3CG TCS use?

[nurseprnRN, BSN, RN]

"When relying on the patient's ECG signal, the Sherlock 3CG TCS is indicated for use as an alternative method to chest X-ray and fluoroscopy for P1CC tip placement confirmation in adult patients."

Is anybody able to PM me about using this? Experience? Training? Nurse/physician placed? What kind of facility used in? Xray confirmation required? I am clueless but have been asked to find out what there is to know, and somebody here must know!

[iluvivt, BSN, RN]

Yes I can tell you about it but I have to see a patient right now so when I get home I can do that. I place PICCs using the BARD Sapiens. I have seen the Vasanova as well which also uses Doppler in conjunction with the ECG to confirm tip placement.

[nurseprnRN, BSN, RN]

This was the exact question I was asked:

"Anyone out there using electromagnetic visualization by RNs to confirm accurate PICC placement? If so, is there an age range (i.e., No Pedi) or a cardiac indication, (i.e., pt must be in NSR)?"

Thank you so much, iluvivt! Do you have any protocols or training/demonstration requirements for nurses doing this?

[iluvivt, BSN, RN]

It would not let me PM you..It said you are not accepting

See if this helps:

The system you are asking about ( Sherlock3CG/TCS) by BARD is an integrated system that allows you to track the catheter in real time as well as using cardiac signal detection.to confirm a tip placement at low SVC at or near the cavoatrial junction (CAJ) as long as certain parameters are met. The catheter has a preloaded magnetic stylet. The TLS (tip location system/Sherlock) is placed over the chest in the target area. (touching the neck) As you are threading the catheter into the central circulation the Sherlock II sensor detects the changes in the magnetic field (it must be calibrated before use or if is ever lifted from its position) and then displays the stylet tip location and orientation. You need to make sure your stylet does not protrude past the catheter to ensure accuracy. Some clinicians tape it but I prefer to just fold mine over and make sure it stays that way!

You can use the Sherlock II TLS without using the ECG component but in that case you will need to verify tip placement with a chest radiograph. Here are the IFUs for the product.

http://www.bardaccess.com/assets/pdfs/ifus/0715972_Sherlock_II_TLS_IFU_web.pdf

The 3CG stylet also allows cardiac signal detection as the catheter stylet combo acts as internal intravascular electrode. The P wave will increase in amplitude as it approaches the CAJ. When the P wave reaches it maximum amplitude (its max P) it is at or near the CAJ. Once you have determined that the patient is a candidate for using the ECG technology (at least at this point) Prior to placing the PICC you set up 2 leads and get you ECG tracing on the screen . After you have advanced your PICC to the premeasured length that you determined you attach the wire from the catheter stylet to the fin and this slides into the Sherlock that is sitting on the chest. You can do this through a sterile drape. I just use the clear section of our drapes since the drape we use is thick. Once you set that up you flush with some NS through the stylet loaded lumen to stabilize the ECG. You will then see your internal ECG waveform as well as the external ECG waveform. You can also still see the Sherlock, You can copy and freeze your waveforms so you can compare them and nail the tip placement , Determining max P can ranged from being easy to a tad difficult. The P wave MUST be present, identifiable and consistent ( I remember this as PIC (clever I thought)) and with no negative defection. Here is where your question comes in.....It cannot be used unless the patient is in Sinus rhythm and it is easy to understand why once you understand how the system works. You must get a copy of the tracing and place it in the chart and have some charting mechanism to communicate that the tip has been confirmed by the use of ECG TCS system.

Here are some more IFUS

http://www.bardaccess.com/assets/pdfs/ifus/0728446_Placement_3CG_Sherlock_IFU_web.pdf

Bard has a video course that is free but you do need to call and get an access code. Once you set that up and access the course you have access to it for 90 days but then after that you can just re=register for it if you need to see it again

. https://www.bardaccess.com/clinical_training/course_overviews.php

[iluvivt, BSN, RN]

I will post some more and answer the rest of your questions in a bit. This will give you some food for thought and call the number on the training website to get an access code and watch the two videos as they explain it well.

[iluvivt, BSN, RN]

Here is an good learning tool that explains terminology.

http://www.angiodynamics.com/uploads/pdf/072514-080922_NAVED_150_ECG-Education_Rev1.pdf

[PICC'N&GRINNING]

Grn Tea

I am on the VAC team in a rural hospital(team of 3 and 1/2). We average about 3 PICCs a day. We use 3CG and LOVE it. Once you've become familiar with the system, it cuts down wait time for x-ray confirmation and radiation exposure to your patient. We do bedside chest x-ray on about 7% of our PICC patients due to a-fib or paced rhythms. It was super easy to learn. The biggest thing for me was building confidence in my own assessment of tip placement. For several weeks I continued to do routine CXR in addition to 3CG and my placements have been in the distal SVC or at the cavoatrial junction when trimmed appropriately.

[Ellie G]

I love it. We just started using it a few weeks ago and it is a huge time saver as we don't have to wait for x-Ray confirmation. As long as we have a p-wave, it's gold