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I went and trained at a university hospital and used it for 12 PICC placements. I really liked it and the nurses there really liked it. It sometimes does get some interference but in general it worked very well. you really tell when it went up to the jugular. We used the battery pack one that was not connected to the US machine but it was fine. I guess it is even better when you get the sonisite it can be attached to. Does anyone know how much the battery pack one costs?
Yes have used them both and much prefer Sherlock 2. It is so much easier to see the screen and the tip is highlighted with what we call jokingly call the lollipop. You need to read the manufacturers guidelines so you are aware of the problem of parallax. Could you tell me what kind of problems you are having ?......most can be solved....b/c the benefit of being able to make corrections at the bedside in real time is great!!!!! We have found you need to wait to calibrate until after you have used the dilator and removed the wire b/c you can get interference and you MUST advance your catheter slowly (1 cm per sec) or the screen image of the sylet whips around on the screen,,,,,go nice and slow and it works perfectly. Once you learn what perfect looks like you can easily detect malpositions and correct them.
The Sherlock was really cheap......the price can vary .....if your hospital buys a lot of BARD products they give you a better price. i think ours was $2500.00 or therabouts.it pays for itself in a few extra chest radiographs and a few re-positions or PICC re-dos. The Sherlock loaded PICC kits cost a bit more based upon the actual product...that varies too but the range is 35-60 dollars extra per kit. Again you have to look at all the cost saving achieved by being able to correct malpositions in real time at the bedside,not to mention all the benefits to the patient.
That sounds not too bad. I think it would pay for itself. We do order bard and I think we have been thinking of getting the basic kit with microintroducer and then put our own extra stuff in a kit to go with it. I cant wait to start putting them in. We are getting all our supplies and will take over doing PICC's in our out pt treatment center.
Make sure and metal including patient jewlery is our of the way or you wll get interference. Siderails may need to be down and IV pumps need to be 3 feet away...also discovered that an underwire bra will cause interference as well...had this happen twice...as well as an I-pod headset. Also the nurses rings and watches can also be problematic. It is really easy to control if you just check everthing before you start.
Bard will be coming out with an EKG guided tip locating system by the end of the year. You may want to wait until that happens because it will be integrated with the Sherlock. Ultimately, in the near future, I think the need for x-rays will be eliminated. Aside from that, I love my Sherlock. I find that when there is a problem it is usu the Sherlock telling you what is really going on. You need to trust it.
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!!