sherlock

Our hospital uses the Sonosite for placement of PICC's and after review of the directional guides available concluded that the time used to set one of them up,the added cost of the equipment and STILL having to get a CXR to determine placement did not make sense. A small number of PICC's we place require redirection after going up the neck,curling,looping,rarely transversing. I use the Sonosite to view the neck vessels after placement and have caught the PICC up the neck and redirected BEFORE the CXR. Occasionally I have missed the catheters presence there even when I try my best to see it before the CXR.Also,it is not even possible to do this manuever if the pt has a trach strap,is intubated or has an existing IJ line on the PICC side already.The end game is that there is still a CXR necessary for absolute tip confirmation.Relying on a directional guide, though helpful to some practitioners has it's limitations but I will concede that if using the device helps to better your practice then continue with it's use.

How does the sherlock show when the tip of the PICC is in the azygous vein. This is my question. As far a effectiveness, it depends on who pays for it. If i were to pay for it, i will not use it. If the hospital pays for it, i go for it. The only time that this equipment will be totally and convincingly be useful is if its result is acceptable to the medical community. Its a good help in terms of time but not financially helpful.

Thanks for your opinion.

Sherlock won't tell you that either. It gives you the approximate location of the tip of the PICC, but a lot depends on your measurement. It gives you a change in tone when it believes the PICC is SVC, but the CXR is still needed to confirm. As an aside, I love the Sherlock because there are times when I wouldn't know the PICC was going up the jugular without it. To me, it's worth the cost. So far this week I've put in about 8 PICCS (we trade assignments and I was only the PICC nurse one day, but did an extra two PICCS to help out) and the PICC was trying to go up the jugular on two of those patients. That fact alone justifies the cost of Sherlock to me! We average about 50 PICCS per week in my hospital and the savings in having to reposition and re-xray makes the Sherlock worth it! Hope this helps, PICCLINEMAN

you will still know when your tip is in the jugular vein WITHOUT sherlock or naviagtor. Use your ultrasound. So the sherlock/naviagtor is really useful to help identify your line is in the rpojection of the SVC RA region/contralateral/retrograde. This is also useful for me in cases where i dont want to readjust lines such as combative /confused/severly anxious/ cases where you opnly have one arm to work on.This is probably in my experinece 1% of my population. If not for this and the fact that i have to cater to several hospitals, i probably will not use it. I just got frustrated over one of my cases thw other week where two times i used the naviagtor and it was in the azygous vein. Thanks for your opinion.

I'll admit I hadn't thought of using the ultrasound to check the jugular....but then your ultrasound probe cover wouldn't be sterile anymore and you'd have to put on a new one. possible to do, just a pain. Our hospital policy requires us to use the Sherlock anyway, so it's not an option. I do appreciate the information, though...if Sherlock ever isn't working correctly during the procedure I'll check the jugular with the ultrasound! We also must have two IV team nurses present to insert a PICC, except in extreme circumstances. Sounds like you're on your own. God bless you! =) Glad to know the Navigator is an option, too. Take care.