Effect of the Sherlock 3CG Tip Positioning System on Power Peripherally Inserted Central Catheters (PICCs) position in critical care patients
CCCF ePoster library. Nasim N. Oct 4, 2017; 198128; 106
Nasir Nasim
Nasir Nasim
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Effect of the Sherlock 3CG Tip Positioning System on Power Peripherally Inserted Central Catheters (PICCs) position in critical care patients

Mahmood Nasim Nasir 1, Mumtaz Shahzad Ahmad 1, Mahmood Waqas 1, Balshi Ahmad 1, Youspouv Khalid 1, Huwait Bassim1, Aletreby Waleed1,Jakaraddi Gunavathy1, Shahzad Saima 1, Brindley Peter 2, Gillman Marshall Lawrence 3, Alharthy Abdulrahman 1, Karakitsos Dimitrios

1.            King Saud Medical City, ICU department, Riyadh, KSA

2.            Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada

3.            Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada


Background: By-the-bed insertion of PICCS in the intensive care unit (ICU) oftentimes results in high malposition rates. When we performed a 5 year retrospective analysis of our own historical data (unpublished), a malposition rate of 15% was identified for PICCs which were placed mainly based on anthropometric data in our institution. 

Aim: In this prospective observational study, we aimed to determine how the application of the Sherlock 3CG Tip Positioning System may affect PICCs’ malposition rates.
Patients and Methods: In this preliminary report, 40 patients (15 females/25 males, aged 47.5 years±20 years old, height 165±15 cm, weight 75±30 kg) were recruited in our polyvalent 140 beds ICU for placement of PICCs (per institutionalpolicy). Thirty five patients were recruited from the medical ICU and 30% from the surgical ICU site, respectively. Power PICCs were inserted, under ultrasound guidance, by means of the Sherlock 3CG Tip Positioning System that employs an electro-magnetic system to guide positioning in the superior vena cava, and then intra-cavity ECG to guide positioning at the cavo-atrial junction. The catheter used for all patients in this study was a Power PICC (Bard Access Systems). All patients underwent a post-insertion chest radiography to define the malposition rate. In our protocol, adequate catheter tip locations were: a mid-superior vena cava placement that was defined when the tip position superimposed over the right main bronchus, a low-superior vena cava placement when the tip position was visualized below the right main bronchus, but above the cavo-atrial junction and a cavo-atrial junction placement that was defined as being in a position two vertebral body units (one vertebral body unit equal to vertebral body plus vertebral disc) below the lower border of the carina.

Results: All catheters were placed by certified specialists according to our protocol and under sterile conditions in all cases. No malposition rates were recorded. Five PICCs’ tips were positioned in the mid superior vena cava (12.5%), 15 in the low superior vena cava (37.5%), and 20(50%) in the cavo-atrial junction, respectively. Complications of PICCs in this cohort included in one case of upper extremity PICC-related thrombosis and two cases of PICC-related blood stream infections.

Conclusion:Our data suggest that the use of the Sherlock 3CG system has clearly minimized the malposition rate of PICCs in our institution. Surely, further studies and randomized control trials are required to confirm the aforementioned findings.However, the present results suggest a trend of reduction in the number of PICCs that need to be repositioned avoiding thus routine post-insertion radiographs when using this technology. In that sense, the latter might be considered as a cost-effective asset in critical care vascular access. 

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