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.