The vast majority of PICCs are inserted at the patient's bedside without fluoroscopy as this is not required for insertion. Your initial PICC insertion education should have included the methods for patient measurement and how to reposition a PICC that went into the IJ. If not, this information is included in most basic insertion education courses. You can contact the manufacturer of the catheter you use as many have this education on CD or other self study methods. Also PICC Excellence has lots of self study processes you can purchase.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
ECG guidance (see http://www.pacerview.com/index_files/CVC_AND_PICC_TIP_LOCATION_WITH_PACERVIEW.htm) allows you to place the tip of your catheter without any radiology support. It is a technique that is growing in acceptance (see Glenda Dennis' comment at http://www.iv-therapy.net/node/2369 - her hospital accepted ECG guidance for tip location without the need for confirmatory x-ray.) The tip of your catheter can be located accurately, correlating close to 100% with echocardiographic location. (Chest x-ray is only about 80% and surface landmarks about 60%).
However, ECG guidance only tells you whether you are approaching the caval-atrial junction. It will not tell you if you have taken an aberrant course.
Most bedside PICC teams use some type of navigational device to help ensure proper placement at the bedside before x-ray. As Dr. Peter posted, there is pacer view, but there is also Navigator by Cortrack Medsystems and Sherlock by Bard. You must use Bard PICC's to use Sherlock, but Navigator can be used with any type of line. Email me privately if you would like more info. These products will not place your PICC for you, but it will let you know where your PICC is before you break down your sterile field and call for x-ray.
Heather Nichols RN BSN CRNI