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PICC Insertions

When you work in healthcare research, you get the opportunity to learn a lot about our healthcare system and to hopefully improve patients’ lives. Certain research topics tend to have a greater impact on the researcher than others (let alone on patients), such as cardiology, oncology, mental health, or rare disease, to name a few. With all due respect to plastic surgery or sports medicine perhaps, research in these other areas often means more due to high rates of morbidity and/or mortality. When you can combine multiple of these areas, it really hits home.

Peripherally inserted and centrally inserted central catheters help deliver critical intravenous (IV) therapy into the bloodstream. Treatment often includes chemotherapy or antibiotics for patients who are sick and hospitalized. Peripherally inserted central catheters (PICCs), in particular, are an ideal way for vascular access teams to provide temporary access for medication delivery (typically when treatment will be needed for 2-12 weeks).1 They have also been shown to decrease complication rates and decrease system costs.2

PICCs are inserted into a patient’s upper arm and weaved through a patient’s venous system until it reaches a patient’s heart. The vascular access team uses ultrasound to maneuver the catheter. Based on clinical guidelines, the PICC should be placed just above the right atrium (residing in the lower third of the superior vena cava).3

Historically, the location of the PICC tip has been confirmed using a chest X-ray (Standard of Care, SoC). Bard’s Sherlock 3CG Tip Confirmation System provides the ability to confirm peripherally inserted central catheter (PICC) tip location in real-time. It uses passive magnet navigation using a pre-positioned sensor on the patient’s chest. Electrocardiogram electrodes gather the patients’ cardiac electrical activity, confirming the tip location in relation to the patient’s sinoatrial node.

To help Bard support the use of the Sherlock 3CG, we conducted a Time and Motion study by collecting data at four hospitals in the United States; two hospitals used the Sherlock 3CG and two used the SoC. We observed PICC insertions for 30 patients at each hospital. We compared the time from the beginning of the procedure until the catheter tip was confirmed and the patient was released for IV therapy.

The results of the study showed a stark difference between arms. While it took just over half an hour (33.9 minutes) to complete the procedure and confirm tip placement with the Sherlock 3CG, it took nearly 3 hours on average (176.3 minutes) in the SoC arm. Beyond a time savings, 75 chest X-rays were performed in the SoC arm compared to only 2 in the Sherlock 3CG arm.4

As a researcher, there is nothing more rewarding than working on a product that gets patients their medication faster, decreases their burden, decreases their exposure to chest X-rays, and has the potential to save money for a hospital.



1 Chopra V, Flanders SA, Saint S, Woller SC, O’Grady NP, Safdar N, Trerotola SO, Saran R, Moureau N, Wiseman S, Pittiruti M, Akl EA, Lee AY, Courey A, Swaminathan L, LeDonne J, Becker C, Krein SL, Bernstein SJ, Michigan Appropriateness Guide for Intravenouse Catheters (MAGIC) Panel The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med. 2015 Sep;163(6 Suppl):S1-40.

2 Moureau N, Gabriel J. Peripherally inserted central catheters. In: Hamilton H, Bodenham A, editors. Central Venous Catheters. Chichester, England: Wiley-Blackwell; 2009:114–126.

3 Infusion Nurses Society. Infusion nursing standards of practice. J Infusion Nurs. 2016;39(Number 1S):S47. Standard 23, Practice Criteria C.

4 Tomaszewski, KJ, Ferko, N, Hollman, SS. Time and resources of peripherally inserted central catheter insertion procedures: a comparison between blind insertion/chest X-ray and a real time tip navigation and confirmation system. Clinicoecon Outcomes Res 2017; 9: 115–125.