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Table 2 Summary of studies included [9–14]

From: Sherlock 3CG® Tip Confirmation System for Placement of Peripherally Inserted Central Catheters: A NICE Medical Technology Guidance

References Study design and details Population Intervention and previous technology Accuracy of Sherlock 3CG® TCS (ECG tip placement in agreement with subsequent X-raya) Comments by the EAC
Johnston (peer reviewed paper) [13] Consecutive case series (UK) ICU patients needing PICC insertion, excluding those not in sinus rhythm (n = 250) 11/250 (4.4 %) excluded Sherlock 3CG® TCS. Previously used chest X-ray confirmation 79.5 % of PICCs in acceptable position (mid and lower SVC/CAJ/high RA Peer-reviewed publication. Aims, methods, patient population, results and exclusion criteria are fully reported. Chest X-rays reviewed by at least 2 authors
Barton [12] Case series (UK), abstract and additional information from author Adults with no AF needing PICC insertion (n = 65 in original study, n = 225 total, including follow up)
11/225 (4.9 %) excluded 		Sherlock 3CG® TCS. Previously used chest X-ray confirmation 100 % of PICCs in acceptable position (lower 1/3 of SVC or CAJ) Full critical appraisal not possible, not peer reviewed
Adams [9] Case series (USA), abstract and poster People needing PICC insertion excluding those without identifiable p-wave (n = 333)
55/333 (16.5 %) excluded 		Sherlock 3CG® TCS. Previously used chest X-ray confirmation 96.4 % on 1st review
98.2 % on 2nd review 		Full critical appraisal not possible, not peer reviewed
Stewart [11] Case series (Australia), abstract and poster Unknown, abstract states “over 65” patients treated Sherlock 3CG® TCS. Previously used chest X-ray confirmation 96 % within CAJ
4 % within RA
Number unable to confirm tip location using Sherlock 3CG® TCS not reported 		Minimal information available, full critical appraisal not possible, not peer reviewed. Information should be treated cautiously
Parikh [10] Prospective case series (USA), abstract and poster. Two phases, with increased nurse training in 2nd phase. Additional patients after trial also reported People needing PICC insertion excluding those with AF, atrial flutter, increased risk of bleeding and without identifiable p-wave
1st phase n = 65, 3/65 (4.6 %) excluded,
2nd phase, n = 182 35/182 (19.2 %) excluded 		Sherlock 3CG® TCS. Previously used Sherlock II TLS (magnetic tracking) plus chest X-ray confirmation Phase 1:83 % placed within SVC or CAJ
Phase 2: 96 % placed within SVC or CAJ 		Poster, not peer reviewed, but with sufficient detail for partial critical appraisal. Clear patient population, tip position criteria, exclusion criteria, assessment by 2 independent operators
For follow up phase patients, 437/567 (77 %) used Sherlock 3CG® TCS, 109/437 (25 %) still required a chest X-ray
Symington [14] Prospective case series (USA). Presentation People needing a PICC insertion (n = 63) Sherlock 3CG® TCS. Previously used Sherlock II TLS (magnetic tracking) plus chest x = ray confirmation 98.4 % placed in acceptable position Minimal information available, full critical appraisal not possible, not peer reviewed
  1. CAJ cavo-atrial junction, PICC peripherally inserted central catheter, RA right atrium, SVC superior vena cava
  2. aAccuracy outcomes only include patients where a successful ECG tip placement was thought to have been achieved. If ECG tip confirmation was not achieved, then these patients would be in the excluded category
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