Guidance

4 NHS considerations

4 NHS considerations

System impact

4.1

The company claimed that the Sherlock 3CG Tip Confirmation System (TCS) increases efficiency in the care pathway by eliminating the need for a confirmatory chest X‑ray following the insertion of a peripherally inserted central catheter (PICC). The costs and time involved in transporting patients to an X‑ray department for a confirmatory X‑ray would be eliminated in most cases. This would reduce staff requirements, particularly in nursing and radiology, and allow these staff to be directed to other areas of need.

4.2

Experts also advised the Committee about potential system benefits associated with the reduced need for fluoroscopy and reduced number of X‑rays, including cost savings and an increased throughput of patients, meaning that patient access to radiology departments would be quicker and more efficient. One expert also advised that earlier access to infusion treatment may result in earlier discharge of patients from hospital.

4.3

The Sherlock 3CG TCS was launched in the UK in April 2013. The company reported that it was being used in 14 NHS hospitals in England and 2 in Northern Ireland. The company also stated that 9 of the English hospitals have discontinued routine chest X‑ray confirmation following PICC placement. The External Assessment Centre was able to confirm this for 6 of the 9 hospitals.

Committee considerations

4.4

The Committee recognised that avoiding the need for routine confirmatory chest X‑rays by using the Sherlock 3CG TCS for PICC placement would release resources in X‑ray departments. It would also mean that nurses and porters would not be needed to help transfer patients between X‑ray departments and other parts of the hospital.

4.5

The Committee noted that using the Sherlock 3CG TCS could increase staff and patient confidence compared with using blind insertion. An expert adviser from a hospital which has discontinued X‑ray confirmation advised the Committee that procedures performed without the Sherlock 3CG TCS now feel more uncertain and less secure.

4.6

The Committee considered the need for training in the use of the Sherlock 3CG TCS. It recognised that there is a learning curve associated with the technology and that confirmatory chest X‑rays may be useful during this phase. It was also advised that clinical experience and judgement are needed to use the system reliably. An expert adviser described to the Committee some incidents of the ECG component of the Sherlock 3CG TCS showing that the PICC had reached the cavoatrial junction before this was actually the case. This could have led to a malpositioned PICC without sufficient understanding of the procedure and the application of appropriate clinical judgement.

4.7

The Committee was advised that the Sherlock 3CG TCS may also be useful for patients for whom it is difficult to identify a P wave (patients with atrial fibrillation, tachycardia, or paced rhythm). In such cases, the magnetic tracking component functions normally and can help to guide insertion, although a confirmatory chest X‑ray is still needed in these patients.