CONCLUSION
Notwithstanding inconsistencies in CVC placement
guidelines,7,9,10 TCS-guided PICC insertions seem to
produce lower rates of tip malposition and PICC-related complications;
however, PICCs inserted with the Sherlock 3CG™ TCS
tend to be located further into the RA or right ventricle (RV) than
conventionally placed PICCs under fluoroscopic or radiographic guidance,
and might induce arrhythmias upon changes in patient’s position. In
unconscious and sedated patients as well as in patients under general
anesthesia, these arrhythmias should be suspected, and vigilant ECG
monitoring should be performed. Positioning the patient in the final
intraoperative position immediately after PICC insertion might be
reasonable; however, further studies are required to assess the validity
of its routine implementation.