I've searched the forum and read all of the discussions. Our staff would like to hear from clinicians - non vendor-related - that have completed a lengthy product evaluation of both the Vasonova and the 3CG. We've completed an extensive 2-3 month eval for each device.
I've made up my mind, but the staff have unresolved issues/questions.
If you're a non-vendor related clinician who has been through a thorough product evaluation, please comment here, including to say WHY you chose the device that you chose. If you know of such folks, by all means, please point me in their direction.
Thank you!
Mari
First, I do not work for Teleflex.
I did an IRB approved study with the VSP(G4). Results were impressive 25 patients in normal sinus rhythm achieved a “Blue Bulls Eye” and correlated with the CXR 100%. 5 patients had A-fib, 3 of the 5 A-fib patients also achieved a “Blue Bulls Eye” and they too correlated with the 3 CXR. The 2 patients that a “Blue Blues Eye” was not achieved were left on a green arrow and the CXR reviled lower one third, this was a positive unexpected outcome to get the “Blue Bulls Eye in the A-Fib patients. I personally liked not having to depend on the single vector technology. Having three vectors was much more reassuring. I have a low malposition rate, having the algorithm was a nice addition. Eliminating the CXR was the goal and the end result of the study.
I also decided on this technology because I am moving to the placement to CVCs. This technology can be used with CVCs as well. My physicians are also very interested in using it too. So now we can eliminate CXR for CVCs and PICCs placed by physicians and nurses.
The technology attached nicely to the ultrasound, the remote control for the G4 is very convenient.
Finally the G4 can be used with any PICC; we use two different PICCs and don’t know what the future holds as far as GPOs. This technology is very versatile and does not tie me to one product line.
we trialled both last year
we started using VSP Jan this year
one advantage of VSP is that we do not need to interpret the result/finding
(the VSP 'diagnoses' the tip location, not the RN)
when the RN needs to know well how to interpret the p waves, that makes the competency part tricky
please email me -- [email protected]
I would like to know your finding
or I can call you if you give me your #
We did not trial the Vasonova but we did trial the 3CG and we did go with the 3CG. We have been using the 3CG since Feb. of this year and we love it. We eliminated chest x-rays within one month of starting use of the 3CG. Having the Sherlock gives us the satisfaction of knowing the PICC is going South and then the P-wave reading is easy. I cannot say I have had it work for any patient's in A-fib but at least I know the PICC is heading toward the SVC/RA junction with the Sherlock. We have had the Sherlock for about 4 years. We have a Vision and a SiteRite 6 ultrasound. All the software is in the Vision and we are getting the software upgrade for the SiteRite 6 very soon. I have seen the Vasonova in another hospital in use but with the Sherlock I feel more comfortable seeing something on a screen. Another reason we would not consider the Vasonova is because we work alone I saw how you either have to have a second person to hand off the wire to or you have to contaminate your gloves, plug in the wire, and then put a new pair of gloves on with the Vasonova. Don't like that part at all.
Good luck in evals.
Karen Y. VA-BC
Denver CO
Karen, we work alone too (unfortunately), but the manufacture supplies sterile slip covers (at no extra cost) so that everything is connected sterilely. On the VSP you see 3 different indicators on your screen, giving you information that the tip is going down. Best part is, in A-fib patients you get two of the three indicators so you know you are in the lower one third and are confident that you don’t have any malpositions.
We have not trialed the Vaso Nova. It seems like fine product and would give you some additional information. I did sit in on an informational group when all of these products were coming out. I was interested in all. I told them then that I thought we would get enough information from aflutter and possibly afib to help guide. They said they weren't expecting anyone to be versed that much in ECG rhythms. We were already Bard users and so the upgrade to 3CG was easy. We have been using it over a year and we love it. While I would like to have the additional information that Vaso Nova offers, I can't at this time justify the additional costs for the product.
3CG - For patients in normal sinus rhythm you are finished it is ready to go. I have had years of telemetry experience and so have made good use of that with looking at the changes with afib and aflutter and even some paced (atrial pacing doesn't work, although I did think I then saw atrial activity as a result and I have only had this once, the tip ended in the right spot, may have been because I have gotten good at measuring). Most of the time you will see appropriate changes that will guide you in your placement. I have only had to reposition once in this past year. That afib was incredibly chaotic and I think I have learned more since then. All the other since have been at or near the SVC/CAJ area. So the patient only gets one CXR. I made a mistake with a patient with a really long 1st degree block. I turned out to actually be a stable complete heart block and what looked like a p-wave was actually coming from the AV-node. My tip ended up well into the atrium. So just a warning. Watch out for very long PR intervals. If you are not familiar with ryhthm strips, take a class. It will greatly improve your skills with the new technology. Basic ECG is not hard. I would be glad to help. You can scan me a strip and I will help you figure it out.
Everyone is satisfied. Yes it takes a little more knowlege of heart rhythms but just as we trust our ears more than automatic equipment for blood pressures with some patients and heart rhythms. (I worked in a cardiologists office and we never used automatic cuffs, too many heart rhythms can fool the equipment, but can't fool the human brain). I think the same is true of some of the other equipment. The best algorhythms won't cover everything. I would never just trust a machine that said, "You are in the right spot". I want to know that for myself with my intellegence. I have gone back and redone too many blood pressures to trust that. Seeing the "right spot" indicator is fine, I just want it confirmed with other science that I can visualize/hear.
Mary Penn RN VA-BC
St Charles MO
Great insight Mary! I do believe with the VPS you can hear your ECG. The visualization is nice though! Has anyone used the newer VPS G4? I know they had some redesigning.
I agree, great insight Mary, we can become too dependent on technology. We need to use our brain and our gut feeling just as much!
Yes I use the G4VPS it’s amazing! You have an algorithm, Doppler and ECG. Not only do I use basic EKG interpretation, but I can see and hear the Doppler changes and lastly the algorithm. All three of these technologies have dropped our already low malposition rate to zero. We have eliminated CXR for 100% of our patients in NSR. Because I am not dependent on one technology (ECG) about half of the Afib patients have had their CXRs eliminated too, this is because there are three vectors interpreting the P-wave. I like to “hear” the PICC as it approaches the lower one third; the patients think it’s pretty cool too. I have had cases where the patient needed to be sitting up during the placement; this has not been a problem with this technology. The learning curve is low; my procedure time is back to where it was without the technology. Bryan are you using VPS too?
Anyone have problems with too many mid SVC placements with ECG? How about Azygos?
We evaluated both (Allegheny Health Network) I personally preferred the Vasonova as it involves two indicators of proper tip placement -p wave changes and bloodflow-felt it would be the more accurate but there is quite a learning curve involved. Many of my coworkers prefered the Bard 3G because we have used the Sherlock tip finding device for years and they felt more comfortable with it combined with the 3G .
Both are good products.
Ann Y