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NICE plans to support a device to help with positioning catheters in veins

NICE is consulting on draft guidance about a device that aims to make it easier to place a catheter correctly when it’s inserted through a vein in the arm.     

Catheters are thin tubes put into the body which can be used to deliver liquids such as antibiotics or other drugs, so avoiding the need for frequent needle injections. Catheters can also be used in monitoring the body’s functions continuously – such as blood pressure in the central veins near the heart and taking blood samples. When catheters are placed in the body though a vein in or near to the arm, this is known as a peripherally inserted central catheter (PICC). 

The draft medical technology guidance from the National Institute for Health and Care Excellence supports the case for using the Sherlock 3CG Tip Confirmation System for placing PICCs.  

The standard procedure for placing PICCs is blind insertion of the catheter (where there is no imaging to help with positioning it) followed by a chest X-ray to check the catheter’s position.  The process of taking the patient to the X-ray department, then waiting for the X-ray to be performed and checked, can delay the start of treatment or monitoring.  In some cases, fluoroscopy (an imaging technique that uses X-rays to obtain real-time moving images of inside the body) is used instead of standard X-ray to assist with positioning the PICC in patients where placing is difficult. 

The Sherlock system uses magnetic and electrocardiographic (ECG) real-time tracking of a PICC made by the same company to enable the person placing the PICC to detect and correct any error in how the tip is positioned. The device manufacturer claims that the benefits of the Sherlock System include the catheter being more accurately positioned, thus avoiding the need for the patient to have an X-ray to confirm exactly where the tip of the catheter is. This avoids delays associated with having an X-ray so the PICC can be used as intended more quickly. 

Across the whole population in which PICCs are placed, the cost of using the Sherlock system is similar to blind insertion followed by X-ray, but it can save up to £106 per patient in specific clinical situations. 

Professor Carole Longson, director of the NICE centre for health technology evaluation, said: “Using catheters in providing treatment or monitoring is a common procedure, often performed in operating theatres, intensive care, cancer wards and many other clinical settings.   

"This draft guidance, developed by the independent Medical Technologies Advisory Committee, proposes supporting the Sherlock 3CG Tip Confirmation System for placing catheters in central veins.  Using the Sherlock system avoids the need for a chest X-ray to confirm catheter position, which is often required with blind catheter insertion. This avoids any related delay in using the catheter for providing treatments or in monitoring. Using the technology also increases staff and patient confidence of the accuracy of the procedure during catheter insertion. We welcome comments on the draft guidance during this consultation.”

More information on the medical technology draft guidance consultation for the Sherlock 3CG Tip Confirmation System is available at: http://www.nice.org.uk/guidance/indevelopment/GID-MT234. The consultation closes on 9 December 2014.