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This paper summarized the experience of using Sherlock 3CG tip confirmation system for bilaterally placement of peripherally inserted central catheters (PICC) and related nursing countermeasures in a patient with double superior vena cava. In order to meet the treatment needs, PICC catheters were placed on both sides twice, with the catheter tips located in the right and left superior vena cava. The patient's first choice of the right upper arm for catheterization was smooth, and the second choice of the left side for catheterization was smooth. The Sherlock 3CG tip confirmation system was used for positioning. The P wave of the catheter sent to the reserved length continued to be negative. The results of computer tomography (CT) showed that the patient had permanent left superior vena cava. The X-ray positioning was performed to confirm that the tip of the catheter was located in the left superior vena cava. After comprehensive evaluation by the multidisciplinary team, the catheter indwelling length was adjusted, The patient's condition was closely observed, and health education was strengthened in many aspects. Indwelling catheter was successfully placement without complications. (本文总结了应用Sherlock 3CG尖端定位技术为1例急性髓系白血病伴有双侧上腔静脉患者双侧置入经外周静脉穿刺中心静脉导管(PICC)的护理对策。本例患者为满足治疗需求分别于两次经两侧置入PICC导管, 导管尖端分别位于右、左两侧上腔静脉。患者首次选择右侧上臂置管过程顺利, 再次置管选择左侧置入过程顺利, 应用Sherlock 3CG技术定位, 导管送至预留长度范围P波持续呈负波, 查看计算机断层扫描(CT)结果提示患者存在永存左上腔静脉, 行X光定位确认导管尖端位于左侧上腔静脉。经多学科团队综合评估, 调整导管留置长度, 密切观察患者情况, 加强多方面健康宣教, 导管留置成功, 无并发症发生。)

Recently, the Sherlock 3CG™ Tip Confirmation System, including a magnetic tracking system and an intracavitary electrocardiography guidance system, has been introduced for bedside peripherally inserted central catheter (PICC) insertion. Magnetic field sources interfere with the magnetic tracking system. Electromagnetic interference of the ventricular assist device (VAD) has already been reported with various devices but not on Sherlock 3CG™. We assessed the availability of the magnetic tracking system in patients with and without a VAD during Sherlock 3CG™ insertion and evaluated the rate of optimal PICC tip position. We retrospectively reviewed 99 patients who had undergone PICC insertion using Sherlock 3CG™ on the bedside at our institutional intensive care unit from February 2018 to December 2020. Patients were divided into groups with and without a VAD. The availability of magnetic navigation and the success rate of optimal catheter tip position in each group were assessed. Among 87 cases analyzed, there were 12 and 75 cases with a VAD and without a VAD, respectively. The availability of magnetic navigation during Sherlock 3CG™ insertion was significantly lower in the group with a VAD [4/12 (33%) with VAD vs. 72/75 (96%) without VAD, P < 0.001]. In addition, the rate of optimal PICC tip position was also significantly lower in the group with a VAD [6/12 (50%) vs. 63/75 (84%), P = 0.015] The VAD significantly led to magnetic tracking system failure due to its electromagnetic interference during Sherlock 3CG™ insertion and significantly reduced the success rate of PICC insertions in the optimal position. [ABSTRACT FROM AUTHOR]