The National Institute of Health and Care Excellence (NICE) has launched draft guidance supporting the use of a new device that makes it easier to place catheters correctly into veins in the arm.
Catheters are thin tubes put into the body which can be used to deliver liquids such as antibiotics or other drugs, so avoiding the need for frequent injections. They can also be used to continuously monitor body functions such as blood pressure in the central veins near the heart and tor taking blood samples. When they are placed in the body though a vein in or near to the arm, this is known as a peripherally-inserted central catheter (PICC).
The draft medical technology guidance from NICE supports the case for using the Sherlock 3CG Tip Confirmation System for placing PICCs.
The standard procedure for placing PICCs is blind insertion of the catheter - where there is no imaging to help with positioning it, followed by a chest X-ray to check its position. The process of taking the patient to the X-ray department, then waiting for the X-ray to be performed and checked, can delay the start of treatment or monitoring. In some cases, fluoroscopy - an imaging technique that uses X-rays to obtain real-time moving images of inside the body - is used instead of standard X-ray to assist with positioning the PICC in patients where placing is difficult.
Using the Sherlock system avoids the need for a chest X-ray to confirm catheter position, which is often required with blind catheter insertion. This avoids any related delay in using the catheter for providing treatments or in monitoring
The Sherlock system, manufactured by CR Bard, uses magnetic and electrocardiographic (ECG) real-time tracking of a PICC made by the same company to enable the person placing the PICC to detect and correct any error in how it is positioned. The manufacturer claims the benefits of the Sherlock System include the catheter being more accurately positioned, thus avoiding the need for the patient to have an X-ray to confirm exactly where the tip is. This avoids delays associated with having an X-ray so the PICC can be used as intended more quickly.
Across the whole population in which PICCs are placed, the cost of using the Sherlock system is similar to blind insertion followed by X-ray, but it can save up to £106 per patient in specific clinical situations.
Professor Carole Longson, director of the NICE centre for health technology evaluation, said: “Using catheters in providing treatment or monitoring is a common procedure, often performed in operating theatres, intensive care, cancer wards and many other clinical settings.
"This draft guidance, developed by the independent Medical Technologies Advisory Committee, proposes supporting the Sherlock 3CG Tip Confirmation System for placing catheters in central veins.
“Using the Sherlock system avoids the need for a chest X-ray to confirm catheter position, which is often required with blind catheter insertion. This avoids any related delay in using the catheter for providing treatments or in monitoring. Using the technology also increases staff and patient confidence of the accuracy of the procedure during catheter insertion. We welcome comments on the draft guidance during this consultation.”
Click here for more information on the medical technology draft guidance consultation.
