I've had about a dozen piccs and I really do love the convienance of them. I've always had local anesthetic, it is standard procedure here. It doesn't hurt, but feels very uncomfortable. There are a few ways they can begin. Sometimes they start a simple IV in one of the veins in the bicep, and make a small incision to widen the hole, or they go ahead and use a large needle to get at a deeper vein, once they've found one with a sonogram. It can be done at a paitent's bedside by a nurse or by an interventional radiologist in a lab. Since I'm so small, it's eaiser to place it if I go down to the radiology lab. Once they hit a vein, they flush the iv w/ contrast and use an x-ray to see where the veins go. They insert a guide wire through the iv, and watch where it goes in the vein in you chest (you can't feel it in there at all). Then they dialate your vein, this feels very strange, you feel hard pressure, but on the inside of you arm. They then slide a cathader (looks like a long thin noodle) in, make sure it's where they want it, pull out the guide wire and cut off the excess cathader. I've had the "port" stitched to my skin before, and I didn't like it because the stitches were nasty and left a scar. I ALWAYS ask for a "stat-lock", it basically tapes it on real good. My are does get really sore the first day, but a heat pack and some tylenol always does the trick.Debbie23 w/ CF