The Tip Position of Peripherally Inserted Central Catheters by the Sherlock 3CG System Was Almost Deeper Than Zone B: A Case Series.

A first analysis of deaths due to central venous catheterization (CVC) in Japan in 2017 reported peripherally inserted central catheterization (PICC) as an alternative to CVC. In 2018, Sherlock™ 3CG (C.R. Bard Inc., New Jersey, USA) and Power PICC® became available for use in Japan. The electromagnetic mechanism of the Sherlock 3CG system often eliminates the need for the use of fluoroscopic devices, such as C-arm scanners. In this clinical report, we describe five cases of patients who underwent PICC guided by the Sherlock 3CG system and were evaluated by transesophageal echocardiography (TEE). The patients were adapted for PICC for highly invasive urologic, thoracic, and dental surgery. Also, the positions of the catheter tip were confirmed by TEE in all cases. The mean distance from the access vein to the catheter tip was 41.1 ± 3.8 cm. Chest X-ray analysis showed a mean distance of 40.0 ± 21.5 mm between the carina and catheter tip. Bicaval TEE views showed that the Power PICC tip had not been advanced into the right atrium in any of the cases. We concluded that the tip positions of the Power PICC guided by the Sherlock 3CG system were almost deeper than Zone B and not in the right atrium.

A two-handed airway maneuver of mandibular advancement and mouth opening in the neutral neck position for immobilization of the cervical spine.

PURPOSE: Immobilization of the cervical spine after trauma is recommended as standard care to prevent secondary injury. We tested the hypothesis that a two-handed airway maneuver, consisting of mandibular advancement and mouth opening in the neutral neck position, would minimize changes in the angle of the cervical vertebrae at the C0/4 level and tidal volume in non-obese patients under anesthesia with neuromuscular blockade. METHODS: Twenty consecutive patients without cervical spine injury undergoing general anesthesia were enrolled and evaluated. The primary variable was change in the angle of the cervical vertebrae at the C0/4 level during mask ventilation using the modified two-handed technique. Secondary variables included changes in the angles of the cervical vertebrae at each level between C0 and C4, anterior movement of the vertebral bodies, change in the angle between the head and neck, change in the pharyngeal airway space, and tidal volume during mask ventilation. RESULTS: The two-handed airway maneuver of mandibular advancement and mouth opening resulted in statistically significant changes in the angle of the cervical spine at the C0/4 level (3.2 ± 3.0 degrees, P < 0.001) and the C3/4 level (1.4 ± 2.2 degrees, P = 0.01). The two-handed airway maneuver provided adequate mask ventilation without anterior movement of the vertebral bodies. CONCLUSION: Our study suggests that a two-handed airway maneuver of mandibular advancement and mouth opening in the neutral neck position results in only slight change in the cervical vertebral angle at the C0/4 level in non-obese patients under general anesthesia with neuromuscular blockade.