Transforming catheter placement

A tracking tool that uses the electrical activity of a patient’s heart to guide the placement of peripherally inserted central catheters (PICCs) is set to transform the care of adult patients and reduce healthcare costs, with 11 Australian hospitals currently using the device.

The new technology, the Sherlock 3CG Tip Confirmation System (TCS) produced by Bard Australia, eliminates the need for confirmatory chest X-rays or fluoroscopy following the insertion of a PICC by ensuring the catheter is in the correct position by measuring a patient’s ECG.

PICCs allow the long-term delivery of medications, including chemotherapy, intravenous fluids, antibiotics and high-volume blood transfusions without the need to repeatedly penetrate a patient’s veins.

Accurate positioning of the catheter tip is essential for effective administration of therapies and to help avoid potential complications such as central venous thrombosis, irritation of the endothelium or perforation of vessel walls.

“Traditionally, patients could wait hours for a post-procedural confirmatory chest X-ray and then a percentage of patients might be required to undergo a catheter adjustment or repeat insertion and chest X-ray if the catheter was malpositioned,” said Associate Professor Peter Klineberg, Director of the Department of Anaesthesia and Perioperative Medicine at Westmead Hospital who conducted a case study on the device. “ECG-guided catheter placement enables faster initiation of therapy and can save time for everyone involved.”

Professor Peter Klineberg

“Given the potential benefits for patients, medical teams and hospital budgets, we are seeing hospitals update their protocols to incorporate this bedside technology and remove the requirement for confirmatory chest X-ray in patients undergoing PICC insertion,” he added.

The case study showed that the technology:

• facilitated a 96% success rate of positioning the PICC within the cavoatrial junction and correction of malpositions at the time of insertion
• provided cost-savings estimated at more than $300,000 per year
• eliminated the need for confirmatory chest X-rays and avoided consequent radiation exposure to patients and staff
• eliminated the need for a second day in hospital for some patients.

“It can help take the frustration and guesswork out of PICC placement,” said Fiona Stewart, clinical nurse consultant at Westmead Hospital who was also involved in the study.

“PICC malpositions can be avoided or corrected by the nursing team at the time of placement, allowing patients to receive necessary treatment much sooner than with traditional PICC tip confirmation using chest X-ray or fluoroscopy.”

Because of its reliance on ECG measurements, the device may not be suitable for use in patients with altered cardiac rhythms, such as those with chronic lung disease or valvular heart disease.

The TCS received an Award for Excellence in Medical Technology late last year in recognition of the improved health outcomes and quality-of-life benefits it provides.