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Time and resources of peripherally inserted central catheter insertion procedures: a comparison between blind insertion/chest X-ray and a real time tip navigation and confirmation system
Authors Tomaszewski KJ, Ferko N, Hollmann SS, Eng SC, Richard HM, Rowe L, Sproule S
Received 1 September 2016
Accepted for publication 2 November 2016
Published 7 February 2017 Volume 2017:9 Pages 115—125
DOI http://doi.org/10.2147/CEOR.S121230
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 2
Editor who approved publication: Dr Giorgio Lorenzo Colombo
Background: The
Sherlock 3CG™ Tip Confirmation System (TCS) provides real-time peripherally
inserted central catheter (PICC) tip insertion information using passive
magnetic navigation and patient cardiac electrical activity. It is an
alternative tip confirmation method to fluoroscopy or chest X-ray for PICC tip
insertion confirmation in adults. The purpose of this study was to evaluate
time and cost of the Sherlock 3CG TCS and blind insertion with chest X-ray tip
confirmation (BI/CXR) for PICC insertions.
Methods: A cross-sectional, observational Time and Motion study
was conducted. Data were collected at four hospitals in the US. Two hospitals
used Sherlock 3CG TCS and two hospitals used BI/CXR to place/confirm successful
PICC tip . Researchers observed PICC insertions, collecting data from
the beginning (ie, PICC kit opening) to catheter tip confirmation (ie, released
for intravenous [IV] therapy). An economic model was developed to project
outcomes for a larger population.
Results: A total of 120 subjects were enrolled, with 60
subjects enrolled in each arm and 30 enrolled at each of the four US hospitals.
The mean time from initiation of the PICC procedure to the time to release for
IV therapy was 33.93 minutes in the Sherlock 3CG arm and
176.32 minutes in the BI/CXR arm (p < 0.001). No malpositions were
observed for PICC insertions using the Sherlock 3CG TCS, while 20% of subjects
in the BI/CXR arm had a malposition. BI/CXR subjects had significantly more
total malpositions (mean 0.23 vs. 0, p < 0.001). For a hypothetical
population of 1,000 annual patients, adoption of Sherlock 3CG TCS was predicted
to be cost saving compared with BI/CXR in all three analysis years.
Conclusion: The results from this study demonstrate that Sherlock
3CG TCS, when compared with BI/CXR, is a superior alternative with regard to
time to release subject to therapy, malposition rates, and minimization of
X-ray exposure.
Keywords: vascular access devices, catheters, catheterization,
peripheral, X-ray therapy, cost analysis, Time and Motion studies
摘要视频链接：Comparison of chest X-ray and Sherlock 3CG™
