Clinical impact of the Sherlock 3CG® Tip Confirmation System for peripherally inserted central catheters

Abstract

Objective This study was performed to evaluate the technical success rate and catheter tip malposition rate of peripherally inserted central catheter (PICC) placement using the Sherlock 3CG® Tip Confirmation System (TCS). Methods In total, 114 patients who underwent PICC insertion via the Sherlock 3CG® TCS from October 2017 to February 2018 were retrospectively evaluated. The primary endpoints were the technical success rate, malposition rate, and mean procedure time. The secondary endpoints were the sex-related difference in the malposition rate, radiologist's experience level, and side of insertion. Technical success was defined as procedure completion using only the Sherlock 3CG® TCS without a guidewire or fluoroscopy guidance. In accordance with the North American guidelines, an adequate position was defined as the lower third of the superior vena cava and the cavoatrial junction. Results The technical success rate was 97% (111/114). The malposition rate was 16% (18/111), and four catheters were repositioned. There were no significant differences in the malposition rate between the sexes, radiologist's level of experience, or side of insertion. Conclusions PICC placement using the Sherlock 3CG® TCS yielded a high technical success rate and low catheter tip malposition rate regardless of the radiologist's level of experience or side of insertion.

Peripherally Inserted Central Catheters (PICCs) at the Bedside by X-ray Technologists: A Review of Our Experience

“…The tip is graphically shown as a yellow circular icon on the display monitor and its catheter trajectory displayed there, as it is being inserted. When the tip is located near the cavoatrial junction, the p-waves of the ECG tracing become gradually higher, reaching a maximum at the cavoatrial junction [4]. A green diamond icon replaces the yellow circle, confirming successful insertion of the bedside PICC.…”

“…The Site-RiteÒ 8 Ultrasound System, Sherlock 3CGÔ Diamond TCS, and the central venous catheter containing the Sherlock 3CGÔ Tip Positioning System stylet all make up the major components for the bedside PICC insertion [1]. The PICC is inserted into a basilic, brachial, or cephalic vein in the upper arm under ultrasonographic guidance, tunneled through the subclavian and brachiocephalic veins, and the catheter tip positioned at the superior vena cava [4]. The Sherlock 3CGÔ Diamond TCS is composed of an intracavity ECG guidance system, in conjunction with a magnetic sensor navigation system.…”

Vascular access in cancer patients – clinical implications

“…11 The PICC tip-position is verified through non-invasive electro-magnetic devices. [25][26][27][28][29] While inserting PORTs, it is recommended to use of both US and fluoroscopy. 7 11 Fluoroscopy will provide useful information both during guidewire positioning, dilation and catheter advancement.…”

Image Guidance for PICC Insertion: Commentary to “Magnetic Tracking and Electrocardiography-Guided Tip Confirmation System Versus Fluoroscopy for Placement of Peripherally Inserted Central Catheters: A Randomized, Noninferiority Comparison”

“…Adequate positioning of catheter tips is crucial for the insertion of central venous catheters, including peripherally inserted central catheters (PICCs), to minimize catheterrelated complications [1][2][3]. To confirm the location of the tip, imaging is mandatory, and chest radiography is the standard modality.…”

“…Recently, a magnetic tip confirmation system (TCS) with real-time ECG guidance was introduced and has been used as an alternative guiding method. Reported accuracy rates for catheter tip insertion ranged from 79.5 to 100% [3,4]. In a review of clinical and economic evidence by the National Institute for Health and Care Excellence (NICE), the paucity of the evidence was pointed out [4].…”