I supervise the IV team at a childrens hospital, and we went live with sherlock 3CG in January. We are having trouble getting consistent tip locations-they are all over the place.. I have seen this system work well in adults, is anyone else using this in peds? Anyone have problems?
Thanks for the input.
Hi,
I place PICCs in both adults as well as peds. I have tried to use the 3CG on PEDS, but find that in smaller children, especially infants, the 3CG isn't helpful. When I get a perfect max P-wave and the "green diamond" on small children/infants, the PICC tends to be in the atrium after the x-ray is shot. Most of the time I end up retracting and reshooting the x-ray. I rely more on measurements for placement in children but utilze the sherlock to make sure the PICC has dropped into the SVC. As you mentioned, it works great for our adult population as long as there heart rhythm is regular (ex. no Afib).
We have had a lot of success with IC-ECG in our PICU. Now we do not use the Sherlock system. I also have not used their system so am not familiar with the details.
Some things that have caused us to be deep are that people will set the PICC to a maximal P-wave when the arm is still abducted 90 degrees then when the CXR is taken the arm is to the side and the PICC is deeper as expected. Also I have found with 2.6F PICCs the stylet can cause the PICC to be a bit more "straightened out" as it curves down the SVC it take a wide radius. When the stylet is removed the PICC relaxes around the turn and sits lower. What I have done is retract the stylet so it is only in the PICC a few cms and flush with saline to provide a saline column then the stylet does not cause issues with "straightening out" the line.