Successful Implementation of Electrocardiographic-Guided Peripherally Inserted Central Catheter Placement by a Nurse-Lead Peripherally Inserted Central Catheter Placement Team

Background: The use of electrocardiographic guidance has been shown to be safe and effective for the placement of peripherally inserted central catheters (PICCs). The goal of this study was to evaluate the Sherlock 3CG tip confirmation system (TCS) in the placement of PICCs (using chest radiographs as the golden standard) and then to successfully implement use of the Sherlock to reduce the utilization of chest radiographs for PICC positioning at our institution. Methods: From January to June 2017, we analyzed the positions of PICCs placed with the Sherlock 3CG TCS. A chest radiograph performed after each PICC placement was interpreted by four independent observers . A catheter tip located within the superior vena cava (SVC) or cavoatrial junction was considered successful placement of PICC. The study comprised a total of 130 PICC placements. Exclusion criteria included atrial fibrillation, atrial flutter, or atrial dysrhythmias. Fifty-one PICC placements were included in the first phase of trial. PICC training in Phase 1 included 1-h training by the company Rep. 1 h online course. Hands-on training for tip confirmation was not mandatory to start the PICC insertion. Seventy-nine PICC placements were comprised Phase 2 of the trial. This time the hands-on training was made mandatory. Results: Results of Phase 1 were not satisfactory, with 82% of PICCs placed in the SVC or cavoatrial junction. Results of Phase 2 were considered satisfactory, with 96% of PICC placements into the SVC or cavoatrial junction. Conclusion: The Sherlock 3CG TCS is an effective device for guiding PICC placement to the SVC or cavoatrial Junction. Sufficient educational training is important to achieve a successful transition from radiographic confirmation to usage of the Sherlock 3CG TCS. This device will generally eliminate the need for radiographic confirmation of PICC placement in our patient population, except for patients with atrial fibrillation, atrial flutter, or atrioventricular junctional arrhythmic patients.

Publication History

Article published online:
11 May 2021