Peripherally Inserted Central Catheter (PICC) Thrombosis: Reverse Taper Versus Non-tapered Catheters

Inclusion Criteria: * All inpatients, age 18 to 90, in need of de novo central venous access with a double lumen catheter indication of \> 2 weeks * Informed consent and HIPAA consent forms discussed and signed by patient or their authorized representative Exclusion Criteria: * Skin related problems around the insertion site (infection, phlebitis, scars) * History of mastectomy/axillary dissection on insertion side * Coagulopathy with an INR of \> 2.0 * Thrombocytopenia with platelets \< 25,000 uL * Renal insufficiency with a creatinine of \> 3.0 mg/dL * Documented current upper extremity or central venous thrombosis * Hypercoagulable states (protein C or S deficiency, AT-III deficiency, lupus anticoagulant) * Catheters needed for therapy within less than an hour (emergent placement not allowing sufficient time for proper research consent and randomization) * Patient has already been enrolled in this research study * Life expectancy less than 1 month