed lines as the uncuffed ones seem to "fall out" alot:nono: Also, what, if any, kind of medical directives have you documented. Thanks for any guidance.