National Institute for Health and Clinical Excellence (NICE)
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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NICE is consulting on draft guidance about a device that aims to make it easier to place a catheter correctly when it’s inserted through a vein in the arm.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 technologyevaluation, 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: The consultation closes on 9 December 2014. 

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 draft guidance

1. The draft medical technologies guidance, “The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters”, is available at from 11 November 2014. 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.
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About NICE

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