Aim: The correct positioning of ultrasound-guided peripherally inserted central catheters (UGPICCs) is essential to avoid multiple complications. We describe for the first time a retrospective study to evaluate a novel and easy trans-abdominal ultrasound guided approach, so called “Marano Index”, to correctly place the UGPICCs tip, making oncological surgeons able to obtain a high successful initial placement rate without post-insertion chest radiography. Material and Methods: We examined the placement of UGPICCs applying in 53 patients the “Marano index”. This index is based on the catheter retraction for an approximate length of the right atrium/intrapericardial superior cava vein complex of 7.5 cm in women and 8 cm in men, when the catheter tip, identified at transabdominal ultrasonography performing subxiphoid longitudinal view of the inferior vena cava, is positioned at inferior vena cava-right atrium junction. The tip catheter location was then controlled by post-procedural chest radiography. Results: The ultrasonographic guided insertion was successful in all patients (100%). The identification of catheter inside the inferior vena cava was registered in 50 patients (94.3%) and in all cases it was clear the precise catheter placement, after Marano index application, with the real tip position and the concordance between post-procedural radiography in 100% of cases. We experienced only 5.6% inaccurate tip locations: in these cases the technically difficult ultrasonographic examinations due to bad ultrasound body habitus made difficult the inferior vena cava-right atrium junction complex landmarks detection, with the consequential inapplicability of our index. The overall accuracy of this index was 94%, with positive predictive value of 94% and sensitivity of 100%. Conclusions: This technique, once validated in a larger cohort, would allow the insertion of UGPICC without radiologic confirmation in selected patients with an adequate ultrasound body habitus. This would avoid unneeded radiation exposure from chest x-rays and would potentially save cost and time. This strategy provides only minimal deviation from the current practice and it is hence technically easy to learn and perform accurately with basic training by digestive oncological surgeons.