This paper reviews our experience using sonographic guidance in the insertion of peripherally inserted central venous catheters (PICCs).Three hundred fifty-five PICCs were placed in 262 patients, 19-92 years old, over a 24-month period using sonographic guidance for the initial venous cannulation.The average number of punctures was 1.2, with an average procedure time of 21 min. Our overall success rate to achieve the initial venous access was 99%. I.v. contrast material was used in only 2% of the cases, after successful initial venous access with sonographic guidance alone, to allow demonstration of anatomic variations or lesions that interfered with the completion of the procedure. Two immediate minor complications occurred. A high margin of safety was provided by avoiding the use of iodinated contrast medium and by visualizing the artery and its anatomic relation to the vein before and during needle placement.Sonographic guidance yielded superior three-dimensional localization of the selected vein and i...