NICE has issued final guidance recommending the use of a new device that aims to make it easier to place a catheter correctly when it’s inserted through a vein in the arm.
Having examined the evidence, the independent Medical Technologies Advisory Committee has concluded that using the Sherlock 3CG Tip Confirmation System is likely to benefit patients and the NHS
Catheters are used to deliver liquids such as antibiotics or other drugs, so avoiding the need for frequent needle injections. They can also be used to continuously monitor the body’s functions, such as blood pressure in the central veins near the heart, or for taking blood samples. When catheters are placed in the body through a vein in or near to the arm, this is known as a peripherally-inserted central catheter (PICC).
The Medical Technology Guidance from the National Institute for Health and Care Excellence (NICE) encourages the NHS to use 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 the catheter’s position. The process of X-raying the patient, then waiting for the X-ray to be 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.
The Sherlock System, from Bard Access Systems, uses magnetic and electrocardiographic (ECG) real-time tracking of a compatible PICC to enable the person placing the PICC to detect and correct any error in how the tip is positioned. Benefits 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 of the catheter is. This avoids delays associated with having an X-ray so the PICC can be used as intended more quickly.
In many cases use of Sherlock 3CG TCS system will be at a similar cost to current insertion methods and, in certain clinical situations, there are potential savings of up to £106 per patient
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 MBE, director of the NICE centre for health technology evaluation, said: “This final guidance supports the Sherlock 3CG Tip Confirmation System for placing peripherally-inserted central catheters. These catheters are commonly used in providing treatment or monitoring in many clinical settings including operating theatres, intensive care, and cancer wards.
“Having examined the evidence, the independent Medical Technologies Advisory Committee has concluded that using the Sherlock 3CG Tip Confirmation System is likely to benefit patients and the NHS.
“Using the Sherlock system avoids the need for a chest X-ray to confirm catheter position, which is 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.
“In many cases use of Sherlock 3CG TCS system will be at a similar cost to current insertion methods and, in certain clinical situations, there are potential savings of up to £106 per patient. We hope that this guidance will encourage health staff to use the Sherlock 3CG Tip Confirmation System given the benefits to patients and to the NHS.”
