Peripherally Inserted Central Catheters (PICCs) play a vital role in modern healthcare, supporting the safe and effective delivery of intravenous therapies across a wide range of clinical settings. As the demand for vascular access continues to grow, so too has the scope of practice for nurses and allied health professionals (AHPs), who now play a central role in the assessment, insertion and management of these devices. This article explores the foundations of PICC practice, including the evolving professional landscape, key roles and responsibilities, legal considerations and the essential principles of consent.
The Evolving Role of Nurses in Vascular Access
Over recent decades, the responsibilities of nurses and AHPs have expanded significantly. This evolution has been driven by a number of factors, including increasing pressures on healthcare systems, an ageing population, rising patient expectations and ongoing technological advancements.
Key policy and structural changes have also played a role. The implementation of the Working Time Regulations and the introduction of Modernising Medical Careers led to reduced working hours for junior doctors. As a result, healthcare delivery models adapted, and traditional professional boundaries shifted. One notable outcome has been the development of advanced nursing roles within vascular access.
What was once considered a predominantly medical responsibility has increasingly become part of specialist nursing practice. Today, trained nurses and AHPs routinely perform vascular access procedures, including PICC insertion. Over the past two decades, there has been a steady increase in the number of non-medical practitioners undertaking these procedures, reflecting both service need and the benefits of dedicated vascular access expertise.
At the same time, advancements in device design and insertion techniques have expanded the options available to clinicians. This has reinforced the importance of structured education, competency-based training and ongoing professional development to ensure safe and effective practice.
Roles, Responsibilities and Professional Accountability
With extended roles comes increased accountability. In the United Kingdom, registered nurses are regulated by the Nursing and Midwifery Council (NMC), whose primary purpose is to protect the public through professional standards, codes and guidance.
The NMC supports the development of practice but emphasises that any extension of role must be undertaken safely and competently. Practitioners must be able to demonstrate that they have the knowledge, skill and experience required to perform PICC insertions and related procedures.
Registered nurses are accountable in four key areas:
- The patient
- The public
- Their profession
- Their employer
This accountability underpins all aspects of clinical practice. When performing PICC procedures, clinicians have a duty of care to act in the patient’s best interests, ensuring that decisions are evidence-based and that all actions, or omissions, can be justified.
Maintaining competence is an ongoing responsibility. Clinicians must actively seek to update their knowledge and skills, ensuring that their practice reflects current evidence, guidelines and technological developments.
The Role of Allied Health Professionals and Other Regulators
Allied Health Professionals are also increasingly involved in vascular access services. These practitioners are regulated by the Health and Care Professions Council (HCPC), which sets standards for conduct, performance and ethics.
A core expectation of the HCPC is that professionals maintain their competence through continuous professional development. This ensures that practice remains safe, effective and within the individual’s defined scope.
Medically qualified staff, while less frequently involved in routine PICC insertion in some settings, remain accountable to the General Medical Council (GMC) and must adhere to its professional standards and guidance.
Together, these regulatory frameworks ensure that all professionals involved in PICC practice operate within clearly defined boundaries, with patient safety as the central priority.
Legal Considerations and Duty of Care
PICC insertion is an invasive procedure and carries potential risks. As such, it is essential that practitioners understand the legal implications of their role.
Clinicians must ensure that they:
- Work within their scope of practice
- Follow local policies, national guidance and manufacturer Instructions for Use (IFU)
- Deliver care that aligns with current evidence and accepted standards
- Recognise and respond appropriately to complications
Failure to meet these requirements may result in harm to patients and could have legal consequences for both the individual practitioner and their organisation.
Organisations also have a responsibility to ensure that appropriate training, governance and clinical support systems are in place. However, individual practitioners remain accountable for their own actions and decisions.
Consent in PICC practice
Obtaining valid consent is a fundamental legal and ethical requirement for all invasive procedures, including PICC insertion. Consent is defined as an agreement to proceed with a treatment or intervention based on a clear understanding of what it involves and its potential risks and benefits.
Written informed consent is required prior to PICC insertion. For consent to be valid, it must be:
- Given voluntarily
- Based on sufficient information
- Provided by an individual with the capacity to make the decision
Every adult is presumed to have capacity unless proven otherwise. A patient may lack capacity if they are unable to:
- Understand information about the procedure
- Retain that information
- Weigh the information as part of decision-making
- Communicate their decision
The responsibility for assessing capacity rests with the clinician providing care. This assessment must be documented clearly and carried out in accordance with legal and professional guidance.
Nurses and midwives have three key responsibilities when obtaining consent:
- To prioritise patient care and ensure consent is obtained before any procedure
- To ensure the consent process is thorough, transparent and professionally accountable
- To accurately document all discussions and decisions
In cases where a patient lacks capacity, specific legal frameworks apply. For example, the Adults with Incapacity (Scotland) Act (2000) provides guidance on decision-making on behalf of individuals who are unable to consent. It is important to note that consent legislation varies across the UK, and practitioners must always follow local and national guidance relevant to their practice setting.
Summary
The foundations of PICC practice are rooted in a combination of clinical expertise, professional accountability and legal awareness. As the role of nurses and AHPs continues to evolve, so too does the importance of robust training, clear governance and adherence to regulatory standards.
Safe and effective PICC practice is not defined solely by technical skill, but by a comprehensive understanding of roles, responsibilities and the ethical and legal frameworks that underpin patient care. By maintaining high standards in all of these areas, clinicians can ensure that PICC services continue to meet the changing needs of patients and healthcare systems alike.
