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 through a vein in or near to the arm, this is known as a peripherally inserted central catheter (PICC).

The medical technology guidance from the National Institute for Health and Care Excellence encourages the NHS to use 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 X-raying the patient, then waiting for the X-ray to be 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 compatible 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 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 MBE, director of the NICE centre for health technology evaluation, said: “This final guidance supports the Sherlock 3CG Tip Confirmation System for placing peripherally inserted central catheters. These catheters are commonly used in providing treatment or monitoring in many clinical settings including operating theatres, intensive care, and cancer wards.

“Having examined the evidence, the independent Medical Technologies Advisory Committee has concluded that using the Sherlock 3CG Tip Confirmation System is likely to benefit patients and the NHS. Using the Sherlock system avoids the need for a chest X-ray to confirm catheter position, which is 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.

“In many cases use of Sherlock 3CG TCS system will be at a similar cost to current insertion methods and in certain clinical situations there are potential savings of up to £106 per patient. We hope that this guidance will encourage health staff to use the Sherlock 3CG Tip Confirmation System given the benefits to patients and to the NHS.”

The medical technology guidance for the Sherlock 3CG Tip Confirmation System is available at: http://www.nice.org.uk/guidance/mtg24.

ENDS

For more information call Dr Tonya Gillis at the NICE press office on 0300 323 0142, or out of hours on 07775 583 813.

Notes to Editors

About the NICE guidance

1. The medical technologies guidance, “The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters”, is available at http://www.nice.org.uk/guidance/mtg24 from 25 March 2015. Embargoed copies are available from the NICE press office on request.

2. The Sherlock 3CG Tip Confirmation System (TCS) is manufactured by C.R. Bard.

3. 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, and it can save £106 per patient in cases where when fluoroscopy would otherwise be used.
In intensive care where PICCs are more likely to be placed incorrectly using blind insertion, the savings from using the Sherlock system and a confirmatory X-ray are estimated at around £41 per patient compared with blind insertion and standard X-ray. (In intensive care settings, staff sometimes initially use Sherlock with confirmatory X-ray whilst they are becoming accustomed to using the Sherlock system.) All these savings are subject to some uncertainty and need to be considered in the context of the clinical advantages.

4. A review in 1994 estimated that there were more than 200,000 central venous catheters (including PICCs) inserted in the UK annually.

5. The cost of the Sherlock 3CG TCS is stated in the sponsor’s submission as £9,990 (excluding VAT). The cost of consumables associated with each insertion is £189.91. Maintenance costs associated with the technology are £595 per annum.

About the Medical Technologies Evaluation Programme

6. The focus of Medical Technologies Evaluation Programme is specifically on the evaluation of innovative medical technologies, including devices and diagnostics. The types of products which might be included are medical devices that deliver treatment such as those implanted during surgical procedures, technologies that give greater independence to patients, and diagnostic devices or tests used to detect or monitor medical conditions. The independent Medical Technology Advisory Committee has two core remits: selecting medical technologies for evaluation by NICE guidance programmes and also developing medical technologies guidance itself. The guidance applies to the NHS in England, and is not mandatory.
More information is available at http://www.nice.org.uk/MT.