<P> A PICC is inserted in a peripheral vein in the arm, such as the cephalic vein, basilic vein or brachial vein, and then advanced proximally toward the heart through increasingly larger veins, until the tip rests in the distal superior vena cava or cavoatrial junction . </P> <P> PICCs are usually inserted by physicians, physician assistants (in the US), radiologist assistants (in the US), respiratory therapists, nurse practitioners, or specially trained certified registered nurses and radiologic technologists using ultrasound, chest radiographs, and fluoroscopy to aid in their insertion and to confirm placement . PICC insertion is a sterile procedure, but does not require the use of an operating room . When done at bedside (that is, in the patient's room), a suitable sterile field must be established and maintained throughout the procedure . For this reason, visitors are normally requested to leave the room until the insertion is complete, and some form of skin preparation should be used to clean the patient's skin . </P> <P> The insertable portion of a PICC varies from 25 to 60 cm in length, that being adequate to reach the desired tip position in most patients . Some lines are designed to be trimmed to the desired length before insertion; others are simply inserted to the needed depth with the excess left outside . As supplied, the line has a guide wire inside . This wire is provided to stiffen the (otherwise very flexible) line so it can be threaded through the veins . The wire is removed and discarded after insertion . </P> <P> The PICC is also provided with a "wing" having holes for either sutures or an adhesive securing device . Securing the catheter prevents post-insertion movements of the line, which otherwise could place the tip in an unsafe position . </P>

What does the end of a picc line look like
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