Â Could anyone who is using Navigator tip locating system for PICC placement please let me know who you are and where you are located?
Â Those using Sherlock please do the same.
Victoria Sallese, RN, VAT, PICC service
We have been using the Navigator for years with great success. We briefly trialed the Sherlock because our hospital's contract forces us to use the Bard PICCs, and we absolutely thought it was entirely too cumbersome and a complete pain to continuously calibrate. The Bard rep made big promises about this product but the product offered little if any benefit over the Navigator. Also the Sherlock would lock us into using Bard PICCs which we hope to change when the current contract is up.
I am concerned by the fact that the Sherlock limits you to using Bard products and that it need to be re-zero'ed everytime it is moved.
Jose Delp RN BSN
Clinical coordinator IV Team
Upper Chesapeake Health
CliClinical Nurse Manager IV Team
Boone Hospital Center
The same thing could have been done with the Navigator.
Cindy Hunchusky, BSN, RN, CRNI
We use Navigator here at University of Louisville and love it! I have also used the Sherlock on several occasions. Navigator is a whole lot easier to use. No recalibrations, nothing sitting on your patient, and no trouble with other magnetic devices. I was at a hospital a few weeks ago where Sherlock would not even work (and I mean it would not even come on) due to either the hospitals computer system, or some other magnetic field in their facility. They never really figured it out. Navigator has never had that problem. Also, Sherlock does not give you as much info on where your tip is, no matter where it may end up. If you some how manage to get your tip in the left nostril, the Navigator will find it for you, where as Sherlock will basically only tell you if it is in, or sometime in the area of, the SVC (if you have it positioned right, your patient does not move, calibrated correctly, and Venus is over Jupiter.... you get my drift right?) To much work for me, and I WILL NOT let anyone tell me I have to use a certian catheter to buy their product. I'm just tempremental that way. Like to use what is best for my patients.
And yes, Navigator wires come pre loaded in certian catheters at this time, but if you call the company, Viasys, I am sure you will find them very easy to work with and talk to.
You also do not have to hold the Navigator with one hand as you insert your catherter to track it. You can lay it on the sterile field if it is covered with a sterile bag (an ultrasound probe cover will cover it fine) and listen for the increase in sound as you catheter nears it. You can then pick it up and get an arrow to determine your direction. The arrow is not all that neccessary when you can listen to the increase if sound frequency. All devices have their down falls at one time or another, but i can count on one hand in the last six year of using it, that I have been wrong with it, and I am sure my co-workers would back that up.
I now offer my help to anyone who is having Navigator problems. I assure you they can be straightened out. When we first started using the device, we had no instruction. The developer gave it to us and said, "tell me what you think". That is how hard it is to use. We have used it ever since. Please email me privately with your personal questions and concerns, and I will see if we can fix them.
Have a great holiday!
Another consideration may soon be the CathRite system, which looks very intriguing. From the brief info on the website, it appears that you can actually visualize your PICC in relation to the ribcage to determine tip placement. How amazing would that be! Originally marketed in Australia, there is no indication on the site as to when it will be available in North America.
Picture available at http://www.micronix.com.au/cathrite.php
Daphne BroadhurstDesjardins PharmacyOttawa, Canada
Sorry, I meant to add the reference for clinical trial of the CathRite, which had the following results:
"The PICC was successfully guided into the SVC in 19 patients (100%) in the CathRite group, compared with 14 (74%) in the control group [blind insertion] (P < 0.05). Placement of catheters into the lower third of the SVC was achieved in 14 patients (74%) in the CathRite group, compared with eight (42%) in the control group (P < 0.05). Time to completion of catheter insertion was 31.4 +/- 16.2 minutes in the CathRite group compared with 24.6 +/- 14.5 minutes in the control group (P = 0.18)."
Hockley SJ, Hamilton V et al. Efficacy of the CathRite system to guide bedside placement of peripherally inserted central venous catheters in critically ill patients: A pilot study. Crit Care Resusc. 2007 Sep;9(3):251-5
I am needing some convincing after reading all the comments. Should I go Sherlock or Navigator? Help!
If you use the Sherlock you are locked into using only the Bard PICCs. To me that was a committment I couldn't make and since the Navigator does just as good and most of the time a better job of locating the tip of the PICC, my team thought it was a no brainer to go with the Navigator. Also from what I understand, other PICC manufacturers are working with the Navion to get it "pre-loaded" in their PICCs as well.
Isn't the navigator an old Bard product from the 80's? What picc product are you using, I have trialed several and the nurses have decided to stay with the bard products. What are your thoughts on other products?
I do not know about BARD ever having any ownership of the Navigator product. As far as using the Sherlock and being tied down to the Bard PICC, our staff just didn't want to make that committment. Most of the team has some real concerns about using a tapered catetheter that increases over two French sizes. We already pull a separate MST kit from Arrow because the needle and dilator are much better, we pull a gown, mask, cap, full drape, additional chloraprep, etc. if though we supposedly have Bard's full nursing kit. We have tried some of the Arrow power PICCs and if they would change their cm markings on the catheter and get 5cc/sec power injection approval, I believe my team would like to have a serious trial with them. We will wait and see what comes out in the next few months.
After reading many of your posts over the last hour it is obvious you have an agenda against Bard. Good luck.
Give me a break. If sharing an honest opinion against all mighty Bard is "being against Bard" then you have been drinking the Bard kool-aid too long. I personally think Bard has some good products on the market, but they also have some that are not in the best interest of the patient (ie. a reverse taper that is two French sizes larger then the stated catheter size). I have no dogs in the fight, but I do care about my patients and I refuse to place a catheter that is the size of an regular triple lumen central line (7 French) in their arm!!!!! Also if you are using the Sherlock... you DO have to use Bard PICCs. That is fact not opinion. Using the Navigator allows you to use whatever brand PICC you choose.
OK! So we are not goingto start with the bashing of each other again are we? My thoughts regardgin the use of Navigator were similar. I don't like being limited to one catheter because of my tip locating device. I think Bard will change that when they can prove their device works well enough with other devices. After all they have only been on the market with their system for a couple of years?
I don't think the Navigator was ever connected to Bard. As I understand, it was made by a company called Navion and was then purchased by ViasysHealthcare.com. They also have pre-loaded catheters that you can purchase. The beauty of the Navigator is that it can be used with any PICC.
We have been using the Navigator for 2 years and absolutely love it! It has saved us much cost in time and $$$$ for both the department and the patients: repeat CXR's, overtime, reposition time, catheter reinsertion, IR referrals, total patient time, etc. And of course, without the problem of repositions and repeat CXR's, the patient's perception of the insertion appears to be improved.
Since it is hand held and mobile, it is versatile in its uses. When you feel the sensation during insertion that the PICC malpositioned, you can scan at that time and intervene as needed. You can hold the Navigator in one hand and insert the PICC with another as needed to follow the PICC in with a persistent malposition. And obviously, you can wait until the PICC in fully inserted before you scan. We drape our patient in such a way that we use the Navigator without covering with a sterile cover while maintaining sterility of our field. You can also cover it with a sterile probe cover if you choose. It can be used with patients with Pacemakers or AICD's without any problem. You can instantly see where the tip is.
We did trial the Sherlock and I prefer the Navigator for all of the reasons stated previously. The Sherlock is stationary and required many recalibrations during the insertion. The unit needed to be repostioned on the patient's chest to visualize the tip coming into the SVC range. There was inaccuracy with what was appearing on the screen. For instance, while I was placing a PICC in the right arm, the screen indicated there was a PICC coming in from the left. After reading the instructions that come with the Sherlock I discovered that the Sherlock can be affected by ferromagnetic objects like jewelery, watches, metal instruments, underwire garments, metal bed rails, etc. Electronic pumps within 5 feet of the Sherlock may affect it. Also, you must use care when using the Sherlock with patients with implanted pacemakers since the Sherlock can interrupt the device if the stylette passes to close to the device. It is recommended to use the Sherlock contralateral to the pacemaker.
To eliminate the rare possibility of the Navigator indicator not congruent with the CXR results, it is imperative that you listen to the tone the Navigator makes as you scan. The tone should become higher and more intense as it approaches the tip. The increased tone plus indicator light will give you an accurate tip location. And also, be sure to scan up and down as well as side to side ("+") when you locate the tip. That way, you are also ensuring the location of the tip.
I think the Navigator vs. Sherlock debate will go on and on, just like the PC vs. Mac. Either choice is really okay. In my opinion, to save cost, time and to facilitate a more pleasant experience for the patient, I think all institutions should use a tip locator device. We will probably trial the Sherlock again to satisfy the preference of equipment for our clinicians. Currently we have 2 campuses, 3 navigators and 3 Sono-Site i-Looks. We use Bard Groshongs and Power PICCs and place 1000 PICCs (or more) annually. I am very comfortable with the Navigator and would be happy to help with any questions or concerns. I'd love for you all to have the experience I have with the Navigator: Quick, Easy, Efficient! e-mail: [email protected]
Artie Hansford, BSN, CRNI
Artie Hansford, BSN, CRNI, VA-BC
Thanks, Anna. That was a great attachment.
We are using the Sherlock from Bard and loving it. We are underway to compare the number of xrays per PICC before Sherlock and the number of xrays post Sherlock. It will provide so much info.
The anecdotal info is that before having a tip location system, we were able to insert 4-5 PICCs per 8 hour day. Post tip location system, we are able to insert 6-8 in an 8 hour day.
We are loving it.
The inventor of the Navigator (originally called Cath track, I think) was Don Kay. It was with Bard. Bard chose not to participate (do not know why) and Don renamed his product Navion. That is what it was when we got it almost 7 years ago. Viasys then purchased it from Don Kay about 3 1/2 years ago, and renamed it the Navigator with the Map Cath stylets. I think I got all that right, but if anyone can give a better history (Paul Blackburn- I know your lurking out there some where....) please do. It is a very interesting history, and one I did not know till very recently. It is amazing what all you can learn at AVA conferences!!!! So much fun!!!
And by the way, there seems to be some confusion about the Navigator causing people to do one handed picc insertion. Not true. You can use both hands to insert your picc. I would be glad to explain it to anyone, but email me privately at [email protected], so I do not have to bore everyone with details. ;-)
Have a great weekend everyone out there in PICC land!!
Bard Access Systems
Let me clear up a few points. Bard Access Systems did have a product to place ports and tunneled catheters (I.e. Hickmans) not PICC lines with CathTrack a precursor to Navion. CathTrack was not well received by MD's and has some glitches that fluoro did not display. MD's preferred fluoro for the placement of a port and tunneled line. I don't blame them. Although Sims Deltic still has a product similiar to CathTrack to place ports and tunneled lines. Bard never used CathTrack for PICC lines. CathTrack later evolved into Navion.
The Australian product that is Micronix and maybe the CathRite system is not a real time picture of the rib cage you are looking at. It is an embossed picture on the screen and the system is base on anatomic measurements. It is not available yet in the U.S. market. It is not a real time image of tip and rib cage. If you find one of those I would like it as well.
As far as Navigation systems at this time there are two that are available. The Navion and Sherlock. You need to try both. I suggest that. The Sherlock is now available on the SiteRite screen as well. I suggest always trying what is on the market and formulate your own opinion and what works for your hospital and staff. I would never bias or influence your decision as I have seen other clinicians who wok as consultants for manufacturers do. They shall go un-named. I find it funny that after twelve years of independent consulting and now one real as a full time Bard employee I still maintain my ethics in providing all sides. Try both!!!!!
Can we keep the commentary professional here? I am not on this listserv often and cmment rarely but it doesn't take much to see people throwing darts at each other here.
I have been evaluating both products. I wouldn't buy a car without checking consumer reports and that is why I asked the original question here. (Checking with other consumers). I have to saythough that I cannot purchase a product for our patients from a company that does not provide me the opportunity to trialit for bedside insertions.
This is said as professionally as possible.
As I recall in 1999 when RN's thought I was crazy I wrote the second (after Guy LaRue) article on RN's using portable utrasound to place PICC lines. The majority of PICC line inserters thought they were successful without it at the time.
We are going into 2008 and the only way to place a PICC will be navigation of some kind for the future. The handwriting is on the wall.
I will not sway anyone to which device nor will I show a preference. As your comment states lets be professionals here therefore a professional provides no bias. I am glad you are trying both that is a smart decision. The bottom line is to find a naviagion system that works for you because that is the future. I know that because there are so many new companies working out there on new systems it is mind boggling. I personally have seen three new ones at the last AVA meeting that will be possibley coming to market.
The bottom line is to start thinking navigation.
My comments are ones of future vision or clinically based rarely do they ever address a product unless I have mentioned all products on the market that are sold under that type of design. I am very very careful at what I write. I believe my personal reputation is more important than anything and I do get upset when I hear comments on this ist that slame product A or Product B. It is unfair. I work very hard at representing a factual impression based on published clinical studies if there are any or market trends based on healthcare lectures, websites, articles.
I am as a reprsentative of a Medical Company very concerned what I say. I am so careful that I always try to list all the companies providing devices when I do mention a device name. I think that is the only responsible thing to do.
Are we done now?
I've been using Navigator since it first hit the market as Navion. I'm truly sold on its ability.... you're welcome to head south & see it in action.
How far south?
Guess it depends which campus you work at.... I'm in Chesapeake VA. Probably 4 or 5 hrs from the top of the bay.
Not so far.... and you may hear from me soon.
Same invitation stands from the big ole' U here in Louisville. I'll even go one farther and let ya stay at the homestead. We would love to have ya, and we will give you several Navigator demo's. Then we can go home, saddle up the horses and go for a ride!