Pittiruti Mauro, Scoppettuolo Giancarlo, Dolcetti Laura, Emoli Alessandro
1 Department of Surgery, "A. Gemelli" Hospital Foundation, Catholic University, Rome, Italy.
2 Department of Infective Diseases, "A. Gemelli" Hospital Foundation, Catholic University, Rome, Italy.
J Vasc Access. 2019 Jul;20(4):356-361. doi: 10.1177/1129729818805957. Epub 2018 Oct 18.
Intracavitary electrocardiogram technique is recognized as a safe, accurate, and inexpensive method for verifying the tip location of central venous access devices. While the technique can be carried out with any standard electrocardiogram monitor, dedicated electrocardiogram monitors specifically designed for the intracavitary electrocardiogram are also available. One of these dedicated monitors is Sherlock-3CG, characterized by the integration of a magnetic-based tip navigation method with an electrocardiogram-based tip location method.
In this prospective study, we inserted 130 peripherally inserted central catheters using Sherlock-3CG, evaluating the safety, feasibility, and accuracy of both tip navigation and tip location. Magnetic-based tip navigation was compared with ultrasound-based navigation; electrocardiogram-based tip location was compared with electrocardiogram-based tip location performed by another dedicated monitor (Nautilus) and with post-procedural tip location by chest X-ray.
All insertions were successful and the overall safety of the device was 100%. In terms of tip navigation, the maneuver was feasible only in 81%; the accuracy was 100%. In terms of tip location, feasibility was 94% and accuracy was 100%, while Nautilus showed a 100% feasibility and 100% accuracy.
Our study could not demonstrate any specific advantage of Sherlock-3CG either as a magnetic-based tip navigation method or as an electrocardiogram-based tip location method.
腔内心电图技术被认为是一种用于验证中心静脉通路装置尖端位置的安全、准确且经济的方法。虽然该技术可以使用任何标准心电图监测仪进行，但也有专门为腔内心电图设计的专用心电图监测仪。其中一款专用监测仪是Sherlock-3CG，其特点是将基于磁的尖端导航方法与基于心电图的尖端定位方法相结合。
在这项前瞻性研究中，我们使用Sherlock-3CG插入了130根外周静脉穿刺中心静脉导管，评估了尖端导航和尖端定位的安全性、可行性和准确性。将基于磁的尖端导航与基于超声的导航进行比较；将基于心电图的尖端定位与另一款专用监测仪（鹦鹉螺）进行的基于心电图的尖端定位以及术后胸部X线检查的尖端定位进行比较。
所有插入均成功，该装置的总体安全性为100%。在尖端导航方面，该操作仅在81%的情况下可行；准确性为100%。在尖端定位方面，可行性为94%，准确性为100%，而鹦鹉螺显示可行性为100%，准确性为100%。
我们的研究未能证明Sherlock-3CG作为基于磁的尖端导航方法或基于心电图的尖端定位方法有任何特定优势。
