6 How to implement NICE's guidance on Sherlock 3CG TCS

The experiences of NHS trusts have been used to develop practical suggestions for how to implement NICE guidance on the Sherlock 3CG TCS.

Project management

It is the experience of the Health Technologies Adoption Programme that in order to gain maximum benefit, this technology should be adopted using a project management approach.

NICE has produced the into practice guide which includes a section on what organisations need to have in place to support the implementation of NICE guidance.

Project team

The first step in this approach is to form a local project team who will work together to implement the technology and manage any changes in practice.

Individual NHS organisations will determine the membership of this team and how long the project will last. In order to implement this guidance in an effective and sustainable way, consider the following membership of the team:

  • Clinical champion(s): could be a radiologist or physician with an interest in PICC placements. They should have the relevant knowledge and understanding to be able to drive the project, answer any clinical queries and champion the project at a senior level.

  • Project manager: could be someone in a clinical or managerial role and will have responsibility for the day-to-day running of the project, coordinating the project team and ensuring the project is running as planned.

  • Management sponsor: will be able to help assess the financial viability of the project, drive the formulation of a business case and help to demonstrate the cost savings achieved.

  • Vascular access nurse(s): will be valuable members of the project team because they will be providing the service.

  • Clinical audit facilitator: to help set up mechanisms to collect and analyse local data related to the project metrics and audit requirements.

Early questions that the team may wish to consider are:

  • How will the project be funded?

  • How will local metrics be identified and measured?

  • Who will be responsible for collecting clinical data?

  • How will the necessary education be provided?

  • How can effective communication be ensured?

  • Are there any obvious challenges and how can these be overcome?

Measuring success

In order to demonstrate the benefits of adopting the Sherlock 3CG TCS it is important to take measurements before, during and after implementation.

A number of NHS sites have developed Excel spreadsheets to record all PICC insertions to enable local audit.

Overcoming implementation challenges

The implementation challenges reported by NHS sites using the Sherlock 3CG TCS are set out in table 4.

Table 4 Reported implementation challenges when using the Sherlock 3CG TCS

Implementation challenge


Capital and ongoing revenue costs.

Prepare a business case including full cost considerations for PICC placements compared with the current service model.

Select appropriate metrics to demonstrate cost and clinical benefits, safety and demand.

Clinical confidence in stopping routine chest X‑rays for PICC tip confirmation.

Include interventional radiology and senior medical staff who refer for PICCs in the adoption of the technology.

Ask consultant physician or interventional radiologist to independently review all chest X‑rays and ECGs for the placements undertaken during the pilot period.

See insights from the NHS for more information.

Business case development

Resource impact

Some NHS trusts reported that using the Sherlock 3CG TCS reduced their use of chest X‑rays and the number of PICC re-insertions, therefore saving money. Further details of these examples can be found in the insights from the NHS section.

Business case

The implementation team should treat the development of a robust business case as an early priority in the life of the implementation project.

Local arrangements for developing and approving business plans will vary from trust to trust and each organisation is likely to have its own template and process in place.

The following are examples of procurement proposals developed by trusts using the Sherlock 3CG TCS which can be used to inform the development of local business plans.

  • The Bristol Haematology and Oncology Centre developed an implementation application for funding the Sherlock 3CG TCS and consumables.

  • Frimley Park Hospital NHS Foundation Trust developed a project report appraising three options for the purchase and placement of PICCs.


The successful adoption of this technology relies on the knowledge and skills of those staff doing the placements and interpreting the results.

The company offers 2 PICC training programmes: 1 for experienced placers and 1 for novice PICC placers[1]. The appropriate programme must be completed before the operator can be signed-off as being competent with the Sherlock 3CG TCS by a company nurse specialist. Following training all documentation is made available to the practitioner and their line manager for clinical governance purposes.

Competent PICC Placers (2‑week training programme)

  • Experienced PICC placer (as determined by local NHS trust policy).

  • 1‑hour online Sherlock 3CG TCS course and examination including the theory and evidence supporting the technology must be successfully completed prior to hands-on training.

  • Half day workshop covering anatomy physiology, theory and evidence with hands-on skills training for equipment and hardware.

  • Successful placement of at least 6 PICCs with the Sherlock 3CG TCS (observed by a nurse specialist from the company and signed-off using an observational Standard Operating Procedure).

Novice PICC Placers (4‑week training programme)

  • 1‑hour ultrasound for peripheral access online course and examination.

  • 1‑hour vascular access device selection, insertion and management online course and examination.

  • 1‑hour online Sherlock 3CG TCS course (as above).

  • 1‑day on-site advanced PICC placement workshop:

    • anatomy and physiology related to vascular access, catheter device choice, complication management and ultrasound techniques

    • practical training on mannequins, sterile PICC procedure and ultrasound upper arm anatomy scanning.

  • Successful placement of at least 15 PICCs with the Sherlock 3CG TCS observed and signed-off as above. The number of PICCs placed to reach competency will be assessed on an individual basis.

Ongoing clinical support

  • Annual peer review by nurse specialists from the company for PICC placers whose competency must be formally assessed as part of their organisation's clinical governance remit.

  • PICC Precepting Programme Education and Clinical Supervision Day held 3 times a year by invitation.

Development of local documentation

The following are examples developed by NHS trusts using the Sherlock 3CG TCS which can be used to inform the development of local documentation.

PICC insertion records:

[1] Details of how the company support training and education for staff was correct at the time the adoption resource was written (March 2015).

This page was last updated: 25 March 2015