Objective To explore the feasibility and complications of ultrasound-guided peripherally inserted central catheter (PICC) insertion in elderly patients. Methods Ultrasound-guided PICC insertion was performed in 37 elderly patients with modified Seldinger's technique. Eighteen (48.6%) patients had invisible or impalpable shallow veins in elbow joints. The post-insertion success rate and complications were analyzed. Results The success rate was 100% among these 37 elderly patients. The indwelling patency duration was (32.0 ± 19.8)days. Two catheters in 2 (5.8%) patients were removed on the 21st and 39th day because of deep venous thrombosis. PICCs remained in place in 18 (48.6%) cases. Conclusions Ustrasound-guided PICC insertion is a safe procedure with high success rate. It can also be applied in patient whose shallow vein is not visible or palpable in elbow joint.