{"entity":{"id":"picc-tip-location-systems","kind":"technology","name":"PICC tip location systems (Sherlock 3CG, SmartPICC)","aka":["Tip confirmation system","ECG-guided PICC placement","Sherlock 3CG","SmartPICC"],"tldr":"Systems that use the heart's electrical signal and a magnetic tracker to show where the tip of a PICC line is while it is being put in, so most patients do not need a chest X-ray afterwards before the line can be used.","summary":"NICE medical technologies guidance MTG24, now HealthTech guidance HTG368 (published 25 March 2015, updated 30 May 2019), says the case for adopting the Sherlock 3CG Tip Confirmation System \"is supported by the evidence\" and that it \"usually avoids the need for a confirmatory chest X-ray in patients who would otherwise have blind insertion\". It recommends it be considered for adults, noting that patients whose electrocardiogram shows no P wave, for example with atrial fibrillation, still need a chest X-ray. The Sherlock 3CG tip positioning stylet was most recently cleared in the United States in 2022 (K222232, Bard Access Systems). Piccolo Medical's SmartPICC system, an ECG-guided navigation system, was cleared on 22 January 2021 (K200037).","status":"established","asOf":"2026-11-04","links":[{"label":"NICE HTG368: Sherlock 3CG Tip Confirmation System for placement of PICCs","url":"https://www.nice.org.uk/guidance/htg368"},{"label":"FDA 510(k) K222232: Sherlock 3CG tip positioning system stylet (24 August 2022)","url":"https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K222232"},{"label":"FDA 510(k) K200037: Piccolo Medical SmartPICC system (22 January 2021)","url":"https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K200037"}],"tags":["devices-gaps-2026-11"],"related":[],"cancers":[],"sections":["chemotherapy","supportive-care","devices"],"technologies":["picc-lines","infusion-devices-vascular-access"],"targets":[],"drugs":[],"companies":["becton-dickinson"],"institutions":[],"pathways":[],"terms":["central-venous-access"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"provenance":{"editedBy":"OnCo device gap fill (openFDA, accessdata.fda.gov, NICE, NHS Drug Tariff Part IX, FDA, maker and society pages)","editedOn":"2026-11-04"},"principle":"A stylet in the catheter acts as an intracavitary ECG lead: the P wave grows as the tip approaches the junction of the superior vena cava and right atrium, while a magnetic sensor on the chest tracks the tip's path.","strengths":["Avoids most confirmatory chest X-rays (NICE)","Line can be used sooner after insertion"],"limitations":["Needs a visible P wave on the ECG","Adds a device cost per insertion"],"since":2015},"route":"/technologies/picc-tip-location-systems/","neighbours":{"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"devices","kind":"section","name":"Devices & Physical Therapies","route":"/fronts/devices/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"infusion-devices-vascular-access","kind":"technology","name":"Infusion pumps, ports, and ambulatory chemotherapy devices","route":"/technologies/infusion-devices-vascular-access/"},{"id":"picc-lines","kind":"technology","name":"Peripherally inserted central catheters (PICC lines)","route":"/technologies/picc-lines/"}],"company":[{"id":"becton-dickinson","kind":"company","name":"BD (Becton, Dickinson and Company)","route":"/companies/becton-dickinson/"}],"term":[{"id":"central-venous-access","kind":"term","name":"Central venous access (port, PICC line)","route":"/terms/central-venous-access/"}]}}