PICC RN Mellody Brackemyer points at the readout from the Sapien Tip Confirm

“The two chief advantages are that no radiation is required like what would be received as a result of a post operative x-ray, and it is also faster,” said John Meadors, MD, a vascular and interventional radiologist at St. Vincent in Little Rock. “Often times it is critical for these patients to begin using the PICC line as soon as possible. It can take an hour or more to get a report from a portable chest x-ray. It also saves money. There is no question about it. There are huge cost savings.”

PICC is a device that provides reliable vascular access for the delivery of medication, blood products, nutrients or other IV fluids. PICCs improve treatment while also enhancing patient comfort by reducing the number of times a patient gets a needle stick. 

The Sapiens* Tip Confirmation System provides the RN with real-time PICC tip location information by using the patients’ heart electrical activity. Before this technology, the regular method of finding the right location for the central line catheter was by x-ray. 

Meadors said people often don’t realize how labor intensive it is to get a portable x-ray done at the bedside of a patient. The x-ray machine has to be transported back and forth to the room, and either two x-ray techs or an x-ray tech and nurse are needed to take the x-ray.

“It is a relatively labor intensive thing, and it is a use of resources,” Meadors said.

St. Vincent PICC RNs participated in a technology trial in June 2011 that found 100 percent accuracy using the Sapiens* System. Since December St. Vincent has been using Sapiens without the need for backup checks with chest x-rays.

“I trust the Sapiens System completely,” Meadors said. “My experience with it is with 200 or 300 cases where I have seen follow-up films verifying the correct placement of the PICC. We were working with PICC nurses initially to confirm the Sapiens location with film. I’ve never seen there be an error. I don’t expect it to be right 100 percent of the time. But so far in my limited experience, that is what I have seen.”

Meadors used fluoroscopy radiation for many years to make sure PICC lines were in the correct position.

“Now we can eliminate the need for that ionizing resolution,” he said.

The Sapiens doesn’t work in all cases. Meadors said radiology is still called in about one percent of the time when total parenteral nutrition is needed, and the PICC nurse has been unable to get the PICC in a central vein.

“At St. Vincent, our nurse’s goal is to put it in a central vein,” Meadors said. “If they can’t find it with Sapiens, that is when they call us. But in most patients it is not critical that it is in a central vein. Even if the PICC nurses using Sapiens aren’t able to get it in a central vein, we know it is in a vein. That is all most patients need. They don’t need central venous placement.”

Mellody Brackemyer, a PICC RN at St. Vincent, said placing the PICC in a central vein is the standard of practice for PICC RNs. PICCs are placed in patients of any age, but are particularly helpful for elderly patients.

“We placed a PICC line in a woman 100 years old the other night,” Brackemyer said. “Sometimes people who are older have such poor veins they are difficult to access.”

Before using Sapiens, nurses might have had to wait two or three hours to be able to confirm the line placement was okay.

“We narrowed that time down from one to two hours, and now with Sapiens it is almost immediate,” Breckemyer said. “From the patient’s point of view, they are able to get treatment much quicker. We place about 200 PICCs a month. The Sapiens has really improved what we do. This new technology has really allowed us to become more accurate with our placement. I find it to be very, very comfortable. There are times I have to do it without Sapiens for some reason, and I miss it then. Sapiens has made my job so much faster. We are excited about it.”

The Sapiens System increases the confidence of PICC nurses.

“When I was training new people, it was really nice to see that when the nurse dropped the line and saw a change in the heart rhythm that showed the placement was good, their confidence increased and things moved along much quicker,” Brackemyer said. “The PICC nurse doesn’t need to have special knowledge reading EKGs. It is simply understanding that p-wave and how it acts when you put a line in. Nurses on the floor are loving it because when we come out of that room, we can say, ‘You can use that line.’”

Brackemyer said many hospitals use PICCs, but St. Vincent is believed to be the first in the Little Rock area to start using the Sapiens System. However, now a lot of other hospitals in the area are starting to trial the Sapiens.

System while another St. Vincent PICC RN, Julie Buss, watches.

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