Since its inception in early 2000, Vanderbilt University's Peripherally Inserted Central Catheter (PICC) Service has experienced a high level of success as measured by high proficiency rates and increasing patient procedures each year, low complication rates during and after PICC placements, and an increasing scope of influence within the Vanderbilt University Medical Center and Children's Hospital, the surrounding community, and in the Southeastern United States. Primary drivers of the PICC Service's continuing success include consistent applications of technique and technology, a data-driven approach to assessing the program's progress, and appropriately managing customers' expectations and needs. Over the past five years, data were collected on more than 12,500 PICC placements performed in this specialized nursing program. Retrospective analyses of the data demonstrate an increasing rate of successful placements (from 87.2% to 92.4%) since the program's inception in 2000 to late 2004. Furthermore, the choice of PICC technology has had a significant impact on the odds for occlusion or infection. The Vanderbilt PICC Service provides a model by which other programs can be established, maintained, and expanded into advanced practice.