Aim
To improve catheter placement, patient satisfaction and achieve economical benefits utilising the Sherlock 3CGTM Tip confirmation system (TCS)
Outcomes
- patient satisfaction improved (at the bedside)
- efficient - no transfers to Radiology
- no exposure to radiation
- cost effective
- PICC can be used immediately
- mobile (can travel between facilities with minimal equipment)
Background
Prior to 2009 all PICC insertions were limited to the medical imaging (MI) department using XRay and or Fluro as confirmation. A Hospital in the Home service was introduced in mid-2009 and at that time the MI department did not have the capacity to insert the increased number of PICCs. This led to the introduction of a Nurse-led bedside service to assist with the predicted increase of PICCs.
The Nurse-led PICC service model was 'blind bedside placement' - a catheter pushed into the vein at a set distance according to anatomical measurement taken externally, followed by a confirmatory XRay.
Often due to pressures there were delays waiting for logistics and medical officers to review X rays, which then delayed treatments and inhibited flow e.g. hospital in the home programmes, total parenteral nutrition (TPN) and chemotherapy.
SCHHS has always had the option of both Fluro and blind methods. The Vascular Access Surveillance and Education service (VASE) utilised the blind method when the service commenced in 2009. Difficult insertions and certain patient populations e.g., Cystic Fibrosis are referred to Fluro directly.
VASE trialled the Sherlock 3CG TCSTM in 2015 with favourable results which included accurate tip placement, decreased malposition’s, time to treatment increased, patient satisfaction and improved patient flow.
The system allows magnetic tracking of the PICC during insertion and confirmation of the final location using ECG.
