1 Recommendations

1 Recommendations

NICE medical technologies guidance addresses specific technologies notified to NICE by companies. The 'case for adoption' is based on the claimed advantages of introducing the specific technology compared with current management of the condition. This case is reviewed against the evidence submitted and expert advice. If the case for adopting the technology is supported, then the technology has been found to offer advantages to patients and the NHS. The specific recommendations on individual technologies are not intended to limit use of other relevant technologies which may offer similar advantages.

1.1 The case for adopting the Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters is supported by the evidence. The technology usually avoids the need for a confirmatory chest X‑ray in patients who would otherwise have blind insertion, minimising the delay before the catheter can be used for infusion. Using the technology increases staff confidence during catheter insertion.

1.2 The Sherlock 3CG Tip Confirmation System should be considered as an option for placement of peripherally inserted central catheters in adults. For patients whose electrocardiogram does not show a P wave (for example, patients with atrial fibrillation), a chest X‑ray will still be needed to confirm tip location of the peripherally inserted central catheter.

1.3 The cost of using the Sherlock 3CG Tip Confirmation System (TCS) is similar to that of blind insertion and subsequent chest X‑ray in adults who need a peripherally inserted central catheter in a non‑intensive care setting. When the Sherlock 3CG TCS is used instead of fluoroscopy, the estimated cost saving is £106 per patient. In an intensive care setting, where the rate of misplacement with blind insertion is generally higher, there is an estimated cost saving of £41 per patient per use of the Sherlock 3CG TCS and a confirmatory chest X‑ray compared with using blind insertion and chest X‑ray. All these cost savings are subject to some uncertainty and need to be considered in the context of the clinical benefits.

  • National Institute for Health and Care Excellence (NICE)