Society of General Internal Medicine

View all recommendations from this society

Released September 12, 2013; Revised January 31, 2017; Revised November 30, 2022

Don’t place, or leave in place, peripherally inserted central catheters for patient or provider convenience.

Peripherally inserted central catheters (PICCs) are commonly used devices in medical practice that are associated with costly and potentially lethal healthcare-acquired complications, including central-line associated bloodstream infection (CLABSI) and venous thromboembolism (VTE). Given the clinical and economic consequences of these complications, placement of PICCs should be limited to acceptable indications (e.g., long-term peripherally compatible infusions, non-peripherally compatible infusions, chemotherapy, palliative care, and frequent blood draws). PICCs should be promptly removed when indications for their use end.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

An ad hoc committee of the Society of General Internal Medicine (SGIM) was impaneled, taking advantage of the clinical expertise of members from the Clinical Practice Committee and Evidence-Based Medicine Task Force within the Society. Members of the ad hoc committee were then solicited to determine possible topics for consideration. The topics chosen were selected to meet the goals of the Choosing Wisely campaign, utilizing the unique clinical perspective of members of the Society in ambulatory general medicine as well as hospital-based practice. The final topics were selected by a vote of committee members based on the strength of the existing evidence, the unique standing members of the Society have in addressing the clinical topics selected, as well as contributions the recommendations would make in terms of patient safety, quality and economic impact. The final recommendations were approved by the governing Council of SGIM.

For SGIM’s disclosure and conflict of interest policies, please visit


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Beccaria P, Silvetti S, Mucci M, Contributing factors for a late spontaneous peripherally inserted central catheter migration: A case report and review of literature. J Vasc Access. 2015; 16(3):178-182.

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Chopra V, Kuhn LK, Coffey C, et al. Hospitalist experiences, practice, opinions and knowledge regarding peripherally inserted central catheters: a Michigan survey. J Hosp Med. 2013; 8(11): 635-638.

Chopra V, Govindan S, Kuhn L, et. al. Do clinicians know which of their patients have central venous catheters? Ann Intern Med. 2014; 161: 562-567.

Son CH, Daniels TL, Eagan JA, et al. Central line-associated bloodstream infection surveillance outside the intensive care unit: a multicenter survey. Infect Control Hosp Epidemiol. 2012; 33(9):869-874.

Schears GJ, Ferko N, Syed I, Arpino JM, Alsbrooks K. Peripherally inserted central catheters inserted with current best practices have low deep vein thrombosis and central line-associated bloodstream infection risk compared with centrally inserted central catheters: A contemporary meta-analysis. J Vasc Access. 2021;22(1):9-25. doi:10.1177/11297298209161

Balsorano P, Virgili G, Villa G, et al. Peripherally inserted central catheter-related thrombosis rate in modern vascular access era-when insertion technique matters: A systematic review and meta-analysis. J Vasc Access. 2020;21(1):45-54. doi:10.1177/1129729819852203

Yu C, Shulan L, Juan W, Ling L, Chun-Mei L. The accuracy and safety of using the electrocardiogram positioning technique in localizing the peripherally inserted central catheter tip position: A systematic review and meta-analysis [published online ahead of print, 2021 Jun 16]. Nurs Open. 2021;10.1002/nop2.932. doi:10.1002/nop2.932

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Luo X, Guo Y, Yu H, Li S, Yin X. Effectiveness, safety and comfort of StatLock securement for peripherally-inserted central catheters: A systematic review and meta-analysis. Nurs Health Sci. 2017;19(4):403-413. doi:10.1111/nhs.12361

Kramer RD, Rogers MA, Conte M, Mann J, Saint S, Chopra V. Are antimicrobial peripherally inserted central catheters associated with reduction in central line-associated bloodstream infection? A systematic review and meta-analysis. Am J Infect Control. 2017;45(2):108-114. doi:10.1016/j.ajic.2016.07.021

Ma D, Cheng K, Ding P, Li H, Wang P. Self-management of peripherally inserted central catheters after patient discharge via the WeChat smartphone application: A systematic review and meta-analysis. PLoS One. 2018;13(8):e0202326.

Published 2018 Aug 28. doi:10.1371/journal.pone.0202326 Pan M, Meng A, Yin R, et al. Nursing Interventions to Reduce Peripherally Inserted Central Catheter Occlusion for Cancer Patients: A Systematic Review of Literature. Cancer Nurs. 2019;42(6):E49-E58. doi:10.1097/NCC.0000000000000664

Ray-Barruel G, Xu H, Marsh N, Cooke M, Rickard CM. Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review. Infect Dis Health. 2019;24(3):152-168. doi:10.1016/j.idh.2019.03.001

Webster J, Osborne S, Rickard CM, Marsh N. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2019;1(1):CD007798. Published 2019 Jan 23. doi:10.1002/14651858.CD007798.pub5

Chopra V, Flanders SA, Saint S, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med. 2015;163(6 Suppl):S1-S40. doi:10.7326/M15-0744

Swaminathan L, Flanders S, Horowitz J, Zhang Q, O’Malley M, Chopra V. Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications: A Multicenter Study. JAMA Intern Med. 2022;182(1):50-58.