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New Technology: A Positive Impact on Patient Care

by Elizabeth Miniscalco | Dec 21, 2018

The Cancer Center has a new technology used for the insertion of Peripherally Inserted Central Catheters (PICCs). PICCs are used for many patient groups including
those requiring chemotherapy agents and antibiotics. PICC use has increased due to cost effective nurse insertion teams, increased patient satisfaction and to facilitate
out of hospital care. This new technology is called the Site Rite 8 Ultrasound and the Sherlock 3CG Tip Confirmation System (TCS). This is a fully integrated venous access,
visual magnetic tracking and electro-cardiogram (ECG) based tip confirmation system.

Before this new technology was available, proper PICC tip placement required a confirmatory chest X-ray. This X-ray takes time for the nurse to enter the order. Radiology staff then arranges to carry out the order and take the Chest X-ray. The X-ray images are reviewed by the Radiologist and a report is dictated. The report once generated is available for the PICC nurse to review and ensure that the tip is in the desired location. All of these steps result in delays in getting the intravenous medications started. These X-rays contribute to increased operational costs and more importantly increase the radiation exposure to our patients.

The magnet tracking and ECG technology is indicated for guidance and positioning of Peripherally Inserted Central Catheters.This technology provides real-time PICC tip location information by using passive magnet navigation and the patient's cardiac electrical activity. As a result the X-ray is not required, improving the treatment start times, decrease patient exposure to radiation and decreasing overall cost.

This is a valuable technology with the following benefits:

    1. Improved picture quality
    2. Touch screen capability
    3. Pinpoint guidance technology designed to shorten the learning curve for the nurses on how to insert the needle into the vein, The needle interacts with the probe to guide the nurse on what angle to hold the needle and gives proper tip positioning before insertion into the vein.
    4. Sherlock 3CG software confirms the PICC tip placement and eliminates the need for an X-ray on any patients with consistent ECG waveforms. This new technology is color coded and shows up green when a nurse reaches the target which is  the caval atrial junction (CAJ) or the lower third of the superior vena cava (SVC) which is the optimal location for the PICC tip.
    5. Vessel measurement tools to give the clinician the vessel's size and the catheter to vein ratio.The goal here is to strive to take up less than 45% of the vessel to potentially reduce the risk for a blood clot.
    6. Customized fields for documentation
    7. Wireless dicom connection where the nurse can automatically download the ultrasound images and EKG waveforms into PACS.
    8. Ability to save vessel images and EKG waveforms to ultrasound's hard drive which allows clinicians to do several PICC insertions in a row without the need to stop.

PICCS are an integral part of patient care due to low insertion costs and the facilitation of out of hospital care. Our patients have benefited from our PICC line services for decades.

With this new technology the patients will experience an improvement in PICC tip location, no requirement for Chest X-ray, diminished delays, and decreased radiation exposure.
This quality improvement will provide a better patient experience and promote staff satisfaction.