sherlock

I have started to use the corpak electromagnetic CVC tip placement device. This is by the way a competition to the shelock system.The device is wonderful. It is one hundred % accurate. I tested all the patients i saw with a chest xray to confirm tip placement. I used this device with a measurement technique that i have developed and it works wonderful. Personally, i am comfortable using the line and comfortable convincing a physician to use the line even without a chest xray to confirm placement. I tried selling this idea to a nursing home saying with this method, tip confirmation can be done without a chest xray. The first question thrown to me by the DON was does the machine ( corpak) print anything that says the tip is in the SVC ( which is required by INS/AVA standards)? I said NO.

The question i want to ask the sherlock users are as follows:

1. Are u able to use your PICCs after sherlock confirms the tip is pointing towards the SVC? ( Does shelock print out a report that states the tip is in the SVC ?
2. Is there anybody out there ( hospitals ) that allow the use of the PICC post insertion using sherlock or corpak without doing a chest xray to confirm tip pacement ?
3. If there is, can you share with me how you convinced the hospital?

This device is wonderful and can be equated with a flouro or a chest xray as far as i am concerned. I beleive that we as nurses will be proactive about the use of this device, we may be able to convince everybody that sherlock or corpak is the way to go. I have asked both companies through their sales rep that their company should take the bold step to formally state that their product can compete with a chest xray tip conformation. This way, if we use the product in lieu of chest xray, then WE PICC nurses can do this work more efficiently and be trusted 100% by our collegues.

Patricip R. Collera BSN CRNI
PICC Line Specialists

We still get a CXR....but I tell you they are fast at getting it where I work and then get it on PACs for viewing right away and then we all can read. The Sherlock, of course can not tell you the exact anatomical location and that is what we need to have happen

If we as nurses or bard and corpak cannot use the PICC after insertion with use of the sherlock or corpak, what is the point of using this product. this becomes just an additional expense to the already high expense for inserting a picc. My experience is 99 % of my picc end up in the SVC as long as they advance to my intended lenght. My 1% is azygous, contralateral, coiled on itself. With this situation can i justify spending more for a 1% non SVC placement? The only way i can justify the use of sherlock and corpak is if the report from it can be used as an official report meaning i dont need an xray. I cannot understand why sherlock will sell a product but cannot stand behind its report. It is similar to them (sherlock) saying i want you to use this product but i cannot support you if something goes wrong. i chalenge sherlock and corpak to do a 10,000 patient study, present it to the mdical community and i am convinced they will take this study seriously and hopefully agree to use its report. HOW ABOUT THAT!!

The use of a Sherlock or any TLS for that matter still has HUGE benefits. I have been putting PICCs in since 1989...when we started out we only had single lumens and only had a huge breakaway needle or sheath...I used to have to access with a 12 gauge to place a dual lumen...so I certainly have placed thousands of PICCS. The use of a tip locating system is NOT to verify tip location..it is rather to follow the direction of the catheter tip DURING insertion so you can correct it at the bedside. I think I have seen every malposition there is too see...and believe me I do not see that anymore b/c we can correct them in real time AND it still saves money as we often ended up getting 2-3 CXRs when we did have a malposition....and that does not include the nursing time..additional supplies and possible re-insertion and delays in treatment...it is still a HUGE improvement in our practice and our ability to get a usable PICC so we can get our IV therapies started.....infusion is growing so rapidly that I know it will only get better for PICC nurses out there as well as our patients

There are many many things that are done in the medical field to prevent that 1% bad outcome. The Sherlock does not present itself as a final determination of tip location, it is a navigational aide. If you always see things as black or white, all or none, you are going to get in trouble. As an example, I just read a post on another site that addressed the rare occasion of PICC placed in an artery that no one (incl Radiology) picked up on until the arm started to turn blue. There are all kinds of thngs that can happen, one in a thousand times, so to be confident cuz you're success rate is 99% is setting yourself up for a problem.

my point is is it worth spending 99% to solve a one percent problem? You can look at it from different angles. I agree with you that problems happen when you least expect it. But what i am trying to drive at is if the sherlock or corpak wire technolgy or navigation technology is used, the company should back up it s claim. otherwise, if you just keep on spending without really getting your moneys worth t is not practical. I am trying to share my experience with you not to compete with you. What i am urging everybody is to encourage sherlock or corpak to do a study and present it to the medical community so this technology becomes a standard, because in my humble opinion, if it is not acceptable to the medical community, it is not worth the money spent on it.

Nope....... not trying to compete just give my opinion and experience....and do not agree it only helps 1 percent of the population...many studies have been done pre and post TLS systems and pre...malposition rates were very high...as high as 50 % if you included the RA....so clearly there is a great benefit to patients and nurses and it does save $...ask the PICC nurses if they want to give up that technology and I think you will hear a LOUD "NO WAY" I see your point but again...these are meant to correct malpositions in real time and not used to determine final tip location please clarify a bit about what you mean by the companies not standing behind their products so I can further understand what you are saying....love to have conversations like this

What CLAIM do you say Sherlock is making that they won't back up? I'm going to quote Bard here: "may eliminate REPEAT x-rays", "signal indicates direction of tip position" "increases confidence that catheter is properly positioned". bard then goes on to state that placement should be verified by radiology. I am not familiar with Corpak or the claims that they make. But I get the impression that you are not familiar with Sherlock and the claims that
Bard makes. Bard is actually working on a a new EKG guided product and they are working on clinical studies to prove the accuracy of the product. By the way i have no connection with Bard. When their product comes out, and then I'm sure other companies will get on the bandwagon, I think in due time we will no longer need x-rays. I'm in no hurry. If the day comes that PICC position will be my call, I want to make darn sure that the whatever procedure/equipment I'm using is 100% accurate (not 99%) because I don't want to be responsible for that 1%.

I first PICC'd in 89 and enjoy what I do. 2 years ago our hospital finally evolved th U/S PICC's. I can place about 4 per 8 hour day with the Sonosite and seldom refer to IR for failed attempts.The BARD rep has sold the Sherlock to other hospitals but we elected to not add the $50 expense to each kit for several reasons:

1) Added cost 2) added insertion time due to extra set-up time fiddling with the ( reportedly temperamental) device.3) Before I call for the CXR/placement I place the probe on the neck and visualize the vessel-if it has floated up the neck I can still "save" and reposition.On the infrequent occasion that I am fooled and can't see it there I can take comfort knowing a radiologist will read and clear the PICC for use.

Regarding the use of this device it seems clear that is is marketed as a "navigational aid". I don't begrudge others using it and loving it-we all need certain things to achieve what we feel to be our "best practice".At this point I can't see anyone approving them for confirmation of placement. I am content to let the Dr read the CXR and get the very best read possible for the patient.

I would like to ask the opinion of the PICC experts out there. How does the sherlock system manifest/show when the tip of the PICC is in the azygous vein. I am under the impression that the tip locating machine are directional in nature, in other words it tells you the direction of the tip as opposed to where exactly the tip is. I use the Corpak Navigator Bionavigation System and i have encountered a case where the machine indicated the tip of my PICC to be projecting towards the SVCregion however the chest xray shows the tip is in the azygous vein by approxximately 2 cms. I adjusted this line, but before i retracted the catheter, i used the navigator to see how it would look like ( directional wise). It showed the same as the first time. I proceeded to adjust it and used the navigator which again indicated the tip to be directionally positioned in the SVc region. second xray showed the same with a little difference,but the tip was not too deep n the azygous vein. I have come to a conclusion that the machine cannot really identify when it is in the azygous vein.
Hope to hear from somebody.

Thanks for your opinion