title: Evaluation of the Sherlock 3CG Tip Confirmation System on peripherally inserted central catheter malposition rates.
abstract: Peripherally inserted central catheters are often positioned blindly in the central circulation, and this may result in high malposition rates, especially in critically ill patients. Recently, a new technology has been introduced (Sherlock 3CG Tip Positioning System) that uses 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. In this observational study, we investigated how the Sherlock 3CG Tip Positioning System would affect peripherally inserted central catheter malposition rates, defined using a post-insertion chest radiograph, in critically ill patients. A total of 239 catheters positioned using the Sherlock 3CG Tip Positioning System were analysed. When an adequate position was defined as low superior vena cava or cavo-atrial junction, 134 catheters (56.1%; 95% CI 50-62%) were malpositioned. When an adequate position was defined as mid/low superior vena cava, cavo-atrial junction or high right atrium (≤ 2 cm from cavo-atrial junction), 49 (20.5%; 95% CI 16-26%) catheters were malpositioned. These malposition rates are significantly lower than our own historical data, which used a 'blind' anthropometric technique to guide peripherally inserted central catheter insertion.
authors.affiliation: John Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Johnston
authors.forename: A
authors.initials: A
authors.lastname: Holder
authors.forename: S M
authors.initials: SM
authors.lastname: Bishop
authors.forename: T C
authors.initials: TC
authors.lastname: See
authors.forename: C T
authors.initials: CT
authors.lastname: Streater
mesh_terms: D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D062905:Central Venous Catheters; D006801:Humans; D012189:Retrospective Studies