Clinical use of Sherlock-3CG^® for positioning peripherally inserted central catheters

Intracavitary electrocardiogram technique is recognized as a safe, accurate, and inexpensive method for verifying the tip location of central venous access devices. While the technique can be carried out with any standard electrocardiogram monitor, dedicated electrocardiogram monitors specifically designed for the intracavitary electrocardiogram are also available. One of these dedicated monitors is Sherlock-3CG^®, characterized by the integration of a magnetic-based tip navigation method with an electrocardiogram-based tip location method.

In this prospective study, we inserted 130 peripherally inserted central catheters using Sherlock-3CG, evaluating the safety, feasibility, and accuracy of both tip navigation and tip location. Magnetic-based tip navigation was compared with ultrasound-based navigation; electrocardiogram-based tip location was compared with electrocardiogram-based tip location performed by another dedicated monitor (Nautilus^®) and with post-procedural tip location by chest X-ray.

All insertions were successful and the overall safety of the device was 100%. In terms of tip navigation, the maneuver was feasible only in 81%; the accuracy was 100%. In terms of tip location, feasibility was 94% and accuracy was 100%, while Nautilus showed a 100% feasibility and 100% accuracy.

Our study could not demonstrate any specific advantage of Sherlock-3CG either as a magnetic-based tip navigation method or as an electrocardiogram-based tip location method.