Abstract Purpose This article assesses the feasibility, safety, and efficacy of peripherally inserted central catheters (PICCs) in conjoined twins. Material and Methods A retrospective chart review of all consecutive conjoined twins who had PICC placement at a tertiary center. Seventeen conjoined twins (12 females; 71%) had 25 PICC insertions. The average age of patients at PICC insertion was 15.9 ± 19.3 months. The most common type of twin was thoraco-omphalopagus (5 patients; 29%). The most common access was the brachial vein (N = 10, 40%). Thirteen procedures (52%) were performed before separation. Results Seven long-term minor complications were identified (28%). The most common complication was malpositioning (8%). Average dwell time was 122 days while the average fluoroscopy time was 2 minutes and 3 seconds. Conclusion Image-guided PICC placement in conjoined twins is safe and feasible. It provides excellent durable vascular access.